Pinpointing Pain: Integrating Acupuncture into Emergency Medicine

Allison Gasnick, MS4
Case Western Reserve University School of Medicine
Medical Student Council Editor 2024-2025

The article "Emergency Department Acupuncture Is a Promising Option That Deserves an Open Mind and Continued Rigor" by Mycyk, Seaman, and Yurasek, published in June 2024, in Annals of Emergency Medicine, discusses the growing body of evidence supporting the use of acupuncture in emergency departments (ED) for pain management. The authors highlight the study by Eucker et al. within the same issue of Annals, which provides new data on the effectiveness of acupuncture in treating acute musculoskeletal pain in the ED.

Acupuncture in the ED: Current Evidence and Practice

Acupuncture involves inserting thin needles into specific points on the body to alleviate pain and treat various conditions. The article notes that this traditional Chinese medicine technique has gained traction in Western medical practice, especially for its analgesic properties.

Eucker et al.'s Study: Eucker et al. conducted a randomized controlled trial involving ED patients with musculoskeletal pain. Patients were randomized to receive either usual care alone, usual care plus Battlefield auricular acupuncture, or usual care plus peripheral needle acupuncture. The results showed that both acupuncture groups experienced significant pain reduction compared to the usual care group within one hour of treatment. This pain relief was clinically significant and patient satisfaction with the treatment was high.

Mechanisms and Theoretical Basis: Although the exact mechanisms of acupuncture are not fully understood, the authors discuss several plausible theories. These include the stimulation of endogenous opioid release, reduction of muscle spasm, and modulation of various signaling pathways involved in pain perception. Functional MRI studies have also shown brain responses to acupuncture in areas related to pain processing.

Challenges and Considerations: The study by Eucker et al. faced some limitations, such as the lack of a true placebo group and non-standardized usual care. Despite these limitations, the study demonstrated that acupuncture is a feasible and effective option for pain management in a busy ED setting. The authors call for further research to explore long-term outcomes and the potential benefits of follow-up acupuncture sessions post-ED visit.

Training and Implementation for Emergency Physicians

Training Emergency Physicians: The article underscores the importance of training ED physicians in acupuncture to effectively integrate this modality into their practice. Training programs, certification, and continuing medical education (CME) courses can equip physicians with the necessary skills. Hospitals can also facilitate on-site training and workshops led by experienced acupuncturists.

Institutional Support: Implementing acupuncture in the ED requires institutional support, including access to licensed acupuncturists, dedicated treatment spaces, and clinician education. The authors share their experience of successfully integrating acupuncture into their urban ED, noting initial resistance that was eventually overcome by demonstrating the benefits of reduced ED revisits and hospital admissions for intractable pain.

Future Directions: The authors advocate for continued rigorous research to build on the promising findings of Eucker et al. They suggest that future studies should focus on the long-term benefits of acupuncture, its impact on opioid use, and strategies to operationalize its use in various ED settings.

Conclusion

The article by Mycyk, Seaman, and Yurasek makes a compelling case for considering acupuncture as a valuable tool in the ED for pain management. By highlighting both the current evidence and practical considerations for implementation, the authors encourage emergency physicians to remain open-minded and explore the potential of acupuncture to improve patient outcomes and satisfaction in the emergency setting.

References^1–3

1. Mycyk MB, Seaman L, Yurasek F. Emergency Department Acupuncture Is a Promising Option That Deserves an Open Mind and Continued Rigor. Ann Emerg Med. 2024;0(0). doi:10.1016/j.annemergmed.2024.05.023
2. 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. Published online May 22, 2024. doi:10.1016/J.ANNEMERGMED.2024.03.014
3. Acupuncture: What You Need To Know | NCCIH. Accessed July 28, 2024. https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know