Acupuncture in the emergency department for pain management

Abstract

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.

Fidelity to the acupuncture intervention protocol in the ACUpuncture In The EmergencY department for pain management (ACUITY) trial: Expanding the gold standard of STRICTA and CONSORT guidelines

“…ACUITY focused on recruiting a diverse underserved population including Black/African Americans, Hispanics or Latinos, and those with less education attainment. 41 Another goal of ACUITY was to have the pragmatic delivery of acupuncture occur in various locations within the ED. Additional goals included assessing data quality completeness, evaluating participant recruitment and retention, developing an acupuncture intervention protocol and creating a system to track intervention details to assess fidelity to intervention.…”

“… 35 , 36 , 37 , 38 , 39 , 40 This is especially important in pragmatic clinical trials (PCTs) where research seeks to evaluate responsive acupuncture care in real world clinical settings with generalizable populations to generate actionable clinical evidence at a fraction of the typical cost/time needed to conduct a traditional clinical trial. 28 , 41 PCTs are part of the U.S. National Institutes of Health (NIH) vision for bridging the gap between research and care. 29 PCTs are supported by the Center for Medicare & Medicaid (CMS), Patient Centered Outcomes Research Institute (PCORI), practice-based research networks (PBRNs) and community-based participatory research initiatives across the U.S. Federal government.…”

Acupuncture: Effective and Recommended but More Implementation Needed

“…24 5 Untapped opportunities to support patients in the emergency room presenting with pain with acupuncture in the US According to the U.S. Centers for Disease Control (CDC), 31 every year there are 130 million emergency room visits and pain is the primary presentation for up to 78% of these visits. 32 Opioids remain a mainstay of treatment, despite having a high addictive potential and leading to over 80,000 deaths in 2021 alone (Fig. 7).…”

“…37 In 2022, a protocol was published for a multi-center feasibility study for using acupuncture for pain management in the emergency room. 32 While such a trial would provide information on ef cacy, safety and tolerability, wide-spread implementation is unlikely without a coherent strategy (Fig. 8).…”