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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:S0196-0644(24)00291-9. [PMID: 38888532 DOI: 10.1016/j.annemergmed.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Mark B Mycyk
- Department of Emergency Medicine, Cook County Health, Chicago, IL.
| | - Lisa Seaman
- Department of Anesthesiology and Pain Management, Cook County Health, Chicago, IL
| | - Frank Yurasek
- Department of Anesthesiology and Pain Management, Cook County Health, Chicago, IL
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2
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Razani O, Nasiri M, Yarahmadi F, Zonoori S, Shamsi A, Abbasi M, Asadi M. Alleviating severity of limb trauma pain with coadministration of topical sesame oil and standard treatments: A GRADE-assessed systematic review and meta-analysis of randomised controlled trials. Int Wound J 2024; 21:e14907. [PMID: 38822706 PMCID: PMC11143441 DOI: 10.1111/iwj.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/03/2024] Open
Abstract
Recent randomised controlled trials (RCTs) have investigated the analgesic activity of sesame oil among patients with limb trauma; nevertheless, their findings are inconsistent. Hence, this review aimed to clarify the impact of topical administration of sesame oil on acute pain of adult outpatients with minor limb trauma. The online databases (e.g., Scopus, PubMed, Web of Science) were searched up to 31 January 2024. The RCTs were included if they compared the effect of applying standard treatments plus topical sesame oil to administering standard treatments alone or with a placebo/sham treatment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Cochrane Collaboration's risk of bias tool were applied to address the evidence quality and the study's methodological rigour, respectively. Four RCTs had the inclusion criteria, and their findings were pooled in a meta-analysis employing a random-effects approach. According to the pooled analysis, the reduction in mean change of the pain score from baseline to the second/third intervention day was significantly higher in favour of clients who received standard care plus daily massage of the trauma site with sesame oil compared to those who received a control condition (weighted mean difference: -1.10; 95% confidence interval [-1.62, -0.57]; p < 0.001). However, the evidence quality was moderate, and only two studies had good methodological rigour. Hence, more high-quality studies are needed to make a solid evidence-based conclusion about the favourable consequence of topical sesame oil on alleviating acute traumatic limb pain.
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Affiliation(s)
- Omolbanin Razani
- Department of NursingDoroud Branch, Islamic Azad UniversityDoroudIran
| | - Morteza Nasiri
- Department of AnesthesiaSchool of Allied Medical Sciences, Tehran University of Medical SciencesTehranIran
| | - Fatemeh Yarahmadi
- Department of NursingBroujerd School of Nursing, Lorestan University of Medical SciencesKhorramabadIran
| | - Sahar Zonoori
- Department of NursingBroujerd School of Nursing, Lorestan University of Medical SciencesKhorramabadIran
| | - Afzal Shamsi
- Department of AnesthesiaSchool of Allied Medical Sciences, Tehran University of Medical SciencesTehranIran
- Nursing and Midwifery Care Research CenterTehran University of Medical SciencesTehranIran
| | - Mohammad Abbasi
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Masoomeh Asadi
- Department of Operating Room NursingAbadan University of Medical SciencesAbadanIran
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Nielsen A, Dyer NL, Lechuga C, McKee MD, Dusek JA. Fidelity to the acupuncture intervention protocol in the ACUpuncture In The EmergencY department for pain management (ACUITY) trial: Expanding the gold standard of STRICTA and CONSORT guidelines. Integr Med Res 2024; 13:101048. [PMID: 38841077 PMCID: PMC11151162 DOI: 10.1016/j.imr.2024.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Background Acupuncture shows promise as an effective nonpharmacologic option for reduction of acute pain in the emergency department (ED). Following CONSORT and STRICTA guidelines, randomized controlled trials (RCTs) generally report intervention details and acupoint options, but fidelity to acupuncture interventions, critical to reliability in intervention research, is rarely reported. Methods ACUITY is an NCCIH-funded, multi-site feasibility RCT of acupuncture in 3 EDs (Cleveland, Nashville, and San Diego). ACUITY acupuncturists were trained in study design, responsive acupuncture manualization protocol, logistics and real-time recording of session details via REDCap forms created to track fidelity. Results Across 3 recruiting sites, 79 participants received acupuncture: 51 % women, 43 % Black/African American, with heterogeneous acute pain sites at baseline: 32 % low back, 22 % extremity, 20 % abdominal, 10 % head. Pragmatically, participants were treated in ED common areas (52 %), private rooms (39 %), and semi-private rooms (9 %). Objective tracking found 98 % adherence to the six components of the acupuncture manualization protocol: staging, number of insertion points (M = 13.2, range 2-22), needle retention time (M = 23.5 min, range 4-52), session length (M = 40.3 min, range 20-66), whether general recommendations were provided and completion of the session form. Conclusion To the best of our knowledge, this is the first RCT to assess and report fidelity to an acupuncture protocol. Fidelity monitoring will be fundamental for ACUITY2, which would be a future definitive, multi-site RCT. Furthermore, we recommend that fidelity to acupuncture interventions be added to CONSORT and STRICTA reporting guidelines in future RCTs. Protocol registration The protocol of this study is registered at clinicaltrials.gov: NCT04880733.
