Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Abstract

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

Patient attitudes towards analgesia and their openness to non‐pharmacological methods such as acupuncture in the emergency department

“…There was a high degree of willingness of patients in our study to try non‐pharmacological methods of analgesia including acupuncture, particularly for females, which is consistent with other studies. In recent trials, non‐pharmacological methods such as acupuncture, achieved high patient satisfaction . The reasons for willingness to use non‐pharmacological methods may be because of a desire for holistic care and to avoid UAC adverse effects including addiction.…”

“…In recent trials, non-pharmacological methods such as acupuncture, achieved high patient satisfaction. 3,4 The reasons for willingness to use non-pharmacological methods may be because of a desire for holistic care and to avoid UAC adverse effects including addiction. Our survey showed a significant incidence of UAC adverse effects, but a minority were concerned about addiction.…”

“…Some doubt exists whether opioids improve patient satisfaction in the ED . There is increased interest in the use of acupuncture analgesia in the ED . However, a paucity of research exists on patient perspectives in the ED on: non‐pharmacological methods such as acupuncture, the short‐term adverse effects of opioids and the long‐term concerns regarding addiction.…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…We commend Cohen and colleagues 1 on their recently published study, which is the largest randomised controlled trial (RCT) of acupuncture in the emergency department (ED). We recently completed a systematic review and meta‐analysis on the role of acupuncture for analgesia in the emergency setting 2 .…”

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

“…The conclusions made by Cohen and colleagues 1 can be challenged on the basis of study design and results. A significant flaw in the design is that of all patients not excluded due to additional medical problems, 38% of potential study participants declined to be included, possibly because they were not prepared to be assigned to the acupuncture‐only arm.…”