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Better pain management needed in emergency rooms

The effectiveness of acupuncture for treating acute back or ankle pain in the emergency department is comparable with that of pharmacotherapy, but neither treatment, either alone or in combination, provides adequate acute analgesia within the first hour, according to research published in the Medical Journal of Australia.

Professor Marc Cohen and colleagues from the RMIT University, the Alfred Hospital, the Monash Centre of Cardiovascular Research and Education in Therapeutics, Cabrini Hospital, Austin Health, and Monash University, assessed the pain relief achieved by acupuncture afforded patients presenting to emergency departments with acute low back pain, migraine, or ankle sprain. The primary outcome measure was pain level at one hour (T1); clinically relevant pain relief was defined as achieving a verbal numerical rating scale (VNRS) score below 4 (on a scale of 0 to 10), and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

Between January 2010 and December 2011, 270 patients with acute low back pain, 92 with migraine, and 166 with ankle sprain were randomised to treatment with acupuncture (177 patients), acupuncture and pharmacotherapy (178), or pharmacotherapy alone (173).

Overall, the three treatments were found to be equivalent, but after one hour, clinically relevant pain relief was achieved in only 16% of patients and statistically relevant relief in 37%. Equivalence in providing analgesia was also found for patients with back pain or ankle sprain, but not those with migraine. Adverse events, acceptability and health resource use were similar for all treatments.

“Although the three treatments were similarly ineffective at reducing pain at T1, most patients found their treatment acceptable after 48 hours, about 80% of each group stating they would probably or definitely repeat their treatment,” the authors wrote.

However, they noted that patients in the acupuncture only group were almost twice as likely to receive rescue analgesia. “This may indicate that acupuncture was ineffective and patients sought alternative analgesia or that they were more likely to accept pharmacotherapy because they felt they had missed out on standard care, whereas patients who had already received oral opiates were reluctant to accept parenteral opiates,” the authors wrote.

“Neither acupuncture nor standard pharmacotherapy afforded patients presenting to emergency departments with back pain, ankle injury or migraine clinically relevant reduction in pain within an hour,” they concluded.” Pain management in emergency departments in general must be improved and acupuncture may be a viable option for people who cannot or choose not to use analgesic drugs. “As no therapy provided optimal acute analgesia, more effective options are needed.”

Article: Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial, Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue and Peter A Cameron, Medical Journal of Australia, doi: 10.5694/mja16.00771, published 19 June 2017.