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Affiliation(s)
- Arya Nielsen
- Icahn School of Medicine at Mount Sinai, Department of Family Medicine and Community Health, New York, NY, USA
| | - Natalie L. Dyer
- Susan Samueli Integrative Health Institute, University of California- Irvine, Irvine, CA, USA
| | - Claudia Lechuga
- Department of Family and Social Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - M. Diane McKee
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jeffery A. Dusek
- Susan Samueli Integrative Health Institute, University of California- Irvine, Irvine, CA, USA
- Department of Medicine, General Internal Medicine, University of California- Irvine, Irvine, CA, USA
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Arnold CA, Bagg MK, Harvey AR. The psychophysiology of music-based interventions and the experience of pain. Front Psychol 2024; 15:1361857. [PMID: 38800683 PMCID: PMC11122921 DOI: 10.3389/fpsyg.2024.1361857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.
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Affiliation(s)
- Carolyn A. Arnold
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, VIC, Australia
- Caulfield Pain Management and Research Centre, Alfred Health, Melbourne, VIC, Australia
| | - Matthew K. Bagg
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Institute, Sydney, NSW, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Alan R. Harvey
- Perron Institute for Neurological and Translational Science, Perth, WA, Australia
- School of Human Sciences and Conservatorium of Music, The University of Western Australia, Perth, WA, Australia
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Sodders MD, Gause EL, Bayer S, Metcalf C, Lumiere K, Vavilala MS, Gordon DB. Electroacupuncture for Pain Outcomes in a Trauma Center's Acute Pain Service: A Retrospective Observational Study. Med Acupunct 2023; 35:135-143. [PMID: 37351442 PMCID: PMC10282799 DOI: 10.1089/acu.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background Evidence for acupuncture to treat pain is growing. Electrostimulation of acupuncture needles (electroacupuncture) is common for pain and is thought to augment the therapeutic effect. Objectives To examine the association of pain outcomes after a single acupuncture session with electrostimulation included (EA) compared with no electrostimulation included (NEA). Methods A retrospective observational study was conducted using electronic health records of acupuncture sessions for adults with acute pain under the care of an acute pain service. Paired t-test and linear regression were used to report pain intensity changes after a single acupuncture session and by including EA. Ordered logistic regression was used to report categorical pain relief. Logistic regression was used to explore the odds of adding EA and the patient's age, gender, and pretreatment pain. Results From July 24, 2017, through November 9, 2020, 465 acupuncture sessions recorded EA (n = 194), or NEA (n = 271). Acupuncture, independent of EA status, reduced pain intensity by a mean 2.5 points. EA was associated with a mean 0.38-point reduction in pain intensity more than NEA (confidence interval [95% CI]: -0.75 to -0.01). Among sessions reporting categorical pain relief (n = 415), higher relief was more likely with EA (odds ratio = 2.16, 95% CI: 1.52-3.08). There was no association between EA and the patient's age, gender, and pretreatment pain intensity. Conclusions After a single acupuncture session, both EA and NEA reduced pain intensity. Higher categorical pain relief was reported with EA, though the clinical meaning is uncertain. Future research should focus on well-defined populations for electroacupuncture and factors for including electrostimulation.
