Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study

Burns, John R.; Kram, Jessica J. F.; Xiong, Vashir; Casadont, Jeanne M Stark; Mullen, Tiffany A; Conway, Nancy; Baumgardner, Dennis J

doi:10.17294/2330-0698.1688

Cited by 11 publications

(15 citation statements)

References 12 publications

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“…Studies also reported high acceptability for acupuncture by patients with acute pain in the ED, when measured [ 56 , 60 , 61 ]. A retrospective study of patients with acute pain in the ED found that acupuncture produced a decrease in pain comparable to that produced by analgesics, with the additional benefits of reduction in anxiety as well as high acceptability among both medical providers and patients ( Table 5 ) [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seventy-five percent of providers referred for acupuncture, and 90% of patients agreed to acupuncture. When details were reported in studies, acupuncture sessions for acute pain in the ED averaged 10–30 minutes [ 58 , 63 ], with mean session durations of 23–24 minutes [ 60 , 62 ], and they did not disrupt ED course of care [ 60–62 ].…”

Section: Resultsmentioning

confidence: 99%

“…For acute pain in the ED, six SRs, three of which have meta-analyses, demonstrate increasing interest in and feasibility and acceptability of acupuncture in the ED ( Table 2 ) and ICU ( Table 3 ). Table 5 details pilot, observational, retrospective, or qualitative studies on acupuncture’s reduction of acute pain, high level of acceptance, and low risk of adverse events [ 60 , 62 , 75–80 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update

et al. 2022

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Background A crisis in pain management persists as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis, and the evidence-base for nonpharmacologic strategies. Over 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This paper updates the evidence-base of acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses: post-surgical/peri-operative pain with opioid sparing, acute non-surgical/trauma pain including acute pain in the emergency department (ED). Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials for ‘acupuncture’ and ‘acupuncture therapy’ and ‘acute pain’, ‘surgery’, ‘peri-operative’, ‘trauma’, ‘emergency department’, ‘urgent care’, ‘review(s)’, ‘systematic review’, ‘meta-analysis’ with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit (ICU). There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews find acupuncture therapy to be an efficacious strategy for acute pain with potential to avoid and/or reduce opioid reliance. Future multi-center trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the ED. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update

et al. 2022

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“…[30][31][32] Studies also report high acceptability for acupuncture by patients with acute pain in the ED when measured. [31][32][33] While evidence from systematic reviews [34][35][36][37][38] is encouraging for acupuncture in the ED for reducing acute pain and anxiety, most prior studies have been single-site RCTs and have produced heterogeneous results unlikely to lead to consensus. [39] For these reasons, future, multi-center RCTs are warranted.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture in the emergency department for pain management

et al. 2022

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Pain accounts for up to 78% of emergency department (ED) patient visits and opioids remain a primary method of treatment despite risks of addiction and adverse effects. While prior acupuncture studies are promising as an alternative opioidsparing approach to pain reduction, successful conduct of a multi-center pilot study is needed to prepare for a future definitive randomized control trial (RCT).Methods: Acupuncture in the Emergency Department for Pain Management (ACUITY) is funded by the National Center for Complementary and Integrative Health. The objectives are to: conduct a multi-center feasibility RCT, examine feasibility of data collection, develop/deploy a manualized acupuncture intervention and assess feasibility/implementation (barrier/facilitators) in 3 EDs affiliated with the BraveNet Practice Based Research Network.Adults presenting to a recruiting ED with acute non-emergent pain (e.g., musculoskeletal, back, pelvic, noncardiac chest, abdominal, flank or head) of ≥4 on a 0-10-point Numeric Rating Scale will be eligible. ED participants (n = 165) will be equally randomized to Acupuncture or Usual Care.At pre-, post-, and discharge time-points, patients will self-assess pain and anxiety using the Numeric Rating Scale. Pain, anxiety, post-ED opioid use and adverse events will be assessed at 1 and 4 weeks. Opioid utilization in the ED and discharge prescriptions will be extracted from patients' electronic medical records.Acupuncture recipients will asked to participate in a brief qualitative interview about 3 weeks after their discharge. ED providers and staff will also be interviewed about their general perspectives/experiences related to acupuncture in the ED and implementation of acupuncture in ACUITY.Results: Recruitment began on 5/3/21. As of 12/7/21: 84 patients have enrolled, the responsive acupuncture intervention has been developed and deployed, and 26 qualitative interviews have been conducted.

