Acupuncture for Pain in the Emergency Department
Summary
The purpose of the study is to test auricular (ear) acupuncture for the acute management of patient pain in the Emergency Department as an alternative and adjunct to standard medical treatment. Currently, physicians who practice medicine here in the United States only have pharmacological intervention at their disposal as the only available treatment tool they have for the treatment and management of pain, and as a result, painkiller misuse, overdose, and death has become the leading health epidemic in America. American healthcare is in desperate need of alternative and safer ways to prevent prescription painkiller overdoses and to better manage pain. If prescription painkiller dependencies can be avoided at the source, potentially many lives and healthcare dollars can be saved. Acupuncture is an alternative treatment that has been effectively used to treat pain for thousands of years in countries around the world. The National Institutes of Health (NIH) and the United Nations World Health Organization (WHO) have stated that acupuncture is a safe and effective treatment for the management of pain. Supported by many studies illustrating seventy-five to ninety-nine percent effectiveness in treating pain with an instantaneous drop in pain by twenty-five to eighty percent, acupuncture appears to be the safest and most effective option available to manage pain syndromes in the emergency department. Auricular acupuncture has demonstrated beneficial effects to reduce acute and chronic pain intensity. Specifically, for the thesis of this clinical trial, the investigators hypothesize that auricular acupuncture can be an effective alternative and/or adjunct treatment tool in the civilian emergency department for the acute management of pain. In order to test the safety and efficacy of using auricular acupuncture in the emergency department, people presenting to the emergency department with pain who are willing to participate in the study will be randomized into three separate groups: 1. Standard medical group (tape on ear + standard medical drug) 2. Standard medical group plus auricular acupuncture (acupuncture + standard medical drug) 3. Auricular acupuncture group (acupuncture + placebo pill) The design of these groups will allow the investigators to best test the efficacy of auricular acupuncture versus the placebo effect and standard medical care as well as an adjunct to standard medical care. To accomplish the objective of this proposal, the investigators will pursue the following specific aims: Specific Aim 1: To prove the efficacy of auricular acupuncture over a placebo group in the management of pain syndromes. By having the acupuncture group and sham acupuncture group, the investigators will be able to effectively compare the difference in pain levels with a placebo-group. Specific Aim 2: To prove that auricular acupuncture is an effective alternative and/or adjunct to standard medical care in the Emergency Department. By testing the efficacy of acupuncture in conjunction with standard medical treatment, the investigators expect to see a potentiation of analgesic effects, and this will be noted by an increased reduction in pain between the standard medical plus acupuncture group versus the standard group and acupuncture group. Specific Aim 3: To prove that auricular acupuncture as an effective pain management alternative that decreases short-term prescription painkiller dependency. Through a series of follow up questionnaires and a medication diary that the investigators will give to the patient prior to discharge, the investigators will track the patient's need and use of additional pain medications post treatment. These surveys will give a good indication as to the effectiveness of auricular acupuncture to reduce a patient's dependency on painkiller drugs in the short-term setting.
Timeline
- Start
- 2017-07-27
- Primary completion
- 2017-09
- Completion
- 2017-09
Publications
- Background Asher GN, Jonas DE, Coeytaux RR, Reilly AC, Loh YL, Motsinger-Reif AA, Winham SJ. Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. J Altern Complement Med. 2010 Oct;16(10):1097-108. doi: 10.1089/acm.2009.0451.
- Background Bart-Knauer B, Friedl KE. When will acupuncture become a first-line treatment for acute pain management? Mil Med. 2013 Aug;178(8):827-8. doi: 10.7205/MILMED-D-13-00119. No abstract available.
- Background Bodnar RJ. Endogenous opiates and behavior: 2011. Peptides. 2012 Dec;38(2):463-522. doi: 10.1016/j.peptides.2012.09.027. Epub 2012 Oct 3.