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Affiliation(s)
- Mark D. Sodders
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emma L. Gause
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
| | - Sara Bayer
- Acupuncture and East Asian Medicine, Bastyr University, Seattle, WA, USA
| | - Carol Metcalf
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen Lumiere
- Acupuncture and East Asian Medicine, Bastyr University, Seattle, WA, USA
| | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Debra B. Gordon
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Bosso L, Espejo T, Taffé P, Caillet-Bois D, Christen T, Berna C, Hugli O. Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study. Ann Emerg Med 2023; 81:84-94. [PMID: 35641354 DOI: 10.1016/j.annemergmed.2022.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE We aimed to assess the analgesic and anxiolytic efficacy of distraction, a nonpharmacologic intervention provided by 3-dimensional (3D) virtual reality (VR) compared with that provided by 2-dimensional (2D) VR during minor emergency department (ED) procedures. METHODS This randomized controlled study conducted in the ED of a teaching hospital included patients aged more than or equal to 18 years undergoing minor procedures. The patients watched the same computer-generated VR world either in 3D in a head-mounted display (intervention) or in 2D on a laptop screen (control). Our main outcomes were pain and anxiety during the procedure, assessed on a 100-mm visual analog scale. Secondary outcomes included the impression of telepresence in the computer-generated world assessed using the Igroup Presence Questionnaire, and the prevalence and intensity of cybersickness measured on a 100-mm visual analog scale. RESULTS The final analysis included 117 patients. The differences in median procedural pain and anxiety levels between the 2D and 3D VR groups were not significant: -3 mm (95% confidence interval [CI] -14 to 8) and -4 mm (95% CI -15 to 3), respectively; the difference in telepresence was 2.0 point (95% CI 0 to 2.0), and the proportion difference of cybersickness was -4% (95% CI -22 to 14), with an intensity difference of -5 mm (95% CI -9 to 3). CONCLUSION During minor procedures in adult patients in the ED, distraction by viewing a 3D virtual world in a head-mounted VR display did not result in lower average levels of procedural pain and anxiety than that by 2D viewing on a screen despite a higher sense of telepresence. There were no significant differences in the prevalence and intensity of cybersickness between the 2 groups.
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Affiliation(s)
- Luca Bosso
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Tanguy Espejo
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Vaud, Switzerland
| | - Patrick Taffé
- Center for Primary Care and Public Health (Unisanté), DFRI/Division of Biostatistics, Lausanne, Vaud, Switzerland
| | - David Caillet-Bois
- Emergency Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Thierry Christen
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Chantal Berna
- Centre for Integrative and Complementary Medicine and Pain Centers, Lausanne University Hospital & Lausanne University, Lausanne, Vaud, Switzerland
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland.
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See C, Ng M, Ignacio J. Effectiveness of music interventions in reducing pain and anxiety of patients in pediatric and adult emergency departments: A systematic review and meta-analysis. Int Emerg Nurs 2023; 66:101231. [PMID: 36528945 DOI: 10.1016/j.ienj.2022.101231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/28/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Celine See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Matthew Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
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Nurses' Perceptions of the Management of Acute Pain in Emergency Departments: Cross-sectional Study. CLIN NURSE SPEC 2022; 36:254-263. [PMID: 35984978 DOI: 10.1097/nur.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to describe registered nurses' perceptions of acute pain management in emergency departments. DESIGN The study design was a cross-sectional survey carried out in accordance with Strengthening the Reporting of Observational Studies in Epidemiology guidelines. One hundred one nurses from 5 different emergency departments participated in the survey. METHODS Data were analyzed using descriptive methods, nonparametric tests, and principal component analysis. RESULTS Continuing education was significantly related to pain management. Nurses who had received continuing pain management education thought more often that challenges in pain management impact patients' acute pain management than those who had not received education. Nurses reported that patients received inadequate pain medication. The most used nonpharmacological methods were ice therapy and postural care. The nurses reported that music and conversation with the patient ameliorated the patients' acute pain. Nurses stated that their lack of knowledge concerning pain management and workload affected their acute pain management. CONCLUSION Study results emphasize the need to develop ongoing pain management education for registered nurses and in addition to further research of nonpharmacological alleviation method in emergency departments.
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Kafash Mohammadjani M, Jafaraghaee F, Yosefbeyk F, Kazem Nejad E, Javadi-Pashaki N. Effect of Topical Sesame Oil on the Severity of Pain in Patients With Limb Trauma: A Randomized Controlled Trial. J Chiropr Med 2022; 21:204-212. [PMID: 36124112 PMCID: PMC9481452 DOI: 10.1016/j.jcm.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The purpose of this study was to investigate the effect of topical use of sesame oil on pain severity in patients with limb trauma. Methods A placebo-controlled randomized controlled trial was conducted on 120 patients with nonpenetrating upper and lower limb traumas admitted to the trauma emergency department. The patients were allocated to either the sesame oil group or the placebo group using the stratified random sampling technique based on trauma size and age. Depending on the trauma area, sesame or placebo oil were poured on the trauma site and massaged for 5 to 7 minutes. The intervention was repeated twice a day for 3 days at home. Pain severity was measured using the numeric pain scale before intervention on the first day and 30 minutes after each intervention for 3 days, twice a day. Data were analyzed using descriptive and analytical tests including the independent t test, χ2 test, Fisher exact test, Mann-Whitney U test, Friedman test, and multiple linear regression analysis. The significance level was set at 0.05. Results The decreasing trend of pain was significant in both the intervention and placebo groups (P < .001). Comparison of the trend of changes in pain scores between the 2 groups showed that the mean changes of pain severity were higher in the intervention group compared with the placebo group in all assessments. There was a significant difference in the rate of analgesic consumption in the intervention group compared with the placebo group (P < .001). However, there was no significant difference between the 2 groups regarding pain severity. Pain reduction was negatively associated with body mass index (b = -0.091, P = .003), amount of received pain medication (b = -0.001, P = .039), and area of trauma (b = -0.002, P = .039). Pain reduction was greater in male patients than female patients (b = 0.676, P = .015). The effect of sesame oil on pain changes was not significant. No adverse side effects were reported. Conclusion This study showed that despite less use of analgesics in the intervention group than in the placebo group, sesame oil did not have any statistically significant effects on the severity of limb trauma pain. Further research is needed regarding the effect of topical sesame oil application on pain as a safe and uncomplicated intervention.
