Table 5.

Pilot, retrospective, or qualitative studies: acupuncture for inpatient or ED acute pain

Author/year	Modality/kind of study/n	Setting/type of pain	Intervention/comparator/Outcome measures	Results
Crespin et al. 2015 [75]	Acupuncture/retrospective OBS/n = 2,500	Postoperative pain care after total hip or total knee replacement	Elective acupuncture as adjunct to physical therapy beginning first day after surgery. All Patient Refined-Diagnostic Related Groups (APR-DRG) severity of illness measures; self-reported pre- and post-tx pain scores 0–10	Nearly 75% of patients elected to have acupuncture in addition to PT; acupuncture reduced pain by 45% in short term and improved patients’ capacity to perform PT during initial postsurgical recovery.
Quinlan-Woodward et al. 2016 [76]	Acupuncture/pilot RCT/n = 30	Inpatient / post–breast cancer surgery	Acupuncture (n = 15) UC (n = 15) NRS for pain, nausea	Pain, nausea, and anxiety were reduced in acupuncture group on the first day, and pain was also reduced on the second day after surgery.
Reinstein et al. 2017 [62]	Acupuncture Retrospective OBS n = 248	Pain and anxiety ED Back (n = 57) Head (n = 41) Limb (n = 37) Abdomen (n = 27) Chest (n = 17) Groin (n = 3)	Feasibility outcomes: 248/279 = 89% of patients agreed to acupuncture. 55/75 = 73% of clinical providers referred patients for acupuncture. Acupuncture sessions averaged 23 minutes (SD 8.9) and ranged from 6 to 78 minutes. Acupuncture tx vs UC analgesics. NRS 0–10 for pain and anxiety.	Acupuncture acceptable and effective for pain and anxiety reduction with standard care. Of patients with pre pain (n = 182), 43% reported ≥50% pain reduction, and 57% reported ≥30% pain reduction. Similar benefits were seen regardless of whether any pain medication also was received in the ED (n = 88) vs acupuncture alone (n = 92).
Burns et al. 2019 [60]	Acupuncture Retrospective OBS n = 379	ED acute pain: Neck/back/shoulder/hip (n = 133) Abdominal pain including urinary tract and gastric (n = 123) Chest pain, including anxiety/hypertension related (n = 35) Head pain (including headache, Bell’s palsy, epistaxis, trigeminal neuralgia) (n = 37) Joint/limb pain (n = 31) Substance withdrawal pain (n = 6) Generalized pain (all over or more than one site) (n = 14)	Acupuncture: 53.7% of 706 patients agreed to acupuncture (n = 379). 86% had 8–15 needles. 92.6% had 20- to 30-minute needle time (mean 24.4 minutes) Pre- and post-acupuncture pain, stress, anxiety, and nausea scores.	Acupuncture is feasible and acceptable for acute pain patients in ED. Patient-reported pain, stress, and anxiety scores all significantly improved after acupuncture, with similar benefits seen regardless of whether any pain medication also was received. Receiving only opioids during ED visit was not associated with improved pain scores. AEs not reported.
Aikawa et al. 2020 [77]	Acupuncture OBS n = 102	ED, acute musculoskeletal pain (n = 102) LBP, neck pain, knee pain, shoulder pain.	10-second intense tx at single or 2 acupoints NVS before and after tx. SI 3, BL 62, GB 41.	Almost all reported decrease in pain; only 4% had desire for analgesic medication.
Tsai et al. 2020 [78]	Acupuncture Retrospective study n = 24	Outpatient and inpatient units; pediatric sickle cell pain	90 txs/24 patients, mean tx duration 18.5 ± 4.8 minutes Pre/post pain scores	No AEs. Pain reduction.
Mahmood et al 2020 [79]	Acupuncture retrospective n = 12	Inpatient and outpatient units, pediatric sickle cell pain	Adjuvant acupuncture 15–20 minutes	Acceptable, feasible; improved pain.
Tsai et al. 2020 [80]	Acupuncture manual (75%) Electroacupuncture (1%) Combined manual and electro (24%)	Outpatient, migraine	Acupuncture (n = 477), mean 8.9 sessions, with medications Medications alone (n = 1,908): sumatriptan, rizatriptan, ergotamine, caffeine, acetaminophen, ibuprofen, and other NSAIDs	In migraine patients who underwent acupuncture tx, the medical expenditures on emergency care (P=0.01) and hospitalization (P=0.01) were significantly lower than for patients without acupuncture tx. It is cost-effective to encourage combining acupuncture and Western medicine to treat migraine patients.

AE = adverse events; NRS = numerical rating scale; NSAIDs = non-steroidal anti-inflammatory drugs; NVS = numerical visual scale; OBS = observational study; PT = physical therapy; SD= standard deviation; tx = treatment; txs = treatments; UC= usual care.