Acupuncture for Acute Musculoskeletal Pain Relief in Emergency Department Patients

In a randomized clinical trial evaluating the feasibility, acceptability, and effectiveness of adding acupuncture to usual care (UC) for patients experiencing acute musculoskeletal pain in the emergency department (ED), researchers found that both auricular acupuncture (AA) and peripheral acupuncture (PA) reduced pain compared to UC alone.

Severe acute musculoskeletal pain is a common presentation in the ED and can often be difficult manage effectively with only medication. With this study, the researchers aimed to address a gap in pain management strategies for this patient population and assess the viability of acupuncture as a non-pharmacological adjunctive therapy.

The researchers conducted a pragmatic, two-stage adaptive open-label randomized clinical trial. In Stage 1, they assessed the feasibility and acceptability of AA, based on the battlefield acupuncture protocol, and PA, which involves the use of needles in the head, neck, and extremities. Both acupuncture techniques were compared with UC. In Stage 2, the study evaluated the effectiveness of the selected acupuncture interventions on pain reduction compared to UC. Licensed acupuncturists administered the AA and PA treatments, while the UC group received standard care from blinded ED providers as an attention control.

The results from the trial's Stage 1 interim analysis indicated that both AA and PA demonstrated similar feasibility and acceptability, leading to the continuation of all three treatment arms into Stage 2. Participants (N = 236) were randomized, and baseline demographics and pain levels were comparable across all groups. In the analysis, patients receiving AA in addition to UC experienced a greater reduction in pain, with a mean difference of 1.6 points on an 11-point numeric rating scale (95% CI, 0.7 to 2.6). those receiving PA in addition to UC showed a mean pain reduction of 1.2 points (95% CI, 0.3 to 2.1) compared with the group that only received UC. Participants in both acupuncture treatment arms expressed high levels of satisfaction with the acupuncture interventions.

The study’s limitations include the open-label design, which may introduce bias, as both participants and practitioners were aware of the treatments being administered. Additionally, the focus on immediate pain relief limits the ability to draw conclusions about the long-term effectiveness of acupuncture in this context.

“ED acupuncture is feasible and acceptable and can reduce acute musculoskeletal pain better than UC alone,” the study authors concluded.

Reference:

Eucker SA, Glass O, Knisely MR, et al. An adaptive pragmatic randomized controlled trial of emergency department acupuncture for acute musculoskeletal pain management. Ann Emerg Med. 2024;84(4):337-350. doi:10.1016/j.annemergmed.2024.03.014