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Affiliation(s)
- Mina Kafash Mohammadjani
- Department of Nursing (Medical-Surgical), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Fateme Jafaraghaee
- Department of Nursing (Medical-Surgical), School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Fatemeh Yosefbeyk
- Department of Pharmacognosy, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Ehsan Kazem Nejad
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Nazila Javadi-Pashaki
- Social Determinants of Health Research Center (SDHRC), Associate Professor, Guilan University of Medical Sciences, Rasht, Guilan, Iran
- Corresponding author: Nazila Javadi-Pashaki, PhD, Nursing and Midwifery School of Shahid Beheshti, Shahid Beheshti Highway, Rasht, Iran, 416351873
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Willingness to use nonpharmacologic treatments for musculoskeletal pain in the emergency department: a cross-sectional study. Pain Rep 2022; 7:e1027. [PMID: 35999902 PMCID: PMC9387978 DOI: 10.1097/pr9.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/06/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Patients in emergency department with musculoskeletal pain report high willingness to try nonpharmacologic treatments, and health care provider encouragement correlated with greater nonpharmacologic treatment use. Objectives: Pain is an individual experience that should incorporate patient-centered care. This study seeks to incorporate patient perspectives toward expanding nonpharmacologic treatment options for pain from the emergency department (ED). Methods: In this cross-sectional study of adult patients in ED with musculoskeletal neck, back, or extremity pain, patient-reported outcomes were collected including willingness to try and prior use of various nonpharmacologic pain treatments, sociodemographics, clinical characteristics, functional outcomes, psychological distress, and nonmusculoskeletal symptoms. Least absolute shrinkage and selection operator regression identified variables associated with (1) willingness to try and (2) having previously tried nonpharmacologic treatments. Results: Responses were analyzed from 206 adults, with a mean age of 45.4 (SD 16.4) years. The majority (90.3%) of patients in ED were willing to try at least one form of nonpharmacologic pain treatment, with 70.4%, 81.6%, and 70.9% willing to try respective subcategories of active (eg, exercise), passive (eg, heat), and psychosocial (eg, prayer) modalities. Only 56.3% of patients had previously tried any, with 35.0%, 52.4%, and 41.3% having tried active, passive, and psychosocial modalities, respectively. Patient-level factors associated with willingness included pain in upper back, more severe pain-related symptoms, and functional impairments. The factor most consistently associated with treatment use was health care provider encouragement to do so. Conclusions: Patients in ED report high willingness to try nonpharmacologic treatments for pain. Higher pain severity and interference may indicate greater willingness, while health care provider encouragement correlated with treatment use. These findings may inform future strategies to increase the introduction of nonpharmacologic treatments from the ED.
