Emergency doctors are using Acupuncture to treat pain, now here’s the evidence

Emergency medicine is not all about life and death situations and high-tech solutions. Our study, the largest of its kind in the world, shows using acupuncture in the emergency department can relieve acute pain.

The study, published today in the Medical Journal of Australia, finds acupuncture is as effective as medication in treating pain for lower back pain and ankle sprain. But it took more than an hour for either to provide adequate pain relief.

Our study builds on previous research to show the effectiveness of acupuncture to treat chronic (long-term) pain.

Yet, there are several barriers to using acupuncture routinely in emergency departments.

What is acupuncture and who practices it?

Using acupuncture to relieve pain involves placing needles in various parts of the body to stimulate the release of endorphins and other neurochemicals, which can act as the body’s naturally occurring pain relievers.

For generations various cultures around the world have used acupuncture to treat multiple conditions, including providing pain relief. And in Australia, it is reimbursed through the Medicare Benefits Schedule when administered by a medical doctor.

Further reading: Modern acupuncture: panacea or placebo?

Acupuncture is one of the most accepted forms of complementary medicine among Australian general practitioners. It also appears in treatment guidelines for doctors in how to manage pain.

Why we ran the study and what we did

Anecdotally, we were aware that several emergency department doctors, in both public and private hospitals in Australia, were treating patients’ pain with acupuncture. But until this large federally-funded study, no-one had set up a trial like it to show how effective it was.

Our trial was an “equivalence” study, which means we aimed to see if the different treatments were equivalent rather than seeing if they were better than placebo. We did this as it would not be ethical to give a placebo to people coming to an emergency department for pain relief.

So, we randomly assigned more than 500 patients to receive standard painkillers, standard painkillers plus acupuncture, or acupuncture alone when they presented with back pain, migraine or ankle sprain at four Melbourne hospitals (some private, some public). While the patients knew which treatment they had, the researchers involved in assessing their pain didn’t (known as a single-blind study).

The type of acupuncture we used included applying needles at specific points on the body for each condition, as well as along points chosen by the treating acupuncturist. This was to reflect what would happen during regular clinical practice.

Doctors who were also qualified medical acupuncturists and practitioners of traditional Chinese medicine (registered in Victoria with the Chinese Medicine Registration Board of Australia) performed the acupuncture.

After treatment, we assessed patients’ pain after an hour, and every hour until discharge. We also rang them for an update 24-48 hours after being discharged.

What we found

We found acupuncture, either alone or with painkillers, was equivalent to drugs-alone in providing pain relief for lower back pain, ankle sprain, but not for migraine.

When patients looked back on their treatment, the vast majority (around 80%) were satisfied with their treatment regardless of which treatment they had.

However, no treatment provided good pain relief until after the first hour.

What are the implications?

Our findings suggest acupuncture may be a viable option for patients who come to the emergency department for pain relief. This is especially important for those who cannot or choose not to have analgesic drugs.

This is also an important finding in light of the potential for side effects and abuse with opioid analgesics, which might otherwise be used to relieve pain in the emergency department.

Previous research shows using acupuncture to treat chronic pain is comparable to morphine, is safer and doesn’t lead to dependence. Our findings suggest acupuncture also has a role in treating acute pain.

However, our research raises several issues, not only about conducting such research but also in implementing our findings in practice.

We had to overcome many ethical, policy and regulatory issues before we started. These included issues around the qualifications of medical and non-medical acupuncturists and employing traditional Chinese medicine practitioners to deliver acupuncture in a western medical hospital.

And to more widely implement our findings, we need to discuss the type of practitioners best placed to deliver acupuncture in hospital, what type of training they need to work in the emergency department and what type of conditions they should treat.

Hopefully, our study will spark further research to address these issues and lead to the development of safe and effective protocols for acute pain relief that may involve combining both modern and ancient forms of medicine to achieve rapid and effective analgesia for all emergency department patients.

This article originally appeared on theconversation.com

Acupuncture Improves Head Injury Recovery

New research finds acupuncture effective for regenerating brain tissue and restoring motor and cognitive function after a severe head trauma. An investigative team at the Rehabilitation Department of the First Affiliated Hospital of Xian Jiaotong University (Shaanxi) compared acupuncture combined with standard care with a control group receiving only standard medical interventions. The addition of acupuncture therapy to the conventional regime of care significantly reduced complications and improved the survival rate. The acupuncture group significantly outperformed the control group in all scales and indices. Notably, the acupuncture group demonstrated superior clinical outcomes including better mobility, cognitive function and improved functions of daily activities and living.

Severe head traumas cause diffuse axonal injury (DAI) in approximately half of all cases. This investigation focused on patients having had severe head traumas causing DAI. This type of injury is different than a blow to one area of the brain. It occurs throughout a wider area and is caused by the brain moving in the skull. This type of shaking of the brain occurs in sports injuries, automobile accidents, falls and shaken baby syndrome. The latter is a form of child abuse. As a result of the trauma, inflammation and damage to the brain ensues and many patients slip into a coma and do not revive.

This study compared 60 diffuse axonal injury patients that were divided into two groups. The control group received standard biomedical interventions including hydration & bleeding controls, anti-inflammatory medications, resuscitation and hyperbaric oxygen therapy. Other treatments provided to the control group were standard protocols for the treatment of respiratory and urinary disorders including infections and the treatment of ulcers. The acupuncture group received standard biomedical care plus acupuncture. The Traditional Chinese Medicine (TCM) principles of treatment included tonifying the kidneys, unblocking the yang and regulating qi. The researchers note that the success of the acupuncture therapy improved significantly when applied early as an intervention measure. In addition, acupuncture performed especially well for patients for resuscitation and in the recovery phase. 

The researchers applied acupuncture to the Chong, Ren and Du acupuncture channels as the primary areas. Long courses of treatment were required and individual indications were treated on a case by case basis. Treatments focused on resuscitation, restoring movement after paralysis, relieving muscle tension, improving language skills, regulating salivation, relieving urinary and fecal incontinence, promoting eating, etc….

The researchers compared the data between the acupuncture and control groups 4 hours before the treatment began and upon the completion of six courses of care. There was no significant difference in Fugl-Meyer Assessment, LOTCA Assessment, and Barthel Index prior to treatments. After six courses of treatment, the control group showed some improvements according to above scales. Patients in the acupuncture group significantly outperformed those in the control group in all scales and indices mentioned above. Based on the clinical outcome, the researchers conclude that acupuncture combined with rehabilitation can significantly improve DAI patients’ mobility, cognitive competence and other functions in everyday life.

Prior research was the impetus for this investigation. Other studies demonstrated the ability of acupuncture to regulate cerebral blood flow and cell apoptosis, improve electrophysiological brain activity, improve cognitive function and protect tissues from free radical damage. Prior research demonstrated that acupuncture helped reduce edema of the brain (cephaledema) and promoted expression of GAP43 and PCNA in the brain. Also, acupuncture was shown to reduce infarct sizes due to cerebral ischemia. This and other clinical and basic research prompted the investigators to conduct this study. The findings demonstrate that a rigorous regime of acupuncture care is appropriate for patients with DAI and that the intervention should start in the early stages of illness to achieve the best possible clinical outcome.

Article originally appeared on healthcmi.com