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Needle insertion including auricular points |
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NA |
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Pain VAS or NRS Physiological parameters (respiratory rate, heart rate, systolic and diastolic blood pressure) Medication consumption Length of stay in ED Patient satisfaction with the tx Time points: immediate post-tx acupuncture plus UC vs UC alone Safety, effectiveness, and feasibility of acupuncture in the ED
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Studies showed it feasible to provide acupuncture in the ED and suggested further study to test the role of acupuncture in the ED. |
Overall SOE not assessed. Internal validity assessed with Cochrane Risk of Bias Tool but no rating provided. Current evidence found in study was insufficient to accept or refute the use of acupuncture in the ED. Future studies should address the process and cost-related benefits of acupuncture use in the ED: future research with large RCTs to evaluate effectiveness of acupuncture in the ED and future OBS on the safety and acceptability of acupuncture to ED staff and patients. Current evidence is insufficient to provide any recommendation of acupuncture in the ED setting.
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Auricular therapies, including auricular acupuncture and auricular pressure |
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Meta-analysis 4 RCTs, n = 286 auricular therapies vs sham, n = 127 Auricular therapies+SAC vs SAC alone n = 154 auricular therapies alone or +SC vs control as sham alone or +SC, n = 271
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Acute pain management n = 458
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auricular acupuncture vs sham: SMD of 1.69 (CI 95%: 0.37–3.01) WMD 2.47 (CI 95% 1,79–3.16) AdjA vs SAC: SMD 1.68 (CI 95% 1.18–2.18) WMD 2.84 (CI: 95% 1.45–4.22) 1 RCT showed reduction in NSAID usage for sore throats with reduced mean number of doses at 6 hours, 24 hours, and 48 hours. In OBS AdjA, 62% of respondents said that they “would have the same treatment again,” and 71% reported they were either mostly satisfied or very satisfied.
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Overall SOE not assessed. Ear acupuncture has limited evidence of effectiveness for acute pain in the ED setting as standalone tx as an adjunct. Future studies needed with comparator group of acupuncture vs SAC. Future studies needed with patient satisfaction as secondary outcome. Future studies needed assessing various techniques of ear acupuncture, ear vs body acupuncture, and utilization of certified acupuncturists vs non-acupuncturists. Further testing using acupuncture vs SAC with medication usage as secondary outcome.
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Acupuncture (26), auricular therapy (3), EAS (1) |
SRM 19 RCTs and 11 OBS in SR
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14 RCTs n = 1,210 |
Acute pain management in the ED setting n = 3,169 SR n = 1,210 meta-analysis 11 OBS Migraine, hip fractures, biliary colic, acute LBP, sore throat. 4 spinal pain, 3 mixed pain, 3 limb fractures, 3 migraine, 3 renal colic, 11 traditional acupuncture, 5 ear acupuncture (4 BFA)
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Pain (PS-10) difference: acupuncture vs sham, acupuncture vs SAC, acupuncture as adjunct to other analgesia (AdjA) vs SAC Pain scored recorded within 240 minutes of tx Analgesia use Patient satisfaction Time and cost of acupuncture
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Acupuncture vs sham: SMD 1.08 (95% CI = 0.62–1.54), WMD of 1.60 (95% CI = 0.98–2.23). (both favoring acupuncture) acupuncture vs SAC: (acupuncture comparable to SAC) AdjA vs SAC alone: SMD 1.68 (95% CI 1.18–2.18), WMD 2.84 (95% CI 1.45–4.22) AdjA more effective than SAC (without sham). Patient satisfaction, reported in 5 RCTs, showed improvement compared with sham on 100-point scale. 5 OBS measured patient satisfaction; all reported improvement with AC. 3 RCTs quoted costs of acupuncture consumables less than $5 per patient; 3 other RCTs stated acupuncture is “low-cost treatment.” Acupuncture provided statistically significant, clinically meaningful, and improved levels of patient satisfaction with respect to pain relief in the emergency setting.
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Overall SOE not assessed. Acupuncture appears to provide effective analgesia for some acute pain conditions in the ED, while being noninferior to selected analgesia medications. Low-cost, low-risk, and patient-satisfying therapy. Effectiveness in reducing analgesic medication use is uncertain. Future RCTs might measure the NNT for 30–50% pain reduction or “adequate analgesia,” which has better correlation to patient satisfaction. More RCTs where AdjA is compared with SAC. More investigation into other pain conditions with acupuncture vs SAC, ear vs body acupuncture, and acupuncture delivered by ED health providers vs qualified acupuncturists.
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Acupuncture, auricular acupuncture, EAS |
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NA |
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Acupuncture vs sham for acute pharyngitis: Acupuncture 44.4% vs sham 10.5%, at relieving pain. Acupuncture vs standard ED care for acute pain: Acupuncture was more effective and faster pain control compared with intravenous morphine, success rate acupuncture 92% vs 78%. EAS vs standard ED care for acute pain significant reduction in mean VAS score seen in both groups (acupuncture group 25.90 ± 17.62; conventional ED care group 22.18 ± 24.09). Acupuncture as an adjunct to standard ED care for acute pain syndrome auricular acupuncture +SC better than SC alone in immediate pain control, with 2.18 mean difference in NRS pain reduction.
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Sakamoto et al. 2018 [53]
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Acupuncture, auricular, scalp acupuncture |
SRM 10 acupuncture studies 5 RCTs 1 cohort 4 case series
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Acute pain in the ED n = 724 |
Pain= most frequently assessed outcome with VAS or NRS: acupuncture vs no intervention, acupuncture no comparator, acupuncture vs sham, acupuncture vs titrated morphine, acupuncture vs intravenous acetaminophen vs intramuscular diclofenac
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Acupuncture decreased pain immediately until ED discharge (4 RCTs, 1 cohort, 4 case series) and improved nausea, anxiety, time to pain resolution, and adverse effects. Pain decrease similar to control immediately, 30 minutes, and 24 hours after acupuncture (3 RCTs). 84% of patients reported benefit, 52–82% would use again, nearly all patients reported high satisfaction, with >50% reporting highest satisfaction.
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Overall SOE not assessed. Studies addressing feasibility of implementation, opioid usage, and efficacy in terms of multidimensional functional outcomes are warranted. Interventions have potential to improve acute pain management and patient satisfaction and improve patient outcomes and quality of life, while reducing overall ED utilization and length of stay.
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| Liu et al. 2020 [64] |
Acupuncture; acupuncture+ Chinese herbs/tincture; acupuncture+ massage; acupuncture+ RICE; acupuncture + medications |
SRM 17 trials Acute ankle sprain
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Acupuncture+ RICE vs RICE n = 143 Acupuncture+ dimethyl sulfoxide vs dimethyl sulfoxide alone n = 87 Acupuncture+ Chinese medicine vs Chinese medicine alone n = 530
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Kofoed Ankle Score. VAS, duration of pain, use of analgesics, ankle circumference “Effective rate,” “cure rate” (Chinese studies) Adverse events. Comparators: no tx, placebo, or traditional therapies for acute ankle sprain involve nonsteroidal anti-inflammatory drugs, RICE (rest, ice, compression, and elevation), functional support, exercise, manual mobilization, etc.
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Meta-analysis favored acupuncture vs no tx, vs massage, vs ice/hot pack+ Chinese medicine, vs infrared radiation, and vs RICE but not vs dimethyl sulfoxide. Acupuncture plus dimethyl sulfoxide vs dimethyl sulfoxide alone, acupuncture plus massage vs massage alone, acupuncture plus RICE vs RICE alone.
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