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Acupuncture and pharmacotherapy for acute back and ankle pain in the emergency setting compared

By Nicole Mackee
Acupuncture is as effective as pharmacotherapy in relieving acute back and ankle pain in patients presenting to emergency departments, say researchers, but both therapies show only modest benefit and more effective options are needed. 

In a study published in the Medical Journal of Australia, 1964 patients presenting to emergency departments with acute low back pain, migraine or ankle sprain were randomised to receive acupuncture alone, acupuncture plus pharmacotherapy or pharmacotherapy alone. All patients had a pain score of at least 4 on a 10-point verbal numerical scale. 

The study found that acupuncture alone and in conjunction with pharmacotherapy was as effective as pharmacotherapy alone in providing analgesia for back and ankle pain, but not for migraine. 

After one hour, 36.9% of patients had statistically relevant pain relief of 2 points or more, but there was no difference between the three treatment groups. At this time, 80% of patients still reported a pain score above 4. The researchers said acupuncture may be a safe and effective nonpharmacological option for some emergency department patients, but more effective pain management options were needed.

Dr Jane Trinca, Director of the Barbara Walker Centre for Pain Management in Melbourne, said pain was not generally well managed in busy emergency departments and greater use of dedicated acute and chronic pain specialists in this setting would be helpful. 

She said studies in pain and in acupuncture were difficult to conduct, and there were several issues with the MJA study’s methodology. 

‘The presentation of pain is multifaceted, even in the acute phase, and a “pain score” tells only part of the story. A lot more is required to treat this pain effectively and individually,’ said Dr Trinca, who is also coauthor of Acute Pain Management: Scientific Evidence (4th ed). 

She also noted that the acupuncture group received significantly more rescue medication therapy than the pharmacological group. 

Dr Trinca questioned whether acupuncture, which was generally undertaken in a series of treatments, could be effectively provided in the emergency department setting. 

‘Some conditions lend themselves to successful treatment outcomes more than others, and the process of determining the best treatment seems to take time and considerable history taking by the acupuncture specialist,’ she said. 

However, she added, both the acupuncture treatment and the interaction with the practitioner may help to reduce anxiety and promote muscle relaxation for patients. 

‘This is always beneficial,’ she said. 
Med J Aust 2017; 206: 494-499. 

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