PHILADELPHIA — Acupuncture can relieve pain and reduce return visits to the emergency department (ED) in patients with intractable pain, said a researcher here at the annual meeting of the American College of Emergency Physicians.
“Pain is very difficult to treat in the [ED],” said Emily Zhao, MD, a fourth-year resident at Cook County Hospital, in Chicago. “It is one of the toughest things for us to do.”
At Cook County, “one thing that we do have in our ED is access to acupuncture,” she continued. “We have board-certified acupuncturists who can come to our ED and provide acupuncture treatment for our patients. So we want to incorporate this into our emergency department.”
To see whether acupuncture could help treat intractable pain, Zhao and her colleagues performed a retrospective cohort analysis at Cook County. They offered acupuncture to adult ED patients with intractable acute or chronic pain that was not improved with standard ED pain treatments. The investigators excluded patients that required medical or surgical treatment for their pain, did not speak English or Spanish, or had missing data or incomplete 3-month follow-up. They looked at demographics, pain medicines used before and during the ED visit, and 3-month follow-up data.
The researchers ended up with data on 158 patients seen in the ED from July 1, 2021 through June 30, 2022. Patients had a mean age of 52 (range 21-94); 60% were female. In terms of race and ethnicity, 58% were African American/Black, 29% were Latinx, 5% were Asian, and 5% were non-Hispanic white.
Before getting acupuncture, 79% of patients received non-opioid pain medication in the ED, and 11% received an opioid; only 3.8% were given an opioid prescription at discharge. Acupuncture treatment was performed by board-certified specialists in acupuncture; however, because the on-call acupuncturists’ hours were limited — they were only available from 7 a.m. to 7 p.m. Monday through Friday, and were not there on weekends or holidays — only 30% of patients got initial acupuncture treatment in the ED, and all patients were referred to an acupuncture clinic for outpatient treatment.
Patients presented to the ED with a mean pain score of 7.96, and after acupuncture treatment in the ED, their mean pain score was 3.88; 5% of patients did return to the ED for pain treatment over the next 30 days. “We also surveyed them after the treatment to see what they thought; 98% were highly likely or likely to recommend acupuncture for pain,” she said. In addition, 65% of ED staff said that acupuncture availability reduced patients’ need for opioid prescriptions, and 35% said acupuncture treatment in the ED reduced the need to admit patients to the hospital for pain.
The study results suggest that “if acupuncture is available, it can be a feasible option for treatment of pain in the emergency department,” said Zhao. “And patients are generally satisfied with their treatment in the emergency department, and staff perceive a reduction in opioid prescriptions and admission rates.”
Limitations to the study included the fact that it was a retrospective cohort study and that because the ED staff didn’t know which conditions were appropriate for acupuncture, “we included all areas: neck, back, arm, and abdominal pain,” Zhao said. “Also, there were no comparison groups.”
Session moderator Kevin Weaver, DO, chief of emergency medicine at Lehigh Valley Health Network, in Allentown, Pennsylvania, praised the study and suggested that a great next step might be “if a study looked at patients with a specific diagnosis, and then [finding out] whether they got actual medication — whether that’s opiate or non-opioid — versus acupuncture.”
The researchers disclosed no conflicts of interest.
American College of Emergency Physicians
Source Reference: Zhao E, et al “Acupuncture treatment in the emergency department reduces pain and revisits” ACEP 2023.