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Nielsen A, Olson J, Quesada M, Zhu C, Raskin E, Vang B, Painovich J, Scott M, Xiong VJ, Dusek JA. Acupuncture intervention for acute pain in the Emergency Department trial: a consensus process. Acupunct Med 2022; 40:339-346. [PMID: 35229658 PMCID: PMC10948001 DOI: 10.1177/09645284221076507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This document describes the consensus process and intervention for a National Institutes of Health (NIH)-funded multi-site feasibility study utilizing acupuncture for ACUte paIn in The EmergencY Department (ACUITY). The acupuncture intervention is designed to be flexible and responsive to the most common Emergency Department (ED) scenarios, including trauma, acute pain of the low back, abdomen and/or musculoskeletal system, renal colic and headache. BACKGROUND Opioids remain a primary treatment for acute ED pain with attendant risk of adverse effects, addiction liability, diversion and death. Effective/safer options for acute pain are needed. Although acupuncture therapy has shown promise for acute pain in the ED alone or in conjunction with usual care, pragmatic trials are needed to obtain definitive and generalizable evidence. METHODS An Acupuncture Advisory Panel was convened that included nine acupuncture experts with 5-44 years of experience in practice and 2-16 years of experience in the acute pain care setting. A modified Delphi process was used with provision of a literature review, surveys of our panel members, three online discussions and email discussion as needed. The STandards for Reporting Interventions in Controlled Trials (STRICTA) checklist was used as a guide. RESULTS A responsive acupuncture intervention was agreed on for ACUITY. Session forms were fashioned in REDCap (Research Electronic Data Capture program to capture essential treatment data, assess fidelity and inform our design for a future pragmatic multi-site randomized controlled trial (RCT) of acupuncture in the ED, and for use by other future researchers. CONCLUSION Development of a responsive manualization intervention provides the appropriate framework for conducting a future, pragmatic, multi-site, definitive RCT of acupuncture in the ED. TRIAL REGISTRATION NUMBER NCT04880733 (ClinicalTrials.gov).
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juli Olson
- Department of Veterans Affairs, Central Iowa, Des Moines, IA, USA
| | - Megan Quesada
- University Hospitals Connor Whole Health, Cleveland Medical Center, Cleveland, OH, USA
| | - Chongbin Zhu
- Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt Health, Nashville, TN, USA
| | - Erin Raskin
- Center for Integrative Medicine, University of California San Diego, San Diego, CA, USA
| | - Bobbee Vang
- Penny George Institute For Health and Healing, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Megan Scott
- Tanya I. Edwards, MD Center for Integrative and Lifestyle Medicine at Cleveland Clinic, Cleveland, OH, USA
| | - Vashir J Xiong
- Integrated Medicine, Advocate Aurora Healthcare, Milwaukee, WI, USA
| | - Jeffery A Dusek
- University Hospitals Connor Whole Health, Cleveland Medical Center, Cleveland, OH, USA
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
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Rech MA, Griggs C, Lovett S, Motov S. Acute pain management in the Emergency Department: Use of multimodal and non-opioid analgesic treatment strategies. Am J Emerg Med 2022; 58:57-65. [DOI: 10.1016/j.ajem.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022] Open
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Abu-Snieneh HM, Alsharari AF, Abuadas FH, Alqahtani ME. Effectiveness of pain management among trauma patients in the emergency department, a systematic review. Int Emerg Nurs 2022; 62:101158. [DOI: 10.1016/j.ienj.2022.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
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Nielsen A, Dusek J, Taylor-Swanson L, Tick H. Acupuncture therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: the Academic Consortium Pain Task Force White Paper Update. PAIN MEDICINE 2022; 23:1582-1612. [PMID: 35380733 PMCID: PMC9434305 DOI: 10.1093/pm/pnac056] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Background A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department. Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials for “acupuncture” and “acupuncture therapy” and “acute pain,” “surgery,” “peri-operative,” “trauma,” “emergency department,” “urgent care,” “review(s) ,” “systematic review,” “meta-analysis,” with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance. Future multicenter trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the emergency department. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.
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Affiliation(s)
- Arya Nielsen
- Department of Family Medicine & Community Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Dusek
- University Hospitals, Connor Whole Health, Cleveland Medical Center; Cleveland, Ohio.,Department of Family Medicine and Community Health; Case Western Reserve University, Cleveland, OH
| | | | - Heather Tick
- Department of Family Medicine, and Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
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Dusek JA, Kallenberg GA, Hughes RM, Storrow AB, Coyne CJ, Vago DR, Nielsen A, Karasz A, Kim RS, Surdam J, Segall T, McKee MD. Acupuncture in the emergency department for pain management: A BraveNet multi-center feasibility study. Medicine (Baltimore) 2022; 101:e28961. [PMID: 35244059 PMCID: PMC8896475 DOI: 10.1097/md.0000000000028961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Pain accounts for up to 78% of emergency department (ED) patient visits and opioids remain a primary method of treatment despite risks of addiction and adverse effects. While prior acupuncture studies are promising as an alternative opioid-sparing approach to pain reduction, successful conduct of a multi-center pilot study is needed to prepare for a future definitive randomized control trial (RCT). METHODS Acupuncture in the Emergency Department for Pain Management (ACUITY) is funded by the National Center for Complementary and Integrative Health. The objectives are to: conduct a multi-center feasibility RCT, examine feasibility of data collection, develop/deploy a manualized acupuncture intervention and assess feasibility/implementation (barrier/facilitators) in 3 EDs affiliated with the BraveNet Practice Based Research Network.Adults presenting to a recruiting ED with acute non-emergent pain (e.g., musculoskeletal, back, pelvic, noncardiac chest, abdominal, flank or head) of ≥4 on a 0-10-point Numeric Rating Scale will be eligible. ED participants (n = 165) will be equally randomized to Acupuncture or Usual Care.At pre-, post-, and discharge time-points, patients will self-assess pain and anxiety using the Numeric Rating Scale. Pain, anxiety, post-ED opioid use and adverse events will be assessed at 1 and 4 weeks. Opioid utilization in the ED and discharge prescriptions will be extracted from patients' electronic medical records.Acupuncture recipients will asked to participate in a brief qualitative interview about 3 weeks after their discharge. ED providers and staff will also be interviewed about their general perspectives/experiences related to acupuncture in the ED and implementation of acupuncture in ACUITY. RESULTS Recruitment began on 5/3/21. As of 12/7/21: 84 patients have enrolled, the responsive acupuncture intervention has been developed and deployed, and 26 qualitative interviews have been conducted. CONCLUSION Successful conduct of ACUITY will provide the necessary framework for conducting a future, multi-center, definitive RCT of acupuncture in the ED. CLINICAL TRIALSGOV NCT04880733 https://clinicaltrials.gov/ct2/show/NCT04880733.
