Acupuncture for Pain Control in the Emergency Department

Acupuncture for Non-emergent Acute Musculoskeletal Pain and Primary Headache in an Emergency Department Setting: a Parallel, Randomized, Controlled Pilot Trial

Acupuncture is widely used for managing acute and chronic pain conditions. In the context of an emergency department (ED), patients often present with non-emergent acute pain symptoms. This may result in a delayed triage process and inefficient emergent management. An integrative patient-care approach in emergency departments has been explored that may improve patient satisfaction and promote efficient use of healthcare resources for non-emergent patients in the ED. This implies there is a potential role for acupuncture in such contexts. The aim of this pilot study is to assess the effectiveness and safety of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headaches in an ED setting.

Hypotheses of this study are as follows:

1. A single session of add-on acupuncture, with standard ED management, can reduce pain levels in non-emergent acute pain, compared to standard ED management alone.
2. A single session of add-on acupuncture to standard ED management can reduce additional consumption of healthcare resources for management of non-emergent acute pain, compared to standard ED management alone.

This study aimed to include 40 participants, 20 in the acupuncture plus standard ED management group and 20 in the standard ED management alone group.

Inclusion Criteria:

• Aged over 19 years with acute pain defined as pain occurring within 72 hours of ED presentation
• Acute neck pain with no evidence of neurological abnormality
• Acute headache which meets the classification criteria of a primary headache as described by the International Headache Society (code 1 to 4)
• Acute ankle injury with no evidence of fracture or complete tear of ligaments

Exclusion Criteria:

• Any suspected non-musculoskeletal cause (neoplasm or neurological complications) for neck or ankle pain
• Any suspected secondary headaches classified by codes 5 to 12 in the International Classification of Headache Disorders, 2nd edition
• Pain due to bone fracture or joint dislocation
• Pain with fever (defined by a temperature above 37.5 °C)
• Inappropriate at the ED physician's discretion
• Pain level of less than 4 points of pain intensity on the Numerical Rating Scale (NRS) (range 0 to 10) at the completion of observations after the standard ED management
• Pregnant women