- Background Busch V, Zeman F, Heckel A, Menne F, Ellrich J, Eichhammer P. The effect of transcutaneous vagus nerve stimulation on pain perception--an experimental study. Brain Stimul. 2013 Mar;6(2):202-9. doi: 10.1016/j.brs.2012.04.006. Epub 2012 May 7.
- Background Centers for Disease Control. Prescription Painkiller Overdoses in the U.S. (2012). Prescription Painkiller Overdoses in the U.S.,4.
- Background Cheng RS, Pomeranz BH. Electroacupuncture analgesia is mediated by stereospecific opiate receptors and is reversed by antagonists of type I receptors. Life Sci. 1980 Feb 25;26(8):631-8. doi: 10.1016/0024-3205(80)90239-8. No abstract available.
- Background Cho, Son, Han: (MRI Neurophysiological evidence of acupuncture mechanisms. Med Acupuncture. 2002: 14: 16-22.
- Background Dincer F, Linde K. Sham interventions in randomized clinical trials of acupuncture--a review. Complement Ther Med. 2003 Dec;11(4):235-42. doi: 10.1016/s0965-2299(03)00124-9.
- Background Faircloth AC, Dubovoy A, Biddle C, Dodd-McCue D, Butterworth JF 4th. CME Article: Perceptions of Acupuncture and Acupressure by Anesthesia Providers: A Quantitative Descriptive Study. Med Acupunct. 2016 Apr 1;28(2):79-86. doi: 10.1089/acu.2015.1161.
- Background Fang JQ, Fang JF, Liang Y, Du JY. Electroacupuncture mediates extracellular signal-regulated kinase 1/2 pathways in the spinal cord of rats with inflammatory pain. BMC Complement Altern Med. 2014 Aug 4;14:285. doi: 10.1186/1472-6882-14-285.
- Background Feng Y, Bai L, Ren Y, Wang H, Liu Z, Zhang W, Tian J. Investigation of the large-scale functional brain networks modulated by acupuncture. Magn Reson Imaging. 2011 Sep;29(7):958-65. doi: 10.1016/j.mri.2011.04.009. Epub 2011 May 25.
- Background Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol. 1990 Aug;17(8):1022-4.
- Background Garcia AM. State laws regulating prescribing of controlled substances: balancing the public health problems of chronic pain and prescription painkiller abuse and overdose. J Law Med Ethics. 2013 Mar;41 Suppl 1:42-5. doi: 10.1111/jlme.12037.
- Background Goertz CM, Niemtzow R, Burns SM, Fritts MJ, Crawford CC, Jonas WB. Auricular acupuncture in the treatment of acute pain syndromes: A pilot study. Mil Med. 2006 Oct;171(10):1010-4. doi: 10.7205/milmed.171.10.1010.
- Background Haker E, Egekvist H, Bjerring P. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton Nerv Syst. 2000 Feb 14;79(1):52-9. doi: 10.1016/s0165-1838(99)00090-9.
- Background Hommer DH. Chinese scalp acupuncture relieves pain and restores function in complex regional pain syndrome. Mil Med. 2012 Oct;177(10):1231-4. doi: 10.7205/milmed-d-12-00193.
- Background Ip, V. (1999). The use of acupuncture for pain relief in a Chinese hospital clinic. Acupuncture In Medicine, 17(2), 101-109.
- Background Kawakita K, Funakoshi M. Suppression of the jaw-opening reflex by conditioning a-delta fiber stimulation and electroacupuncture in the rat. Exp Neurol. 1982 Nov;78(2):461-5. doi: 10.1016/0014-4886(82)90063-2. No abstract available.
- Background King HC, Hickey AH, Connelly C. Auricular acupuncture: a brief introduction for military providers. Mil Med. 2013 Aug;178(8):867-74. doi: 10.7205/MILMED-D-13-00075.
- Background Liu J, Qin W, Guo Q, Sun J, Yuan K, Dong M, Liu P, Zhang Y, von Deneen KM, Liu Y, Tian J. Divergent neural processes specific to the acute and sustained phases of verum and SHAM acupuncture. J Magn Reson Imaging. 2011 Jan;33(1):33-40. doi: 10.1002/jmri.22393.