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“…Nonopioid analgesics, increasingly the first-line treatment for certain acutely painful conditions, often provide an inadequate response. Enhancing the response to nonopioid (or opioid) analgesics through adjunctive use of behavior modulatory therapies (eg, cognitive behavioral therapy) [7] or complementary medicine (eg, yoga, acupuncture) is an attractive strategy [8,9], but these therapies are difficult to deploy in the ED. Therefore, exploration of other more feasible and scalable alternative strategies is needed to reduce or replace opioid pharmacotherapy in this context.…”

Section: Introductionmentioning

confidence: 99%

A Brief Music App to Address Pain in the Emergency Department: Prospective Study

Chai¹,

Woods²,

Hasdianda³

et al. 2020

J Med Internet Res

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Background Emergency physicians face the challenge of relieving acute pain daily. While opioids are a potent treatment for pain, the opioid epidemic has ignited a search for nonopioid analgesic alternatives that may decrease the dose or duration of opioid exposure. While behavioral therapies and complementary medicine are effective, they are difficult to deploy in the emergency department. Music is a potential adjunctive therapy that has demonstrated effectiveness in managing pain. Objective Our objective was to understand the feasibility and potential for an effect of a novel music app to address acute pain and anxiety in patients admitted to an emergency department observation unit. Methods This prospective cohort study enrolled patients admitted to an emergency department observation unit with pain who had received orders for opioids. We gathered baseline pain and psychosocial characteristics including anxiety, sleep disturbance, and pain catastrophizing using validated questionnaires. Participants received a smartphone-based music intervention and listened to the music in either a supervised (research assistant–delivered music session 3 times during their stay) or unsupervised manner (music used ad lib by participant). The app collected premusic and postmusic pain and anxiety scores, and participants provided qualitative feedback regarding acceptability of operating the music intervention. Results We enrolled 81 participants and randomly assigned 38 to an unsupervised and 43 to a supervised group. Mean pain in both groups was 6.1 (1.8) out of a possible score of 10. A total of 43 (53%) reported previous use of music apps at home. We observed an overall modest but significant decrease in pain (mean difference –0.81, 95% CI –0.45 to –1.16) and anxiety (mean difference –0.72, 95% CI –0.33 to –1.12) after music sessions. Reduction of pain and anxiety varied substantially among participants. Individuals with higher baseline pain, catastrophizing (about pain), or anxiety reported greater relief. Changes in pain were correlated to changes in anxiety (Pearson ρ=0.3, P=.02) but did not vary between supervised and unsupervised groups. Upon conclusion of the study, 46/62 (74%) reported they liked the music intervention, 57/62 (92%) reported the app was easy to use, and 49/62 (79%) reported they would be willing to use the music intervention at home. Conclusions A smartphone-based music intervention decreased pain and anxiety among patients in an emergency department observation unit, with no difference between supervised and unsupervised use. Individuals reporting the greatest reduction in pain after music sessions included those scoring highest on baseline assessment of catastrophic thinking, suggesting there may be specific patient populations that may benefit more from using music as an analgesic adjunct in the emergency department. Qualitative feedback suggested that this intervention was feasible and acceptable by emergency department patients.

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Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study

Abstract: Centered Research and Reviews (JPCRR) is a peer-reviewed scientific journal whose mission is to communicate clinical and bench research findings, with the goal of improving the quality of human health, the care of the individual patient, and the care of populations.

Cited by 11 publications

References 12 publications

Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update

Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update

Acupuncture in the emergency department for pain management

A Brief Music App to Address Pain in the Emergency Department: Prospective Study

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