Date of Award

2021

Degree Name

Doctor of Philosophy (College of Medicine)

Schools and Centres

Medicine

First Supervisor

Professor Eric Visser

Second Supervisor

Doctor Ian Rogers

Abstract

Background: Pain is a feature of most emergency department (ED) presentations. Exacerbation of chronic pain comprises 40% of pain presentations, with the remainder being a mix of recurrent or one-off painful conditions. Opioids are the mainstay treatment for moderate to severe pain but have both short- and long-term adverse effects, including recurrent use, abuse and death. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also a concern, especially in older patients with comorbidities. Thus, emergency physicians are highly motivated to seek alternatives for pain management. Acupuncture is frequently used in outpatient settings that offer nonpharmacological treatments and has gained acceptance in postoperative analgesia; however, it is rarely used for pain in the ED setting.

Aim: The aim of this thesis is to investigate whether acupuncture has a role in standard analgesia care in the ED setting.

Methods: Based on original research and the extant literature, this thesis investigates the potential role of acupuncture in the ED setting. Primary outcomes include the efficacy of acupuncture as a standalone or adjunctive analgesic. Secondary outcomes include adverse effects, patient satisfaction, opioid-sparing ability, administration time, cost and training requirements. The original research includes two systematic reviews (on all forms of acupuncture and ear acupuncture), a patient survey, acupuncture teaching experiences and a randomised controlled trial. The findings for each outcome were collated and graded for quality. Outcomes were then ranked by priority based on the demands of the ED setting and compared with the ideal and specific analgesics to ascertain the potential clinical role of ED acupuncture.

Findings: Acupuncture is effective as a standalone analgesic but its benefits as an adjunct are unclear. Patients were satisfied with and willing to use it. Acupuncture carries a low risk of adverse events, is low in cost and is teachable to ED clinicians in basic formats such as battlefield (ear) acupuncture. The minimum training required for competency and safety in traditional body acupuncture remains uncertain. There is limited evidence for or against the opioid-sparing ability of acupuncture.

Clinical recommendations:ED acupuncture may be considered for patients with moderate noncatastrophic pain, those at risk of recurrent use or adverse effects of opioids, those for whom NSAIDs, steroid injections or other analgesics are contraindicated and those refusing standard analgesia care.

Future directions: Urgent research is needed on acupuncture as an adjunct to simple analgesia and its opioid-sparing ability in the ED. Special interest groups at colleges of emergency medicine and medical acupuncture should be established to promote ED acupuncture courses and establish standards for minimum acupuncture training.

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