Tuesday, 20 June 2017

Better pain management needed in emergency departments




The effectiveness of acupuncture for reducing acute back or ankle pain in the emergency department (ED) is comparable with that of pain relief drugs, but neither treatment, either alone or in combination, provides adequate relief within the first hour, according to research published in the Medical Journal of Australia. Over 20,000 people are treated in EDs each day in Australia and pain is the primary cause of attendance.1,2 

SPHPM’s Professor Peter Cameron was a co-author on the study, along with researchers from RMIT University, the Alfred Hospital, the Monash Centre of Cardiovascular Research and Education in Therapeutics, Cabrini Hospital and Austin Health. 

Acupuncture is increasingly used to control pain in community settings, however it is rarely used within emergency departments in Australia.

The team assessed the pain relief achieved by acupuncture in patients presenting to emergency departments with intense low back pain, migraine, or ankle sprain in 2010 and 2011. 270 patients were enrolled and randomly assigned to receive acupuncture (177 patients), pain relief drugs (173 patients) or both (178 patients). Pain levels were measured at a number of timepoints by asking patients to rate their pain on scale from 0 to 10.

Overall, the three treatments were found to be equivalent, but after one hour, clinically relevant pain relief was achieved in only 16% of patients and statistically relevant relief in 37%. The effectiveness of acupuncture for pain relief was found to be equivalent to medication in patients with back pain or ankle sprain, but not in those with migraines. 

Although the three treatments were similarly ineffective at reducing pain after one hour, most patients found their treatment acceptable after 48 hours, about 80% of each group stating they would probably or definitely repeat their treatment.  However, they noted that patients in the acupuncture only group were almost twice as likely to receive “rescue” analgesia. 

This may indicate that acupuncture was ineffective and patients sought alternative pain relief. Alternatively, they may have accepted drug-based pain relief because they felt they had missed out on standard care, whereas patients who had already received oral opiates were reluctant to accept parenteral opiates, such as via injection into the blood stream.

“Neither acupuncture nor standard medication afforded patients presenting to emergency departments with back pain, ankle injury or migraine clinically relevant reduction in pain within an hour,” they concluded.

The paper shows a need to improve pain management in emergency departments in general and that acupuncture may be a viable option for people who cannot or choose not to use pain relieving drugs.

References:
1. Australian Institute of Health and Welfare 2016. Emergency department care 2015–16: Australian hospital statistics. Health services series no. 72. Cat. no. HSE 182. Canberra: AIHW. Accessed on 19th June 2017 from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129557623
2. Cohen et. al. (2017). Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. MJA, 206 (11), 494 -499.

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