Needles Help with Pain in the ER. No, Not that Kind

Acupuncture tied to less pain, stress, anxiety

by Judy George, Senior Staff Writer, MedPage Today
April 09, 2019

MILWAUKEE — Acupuncture in the emergency department (ED) was linked to less pain, stress, anxiety, and nausea among patients, a feasibility study showed.

Pain scores of ED patients who received acupuncture dropped from 6.5 to 3.4 points on a scale of 0 (no pain) to 10 (worst pain), according to John Burns, DPT, MSOM, CAc, of Aurora Health Care in Milwaukee, and colleagues.

Stress, anxiety, and nausea scores improved significantly, too, they reported at the American Pain Society Scientific Meeting.

There’s a scarcity of data about non-pharmacological pain treatments in the ED, Burns told MedPage Today.

“When patients present to the ED with complaints of pain, the majority of conventional treatment is limited to prescription medications,” he said.

“We believe this research is very important because America is currently in the throes of a pain management and opioid crisis,” Burns added. “According to Consortium Pain Task Force’s white paper, what contributed to this crisis was a belief that new technologies, surgical procedures, and the liberal use of opioids would be the answers to controlling human pain. As we now know, these strategies have not proven efficacious in mitigating pain, suffering, and disability to the extent the public was led to believe.”

In 2013, Allina Health Abbott Northwestern Hospital in Minneapolis became the first in the nation to staff its ED with an acupuncturist. “It started off with a big focus on pain control,” said Adam Reinstein, LAc, MAOM, of Allina Health, who was not involved with the Aurora study. “But we soon broadened the scope to include patients who were anxious, nauseous, or had any other condition that doctors wanted an extra tool in their toolbox to treat.”

“In the ED, you see this inextricable link between pain and anxiety,” Reinstein told MedPage Today. “The vast majority of patients I treated in the ED benefited from becoming more relaxed and having less anxiety and stress about their situation — and in those patients, we would see pain reduction as well.”

In this study, Burns and colleagues evaluated patients in the Aurora Health Care ED. After shadowing two ED physicians, the researchers determined that patients with an emergency severity index (ESI) score of 3, 4, or 5 — who often spent 1.5 to 2 hours in the ED waiting for treatment — were the most appropriate candidates. ESI can range from 1 (highest severity) to 5 (lowest severity), and about 66% of ED patients present at Aurora each year with an index score of 3, 4, or 5.

The researchers approached 706 patients and 379 (53.7%) consented to receive acupuncture. These patients presented with a median ESI score of 3 and 53.6% did not receive opioids at any time during their ED visit.

Mean pain scores improved among patients who had acupuncture from 6.5 to 3.4 points (P<0.001), and this improvement was not affected by receipt of opioids during the ED visit (P=0.948), the researchers reported. On similar 10-point scales, mean stress scores dropped from 5.7 to 1.9 points, anxiety scores decreased from 4.8 to 1.6, and nausea scores fell from 1.6 to 0.6. These reductions all were statistically significant (P<0.001).

ED acupuncture was well received by patients and physicians and enrollment was higher than anticipated, Burns and colleagues said. The results provide a foundation for more rigorous studies including randomized control trials in other ED settings, they added.

The study has several limitations, including potential selection bias and confounding.

LAST UPDATED 04.11.2019