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Affiliation(s)
- Jeffery A. Dusek
- UH Connor Whole Health, University Hospitals, Cleveland, OH
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Gene A. Kallenberg
- Department of Family Medicine, University of California San Diego, La Jolla, CA
| | - Robert M. Hughes
- Department of Emergency Medicine, Case Western Reserve University School of Medicine, Cleveland OH
- Clinical Decision Unit, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher J. Coyne
- Department of Emergency Medicine and Department of Radiation Medicine and Applied Sciences University of California San Diego La Jolla, CA
| | - David R. Vago
- Department of Physical Medicine and Rehabilitation and Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Arya Nielsen
- Department of Family Medicine and Community Health Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Karasz
- Department of Family Medicine and Social Medicine, Albert Einstein College of Medicine/Montefiore, New York, NY
| | - Ryung S. Kim
- Department of Epidemiology and Population Health and Institute of Clinical and Translational Research, Albert Einstein College of Medicine/Montefiore, New York, NY
| | - Jessica Surdam
- UH Connor Whole Health, University Hospitals, Cleveland, OH
| | - Tracy Segall
- UH Connor Whole Health, University Hospitals, Cleveland, OH
| | - M. Diane McKee
- Department of Family Medicine and Community Health, University of Massachusetts School of Medicine, Worcester, MA
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16
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Motov SM, Vlasica K, Middlebrook I, LaPietra A. Pain management in the emergency department: a clinical review. Clin Exp Emerg Med 2022; 8:268-278. [PMID: 35000354 PMCID: PMC8743674 DOI: 10.15441/ceem.21.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.
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Affiliation(s)
- Sergey M Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Katherine Vlasica
- Department of Emergency Medicine, St. Joseph's Hospital and Medical Center, Patterson, NJ, USA
| | - Igor Middlebrook
- Department of Emergency Medicine, St. Joseph's Hospital and Medical Center, Patterson, NJ, USA
| | - Alexis LaPietra
- Department of Emergency Medicine, St. Joseph's Hospital and Medical Center, Patterson, NJ, USA
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17
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Hill JD, Schmucker AM, Siman N, Goldfeld KS, Cuthel AM, Adeyemi OJ, Edwards E, Bouillon-Minois JB, Grudzen CR. Household Income and Older Adult Population Predict Number of Integrative Medicine Providers Around US Hospitals: An Environmental Scan Study. Glob Adv Health Med 2022. [DOI: 10.1177/2164957x221121077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Integrative medicine (IM) is a growing subspecialty among the American healthcare system, but little is known about geographical and sociodemographic variability in access to services. Objective To better understand access to IM healthcare services, we aim to: 1.) document the number of IM providers within the hospital service area (HSA) of various hospitals across the United States (US) and, 2.) explore the relationship between age, income, and race as predictors of the number of IM providers. Methods We conducted an environmental scan to document the number of IM providers including naturopathic, acupuncture, chiropractic, and massage therapy providers within the HSA of 16 US hospitals using state and national search databases. We examined predictors of the number of providers per HSA using population and demographic data from the U.S. Census Bureau. Search database quality was evaluated using the Center for Disease Control and Prevention Clear Communication Index. Results The number of IM providers varied from 11.6 – 67.4 providers/100,000 persons. Massage therapists were the most prevalent (n = 13.8/100,000), followed by chiropractors (n = 5.2/100,000), acupuncturists (n = 4.6/100,000), and naturopathic physicians (n = .5/100,000). Higher average household income and population >65 years old were associated with more IM providers within an HSA (Rate Ratio (RR) 4.22, 95% CI 1.49-12.01; and 1.14, 1.05 - 1.24, respectively). In addition, the quality of publicly available search databases varied widely among US states (4.84 - 8.00/10), but less so among IM provider types (6.21 - 7.57/10). Conclusions The high variability in number of IM providers and search database quality among various HSAs across the US warrants further investigation into factors influencing access to services. Our findings regarding income and older adult population raise concern for inequitable access to care, but are also promising when considering the increasing demand for healthcare services among the older adult population.