- Background Mohler, Stanley R. "Acupuncture Helps in Treating Medical Problems." Human Factors & Aviation Medicine. Flight Safety Foundation: September-October 2002, Vol. 49 No. 5
- Background Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002 Jul 11;347(2):81-8. doi: 10.1056/NEJMoa013259.
- Background Napadow V, Edwards RR, Cahalan CM, Mensing G, Greenbaum S, Valovska A, Li A, Kim J, Maeda Y, Park K, Wasan AD. Evoked pain analgesia in chronic pelvic pain patients using respiratory-gated auricular vagal afferent nerve stimulation. Pain Med. 2012 Jun;13(6):777-89. doi: 10.1111/j.1526-4637.2012.01385.x. Epub 2012 May 8.
- Background NIH Consensus Conference. Acupuncture. JAMA. 1998 Nov 4;280(17):1518-24.
- Background Shepherd J. Combating the prescription painkiller epidemic: a national prescription drug reporting program. Am J Law Med. 2014;40(1):85-112. doi: 10.1177/009885881404000103.
- Background Pickett, H. (2011). Battlefield acupuncture. Journal Of Chinese Medicine, (96), 12-17.
- Background Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. 1976 Dec 1;19(11):1757-62. doi: 10.1016/0024-3205(76)90084-9. No abstract available.
- Background Qu F, Zhou J. Electro-acupuncture in relieving labor pain. Evid Based Complement Alternat Med. 2007 Mar;4(1):125-30. doi: 10.1093/ecam/nel053. Epub 2006 Aug 17.
- Background Roberts, C. (2008). Easing Pain with Acupuncture. Soldiers, 63(7), 36-37.
- Background Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, Szeles JC, Finster G, Schiesser AW, Heinze G, Kress HG. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesth Analg. 2004 May;98(5):1359-64, table of contents. doi: 10.1213/01.ane.0000107941.16173.f7.
- Background Spielman, F.J. "Acupuncture: What's the Point?" American Journal of Anesthesiology Volume 28 (2001): 306-308.
- Background Substance Abuse and Mental Health Services Administration Public Health Service U.S. Department of Health and Human Services. Summary of the 2009 National Survey on Drug Use and Health. J Pain Palliat Care Pharmacother. 2010 Dec;24(4):434-8. No abstract available.
- Background Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA. 2011 Apr 6;305(13):1299-301. doi: 10.1001/jama.2011.401. No abstract available.
- Background White P, Lewith G, Hopwood V, Prescott P. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial. Pain. 2003 Dec;106(3):401-409. doi: 10.1016/j.pain.2003.08.013.
- Background WHO. The World Health Organization Viewpoint on Acupuncture. <www.sd- acupuncture.com/articles.html>. Aug. 13, 2002.
- Background Yoo YC, Oh JH, Kwon TD, Lee YK, Bai SJ. Analgesic mechanism of electroacupuncture in an arthritic pain model of rats: a neurotransmitter study. Yonsei Med J. 2011 Nov;52(6):1016-21. doi: 10.3349/ymj.2011.52.6.1016.
- Background Zhang AL, Parker SJ, Smit de V, Taylor DM, Xue CC. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupunct Med. 2014 Jun;32(3):250-6. doi: 10.1136/acupmed-2013-010501. Epub 2014 Mar 7.
- Background Zhang Y, Zhang RX, Zhang M, Shen XY, Li A, Xin J, Ren K, Berman BM, Tan M, Lao L. Electroacupuncture inhibition of hyperalgesia in an inflammatory pain rat model: involvement of distinct spinal serotonin and norepinephrine receptor subtypes. Br J Anaesth. 2012 Aug;109(2):245-52. doi: 10.1093/bja/aes136. Epub 2012 May 23.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Acetaminophen | Small molecule | 325 mg | — |
| Subject | Hydrocodone | Unknown | 5 mg | — |