Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis

Abstract

IMPORTANCE Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance.OBJECTIVES To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic. DESIGN, SETTING, AND PARTICIPANTSThis single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score Ն4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022. INTERVENTIONS After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture. MAIN OUTCOMES AND MEASURESThe primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events.RESULTS A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P < .001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI −8.8% to 13.2%; P > .99). No adverse events occurred during the trial. CONCLUSIONS AND RELEVANCEThese findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic.

Acupuncture and integrative oncology for taxane-induced peripheral neuropathy: a randomized multicentered study

“…This ceiling effect has been described by Paterson, who qualitatively evaluated changes in self-perception among patients treated with acupuncture 27. Tu et al examined the effect of acupuncture on the relief of pain among emergency department patients with acute renal colic, explaining the lack of relief observed a possible ceiling effect related to the robust analgesia administered in this setting 28. In the present study, it is possible that a ceiling effect with acupuncture may have been associated with the significant effects of this modality, which may have prevented further relief with the other touch and mind-body therapies.…”

Efficacy of Tuina in chronic low back pain with anxiety: study protocol for a randomised controlled trial

“…If participants report severe pain during treatment and follow-up, and have a VAS score higher than 8, they will be allowed to take painkillers. The type, dosage and duration of painkillers taken will be recorded in CRFs 39…”

Acupuncture for response and complete pain relief time of acute renal colic: Secondary analysis of a randomized controlled trial

“…Details of the initial study have been published. 11 , 15 It was a single-center, sham-controlled, randomized controlled trial conducted in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University. All patients came from the emergency department.…”

“… 9 , 10 Our initial study revealed that in the context of administering diclofenac sodium via intramuscular injection, adjunctive acupuncture can increase the response rate (50 % reduction in baseline pain score) during the early time points (0, 5, 10, 15, 20, and 30 min) but not during the later time points (45 and 60 min) when compared to sham acupuncture. 11 Due to the ceiling effect of response, it remains uncertain whether acupuncture can provide sustained pain relief following the response. In order to provide a comprehensive understanding of acupuncture analgesia, this study supplemented the complete pain relief as an outcome indicator for wide range evaluation.…”