The National Center for Complementary and Integrative Health, a division of the National Institutes of Health, is funding a multicenter study of the feasibility of offering acupuncture to patients who present to the ED complaining of pain and/or anxiety.
In a pilot program that took place between Nov. 1, 2013, and Dec. 31, 2014, at Abbott Northwestern Hospital in Minneapolis, researchers found acupuncture was both acceptable and effective for pain and anxiety reduction.1 (Editor’s Note: Read this November 2019 ED Management article for more background.)
Now, other investigators will be taking a more in-depth look at the protocol used in the Minneapolis pilot, particularly regarding sorting out any practical roadblocks. Jeffery Dusek, PhD, director of research at the Cleveland-based University Hospitals Connor Integrative Health Network, says he and colleagues will consider what patients, providers, and administrators think about the possible benefits of acupuncture.
Establish Criteria
The study is taking place in the EDs of three academic medical centers: University Hospitals Cleveland Medical Center, Vanderbilt University Medical Center, and the University of California San Diego Medical Center. At each site, 50 patients presenting with pain will be randomized to receive either acupuncture or usual care. “This is going to be a heterogeneous mix of pain. It could be neck pain, back pain, flank pain, or abdominal pain,” Dusek says.
A research coordinator will be on site working with the triage nurse to identify appropriate candidates. Generally, anyone with a pain score of 4 or higher on a 0 to 10 scale is eligible for inclusion. “Anything related to an accident or a gunshot or anything traumatic would not be eligible [for inclusion], nor would migraine-related pain because migraine protocols in the ED often have a specific cocktail of interventions,” Dusek says. Patients who are pregnant or who arrive by ambulance also are ineligible.
In every case, the research coordinator will check with the treating provider to ensure there is no reason why the patient should not be randomized to receive acupuncture. Patients assigned to acupuncture will not receive any medications for pain until one hour after they have undergone their acupuncture treatment. At that point, they will go to usual care.
“We will look at pain and anxiety scores at the time of discharge ... and then we also [look at] the scores one week later,” Dusek says.
Consider ED Factors
Each site will include two properly licensed acupuncturists: a primary and a backup. “This will be [an acupuncturist] who has no other duties in the ED,” Dusek explains. “The acupuncturists are totally paid for by the [NIH], and they will be providing the care as they would, for example, in an outpatient clinic.”
Patients will go to a private room or to an area cordoned off by curtains. Here, any risks would be reviewed, and the patient would consent. Regarding treatment time, Dusek notes that in the pilot study, the acupuncture needles usually were retained in a patient’s body for 28 minutes, at which point the practitioner would remove the needles and count them.
The intervention takes place in the early portion of a patient’s ED visit, but then care proceeds as it normally would, with no impediments to the clinician’s prescribed course. Nonetheless, Dusek notes investigators hypothesize patients randomized to receive acupuncture will, over the course of their ED stay, be exposed to fewer opioids than patients in the usual care group.
Address Disparities
Investigators expect to conclude their data collection and interviews by late 2022. At that point, Dusek hopes to conduct a larger efficacy-focused trial that includes five to seven EDs. The goal is to provide data that will convince payors to reimburse acupuncture treatment in the emergency environment, a stumbling block that has thus far prevented larger-scale implementation. Additionally, Dusek and colleagues hope their work leads to fewer unnecessary opioid prescriptions.
“One of the things that I think has been lost in this [discussion] is how these types of therapies have oftentimes been only available to people who are of means who can find these therapies in outpatient clinics,” Dusek explains. “In our pilot work ... half of the participants were African American and half were not. We really like the idea that acupuncture in the ED setting can diminish the disparities between people who have access to this therapy.”
Dusek adds that all three participating sites in the new study serve diverse populations. He anticipates the results will include patients coming from a wide variety of socioeconomic groups.
REFERENCE
- Reinstein AS, Erickson LO, Griffin KH, et al. Acceptability, adaptation, and clinical outcomes of acupuncture provided in the emergency department: A retrospective pilot study. Pain Med 2017;18:169-178.
The goal is to provide data that will convince payors to reimburse acupuncture treatment in the emergency environment, a stumbling block that has thus far prevented larger-scale implementation. Additionally, researchers hope their work leads to fewer unnecessary opioid prescriptions.
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