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Affiliation(s)
- Jacob D. Hill
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Abigail M. Schmucker
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina Siman
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Keith S. Goldfeld
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Allison M. Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Oluwaseun J. Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Jean-Baptiste Bouillon-Minois
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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18
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Winteler B, Geese F, Lehmann B, Schmitt KU. Musculoskeletal Physiotherapy in the Emergency Department – Evaluation of a New Physiotherapy Service in a Swiss University Hospital. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1500-1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Many countries report a significant increase in emergency department (ED) visits. Patients with musculoskeletal disorders account for a large proportion of non-urgent cases.
Objective Characterization and evaluation of a new service that provides immediate access to physiotherapy for patients in the ED.
Method To characterize a new service at the Department of Emergency Medicine, Bern University Hospital, and to evaluate first experiences with it, a mixed methods approach was chosen. Data was collected from the electronic patient file and from a logbook kept by the physiotherapists. In addition, guideline-based interviews with involved health care staff were conducted.
Results During the 63 days of the pilot study 79 patients were treated by physiotherapists. The most frequently reported patient complaint was back pain (47 %). Interventions included taking the medical history, performing manual tests and multimodal treatment and developing recommendations for further treatment. In 59 % of patients no medical imaging and in 58 % no additional physiotherapy was prescribed. Patients rated the physiotherapeutic service as very good or excellent (88 %). Physiotherapy was experienced as positive and appreciated by the other professions, and all interviewees emphasized the added value for patients.
Conclusion The pilot study indicates that the physiotherapeutic consultation service has the potential to improve quality of care. The findings of this study are therefore valuable when considering the introduction of such a service in an ED.
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Affiliation(s)
- Balz Winteler
- Bern University of Applied Sciences, Academic Practice Partnership (APP) with Insel Gruppe, Bern, Switzerland
- Bern University Hospital, Inselspital, Department of Physiotherapy, Insel Gruppe, Bern, Switzerland
| | - Franziska Geese
- Bern University of Applied Sciences, Academic Practice Partnership (APP) with Insel Gruppe, Bern, Switzerland
| | - Beat Lehmann
- Bern University Hospital, University of Bern, Department of Emergency Medicine, Inselspital, Bern, Switzerland
| | - Kai-Uwe Schmitt
- Bern University of Applied Sciences, Academic Practice Partnership (APP) with Insel Gruppe, Bern, Switzerland
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Flynn SB, Gordee A, Kuchibhatla M, George SZ, Eucker SA. Moving toward patient-centered care in the emergency department: Patient-reported expectations, definitions of success, and importance of improvement in pain-related outcomes. Acad Emerg Med 2021; 28:1286-1298. [PMID: 34358379 DOI: 10.1111/acem.14328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/05/2021] [Accepted: 06/23/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. METHODS We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). RESULTS Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. DISCUSSION ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain. CONCLUSIONS Our findings indicate that: (1) patient subgroups by outcome priorities may exist that could inform multimodal, personalized approaches from the ED and (2) patients are flexible in which treatments they are willing to try to meet their individual goals.
