Offering acupuncture to patients in the emergency department continues to decrease acute pain

Background: Acupuncture has been associated with improving various types of acute pain. Our previous study found that acupuncture administered in the emergency department (ED) setting decreases acute pain regardless of analgesics received during visit. Purpose: To determine if 2 years after program onset, acupuncture continues to improve pain scores regardless of analgesics used during ED visits. Methods: We retrospectively reviewed patients from 2019 who accessed our ED acupuncture program. Similar to our previously published work in 2017, acupuncture services were offered to adult patients (≥18 years old) based on their emergency severity index (ESI; highest severity [1] – lowest severity [5]), reason for visit, and physician recommendation. Only patients’ first visit in 2019 was included in analyses. Basic summary statistics were used to describe patient characteristics. Paired t-tests were used to determine differences in pre- and postacupuncture pain, stress, anxiety, and nausea scores (ie, no pain [0] – worst pain [10]). Logistic regression models were used to determine associations between improvements in pain and patient or visit characteristics. Results: Acupuncture services were provided to 199 patients (mean age: 47.5 years; body mass index: 32.0 kg/m2 ), who were predominately female (78.4%) and non-Hispanic White (70.4%) and who had an ESI score of 3 (63.3%) or 4 (31.2%). As in 2017, mean pre- and postacupuncture scores for pain (6.7 vs 3.4), stress (6.3 vs 1.5), anxiety (4.9 vs 1.2), and nausea (1.5 vs 0.4) significantly decreased (P0.05 for all). Conclusion: Similar to 2017 findings, emergency department acupuncture remains associated with significantly decreased pain, stress, anxiety, and nausea. Our findings continue to support ED acupuncture for acute pain in the ED and further support the need for a larger randomized controlled trial

Utilization of acupuncture services in the emergency department setting: a quality improvement study

Context: As opioid fatalities rise, alternative treatments in the emergency department (ED) are warranted for pain management. Acupuncture, a non-pharmacologic treatment involving insertion of needles into skin/tissue at specific points within the body, may decrease acute pain experienced by patients seeking ED services. Objective: Assess utilization and impact of ED acupuncture for pain management. Study Design: Prospective enrollment, retrospective review, quality improvement study; descriptive statistics, paired t-tests used to determine differences in pre/post-acupuncture pain, stress, anxiety, and nausea scores (e.g., no pain [0] - worst pain [10]); regression models. Setting: Milwaukee County, WI, USA. Patients: Adult ED patients during 2017 were offered acupuncture services based on emergency severity index (ESI; highest severity [1] - lowest severity [5]), reason for visit, and physician approval. Results: 379 patients received acupuncture services (mean age 47.5 years and BMI 30.8 kg/m2). Patients were predominately female (68.1%) and White non-Hispanic (77.0%), with ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in ED. Following enrollment, patients had 8-15 needles placed (86.0%) and received 20 or 30 minutes of needle time (92.6%). Mean pre/post-acupuncture pain (6.5 vs. 3.4), stress (5.7vs. 1.9), anxiety (4.8 vs. 1.6), and nausea (1.6 vs. 0.6) scores were significantly different (p\u3c0.001). Increasing patient age predicted improved pain scores; receiving pain medication in ED was not associated with improved pain scores. Female gender and pain medication administration in ED predicted improved stress scores. Overall, patients mean length of stay in the ED was 194 minutes, with 10.6% of patients admitted to the hospital. Following ED discharge, \u3c2% received acupuncture services within 30 days. Conclusion: Patients in ED with acute pain experienced significant decreases in pain, stress, anxiety, and nausea with acupuncture. While further study is warranted, acupuncture may be an alternative treatment to opioid use in selected patients during ED admission

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

Purpose: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain. Our study aimed to assess the utilization and impact of acupuncture in the ED for acute pain management. Methods: We conducted a retrospective analysis of purposefully collected quality improvement data. Patients who were ≥18 years old and who presented to the ED at an urban medical center in Wisconsin during 2017 were offered acupuncture services based on their emergency severity index (ESI; range: highest severity [1] – lowest severity [5]), reason for visit, and physician approval. Paired t-tests were used to examine mean differences between pre- and post-acupuncture pain, stress, anxiety, and nausea scores (range: none [0] – worst [10]). Multivariable regression models also were constructed. Results: A total of 379 patients received acupuncture. Patients presented predominately with an ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in the ED. Mean pre- and post-acupuncture pain scores significantly differed (6.5 vs 3.4; P \u3c 0.001); receiving opioids during the ED visit was not associated with improved pain scores (P = 0.948). Stress (5.7 vs 1.9), anxiety (4.8 vs 1.6), and nausea (1.6 vs 0.6) scores also improved (P \u3c 0.001) following acupuncture. Conclusions: Emergency department acupuncture significantly decreased pain, stress, anxiety, and nausea. Our findings support a larger randomized controlled trial to further assesses the impact of acupuncture for acute pain in other ED settings

A framework for indicators of rehabilitation success based on ecological principles and social values

To understand the meaning of rehabilitation success we need to address two fundamental questions: (1) what does rehabilitation success mean; and (2) how can rehabilitation success be measured? The research objectives of this dissertation are defined by these two questions..

Acupuncture intervention for acute pain in the emergency department trial: A consensus process

Purpose: This document describes the consensus process and intervention for a National Institutes of Health (NIH)-funded multi-site feasibility study utilizing acupuncture for ACUte paIn in The EmergencY Department (ACUITY). The acupuncture intervention is designed to be flexible and responsive to the most common Emergency Department (ED) scenarios, including trauma, acute pain of the low back, abdomen and/or musculoskeletal system, renal colic and headache. Background: Opioids remain a primary treatment for acute ED pain with attendant risk of adverse effects, addiction liability, diversion and death. Effective/safer options for acute pain are needed. Although acupuncture therapy has shown promise for acute pain in the ED alone or in conjunction with usual care, pragmatic trials are needed to obtain definitive and generalizable evidence. Methods: An Acupuncture Advisory Panel was convened that included nine acupuncture experts with 5-44 years of experience in practice and 2-16 years of experience in the acute pain care setting. A modified Delphi process was used with provision of a literature review, surveys of our panel members, three online discussions and email discussion as needed. The STandards for Reporting Interventions in Controlled Trials (STRICTA) checklist was used as a guide. Results: A responsive acupuncture intervention was agreed on for ACUITY. Session forms were fashioned in REDCap (Research Electronic Data Capture program to capture essential treatment data, assess fidelity and inform our design for a future pragmatic multi-site randomized controlled trial (RCT) of acupuncture in the ED, and for use by other future researchers. Conclusion: Development of a responsive manualization intervention provides the appropriate framework for conducting a future, pragmatic, multi-site, definitive RCT of acupuncture in the ED