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Affiliation(s)
- Spencer B. Flynn
- David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute Duke University Durham North Carolina USA
| | - Stephanie A. Eucker
- Department of Surgery and Department of Orthopaedic Surgery Division of Emergency Medicine Duke University Durham North Carolina USA
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Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic. Am J Emerg Med 2020; 46:722-723. [PMID: 33127186 PMCID: PMC7544733 DOI: 10.1016/j.ajem.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
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Aikawa L, Yoshizumi AM, Shirassu MM, Koike MK. Rapid acupuncture for musculoskeletal pain in the emergency room of the Hospital Servidor Publico Estadual, Brazil: A quasi-experimental study. JOURNAL OF INTEGRATIVE MEDICINE 2020; 18:313-318. [PMID: 32553560 DOI: 10.1016/j.joim.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare differences in self-reported musculoskeletal pain before and after receiving rapid acupuncture for pain at an outpatient emergency department. METHODS Exactly 102 patients presenting to the emergency room of the Hospital Servidor Publico Estadual in Sao Paulo, Brazil, participated in this before-and-after study. All participants had musculoskeletal pain and were treated with the technique proposed by Marques Filho. This emergency acupuncture involved inserting a needle at a point defined by traditional Chinese medicine and applying intense stimulation for 10 s; no more than two points were used on any individual patient. Pain was measured using a numerical visual scale before and immediately after the procedure. RESULTS Participants in this study were mostly women (78%), had a college degree (47%) and were below the age of 60 (56%). The most common region of pain was the lower back (31%), and the most common type of pain was acute and exacerbated chronic pain. The meridians most commonly involved were the eight extra meridians (40%), and the points most often used for treatment were Houxi (SI3), Shenmai (BL62) and Zulinqi (GB41). Almost all participants reported a decrease in pain intensity, independent of sex, education level, pain site and pain type (acute/chronic; P < 0.05). At the end of the session, only 4% of the participants reported a desire for allopathic medication. CONCLUSION This emergency acupuncture technique for analgesia appears to reduce musculoskeletal pain. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (http://www.ensaiosclinicos.gov.br/) with No. RBR-8dmfjf.
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Affiliation(s)
- Luciana Aikawa
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil
| | | | - Mirian Matsura Shirassu
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil
| | - Marcia Kiyomi Koike
- Programa de Pós-Graduação em Ciências da Saúde, Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), Vila Clementino, São Paulo, SP 04029-000, Brazil.
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Frumkin K. Behavioral Conditioning, the Placebo Effect, and Emergency Department Pain Management. J Emerg Med 2020; 59:303-310. [PMID: 32451185 DOI: 10.1016/j.jemermed.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
Animals and humans can be readily conditioned to associate a novel stimulus (often a unique taste) by pairing it with the effects of a drug or other agent. When later presented with the stimulus alone, their body's systems respond as if the drug or agent were given. The earliest clinical applications demonstrated both conditioned suppression and enhancement of immune processes. Unique benign stimuli, paired with chemotherapy, come to elicit T-cell suppression when administered alone. The beneficial immune responses to an antigen can be conditioned in the same manner. Further study of what came to be called "psychoneuroimmunology" led to the understanding that the familiar placebo effect, previously attributed to suggestion and expectation, is at least equally dependent on the same sorts of behavioral conditioning. The demonstrated ability to manipulate the immune system by a conditioned taste stimulus is, by definition, a placebo: a therapeutic effect caused by an inactive agent. The purpose of this analysis was to stimulate research in, and the application of, placebo-response conditioning to emergency medicine. Clinical and experimental studies confirm the usefulness of conditioned placebos in analgesia and in placebo-controlled dose reduction. Such conditioning paradigms demonstrate "one-trial learning," making them potentially useful in pain and addiction management within a single emergency department encounter.
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Affiliation(s)
- Kenneth Frumkin
- Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia
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24
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Glauser J, Myslenski M, Money S. Acupuncture in the Emergency Management of Painful Conditions. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40138-019-00193-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Bernard SA, Chelminski PR, Ives TJ, Ranapurwala SI. Management of Pain in the United States-A Brief History and Implications for the Opioid Epidemic. Health Serv Insights 2018; 11:1178632918819440. [PMID: 30626997 PMCID: PMC6311547 DOI: 10.1177/1178632918819440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 12/15/2022] Open
Abstract
Pain management in the United States reflects attitudes to those in pain. Increased numbers of disabled veterans in the 1940s to 1960s led to an increased focus on pain and its treatment. The view of the person in pain has moved back and forth between a physiological construct to an individual with pain where perception may be related to social, emotional, and cultural factors. Conceptually, pain has both a medical basis and a political context, moving between, for example, objective evidence of disability due to pain and subjective concerns of malingering. In the 20th century, pain management became predominately pharmacologic. Perceptions of undertreatment led to increased use of opioids, at first for those with cancer-related pain and then later for noncancer pain without the multidimensional care that was intended. The increased use was related to exaggerated claims in the medical literature and by the pharmaceutical industry, of a lack of addiction in the setting of noncancer pain for these medications-a claim that was subsequently found to be false and deliberatively deceptive; an epidemic of opioid prescribing began in the 1990s. An alarming rise in deaths due to opioids has led to several efforts to decrease use, both in patients with noncancer conditions and in those with cancer and survivors of cancer.
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Affiliation(s)
- Stephen A Bernard
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul R Chelminski
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Timothy J Ives
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shabbar I Ranapurwala
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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