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Journal of Complementary and Integrative Medicine

Editor-in-Chief: Lui, Edmund

Ed. by Ko, Robert / Leung, Kelvin Sze-Yin / Saunders, Paul / Suntres, PH. D., Zacharias


CiteScore 2017: 1.41

SCImago Journal Rank (SJR) 2017: 0.472
Source Normalized Impact per Paper (SNIP) 2017: 0.564

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1553-3840
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Postoperative analgesia by adding acupuncture to conventional therapy, a non-randomized controlled trial

Ilana Levy / Samuel Attias
  • Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
  • School of Public Health, University of Haifa, Haifa, Israel
  • Other articles by this author:
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/ Lior Cohen
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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/ Nadav Stoppelmann / Dan Steinberger / Ofra Grimberg / Eran Ben-Arye
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
  • Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
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/ Ibrahim Matter
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
  • General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
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/ Gideon Sroka
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
  • General Surgery Department, Bnai Zion Medical Center, Haifa, Israel
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/ Mostafa Somri
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
  • Anesthesiology Department, Bnai Zion Medical Center, Haifa, Israel
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/ Elad Schiff
  • Internal Medicine Department B, Bnai Zion Medical Center, Haifa, Israel
  • Complementary Medicine Department, Bnai Zion Medical Center, Haifa, Israel
  • Ruth Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-10-12 | DOI: https://doi.org/10.1515/jcim-2018-0028

Abstract

Background

Postoperative pain is common in patients hospitalized in surgical departments, yet it is currently not sufficiently controlled by analgesics. Acupuncture, a complementary medical practice, has been evaluated for its benefits in postoperative pain with heterogeneous results. We tested the feasibility of a controlled study comparing the postoperative analgesic effect of acupuncture together with standard-of-care to standard-of-care only.

Methods

In this pilot non-randomized controlled study conducted at a tertiary medical center in Israel, patients received either acupuncture with standard-of-care pain treatment (acupuncture group) or standard-of-care treatment only (control group) following surgery. Visual Analogue Scale (VAS) ratings for pain level at rest and in motion were evaluated both at recruitment and two hours after treatment. Acupuncture-related side effects were reported as well.

Results

We recruited 425 patients; 336 were assigned to the acupuncture group and 89 to the control group. The acupuncture group exhibited a decrease of at least 40% in average level of pain both at rest (1.8±2.4, p<0.0001) and in motion (2.1±2.8, p<0.0001) following acupuncture, whereas the control group exhibited no significant decrease (p=0.92 at rest, p=0.98 in motion). Acupuncture's analgesic effect was even more prominent in reducing moderate to severe pain at baseline (VAS ≥4), with a decrease of 49% and 45% of pain level at rest and in motion respectively (p<0.001), compared with no significant amelioration in the control group (p=0.20 at rest, p=0.12 in motion). No major side effects were reported.

Conclusion

Integrating acupuncture with standard care may improve pain control in the postoperative setting.

Keywords: acupuncture; complementary and alternative medicine; integrative medicine; postoperative pain

References

  • [1]

    Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534–40. DOI: .CrossrefPubMedGoogle Scholar

  • [2]

    Warfield C, Kahn C. Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology. 1995;83:1090–4.CrossrefPubMedGoogle Scholar

  • [3]

    Owen H, McMillian V, Rogowski D. Postoperative pain therapy: a survey of patients’ expectations and their experiences. Pain. 1990;41:303–07. DOI: .CrossrefPubMedGoogle Scholar

  • [4]

    Rawal N, Langford RM. Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system. Eur J Anaesthesiol. 2007;24:299–308.PubMedCrossrefGoogle Scholar

  • [5]

    Laskowski K, Stirling A, McKay WP, Lim HJ. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anesth. 2011;58:911–23.CrossrefWeb of ScienceGoogle Scholar

  • [6]

    McMahon S, Koltzenburg M, Tracey I, Turk DC. Wall & Melzack's textbook of pain. 6th ed. Saunders. 2013.Google Scholar

  • [7]

    Chou R, Gordon DB, De Leon-Casasola OA, Rosenberg J, Bickler S, Brennan T, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Commi. J Pain. 2016;17:131–57.CrossrefGoogle Scholar

  • [8]

    Maier C, Nestler N, Richter H, Hardinghaus W, Pogatzki-Zahn E, Zenz M, et al. The quality of pain management in German hospitals. Dtsch Arztebl Int. 2010;107:607–14. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [9]

    Cousins M, Power I, Smith G. 1996 Labat lecture : pain ­­ a persistent problem. PubMed Commons. Reg Anesth Pain Med. 2000;25:6–21.Google Scholar

  • [10]

    Chon TY, Lee MC. Acupuncture. Mayo Clin Proc. 2013;88:1141–6. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [11]

    Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004;27:1–19. DOI: .CrossrefGoogle Scholar

  • [12]

    Ben-Arye E, Karkabi K, Karkabi S, Keshet Y, Haddad M, Frenkel M. Attitudes of Arab and Jewish patients toward integration of complementary medicine in primary care clinics in Israel: a cross-cultural study. Soc Sci Med. 2009;68:177–82.CrossrefWeb of ScienceGoogle Scholar

  • [13]

    Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain therapy. Yale J Biol Med. 2010;83:11–25. DOI: .CrossrefPubMedGoogle Scholar

  • [14]

    Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analisis: acupuncture for low back pain. Ann Intern Med. 2005;142:651–63. DOI: .CrossrefGoogle Scholar

  • [15]

    Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006;166:450–7.PubMedGoogle Scholar

  • [16]

    White P, Lewith G, Prescott P, Conway J. Acupuncture versus Placebo for the treatment of chronic mechanical neck pain. Ann Intern Med. 2004;141:911–19. DOI: .CrossrefPubMedGoogle Scholar

  • [17]

    Lee MS, Ernst E. Acupuncture for pain: an overview of cochrane reviews. Chin J Integr Med. 2011;17:187–9. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [18]

    Furlan AD, Van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine (Phila Pa 1976). 2005;30:944–63. DOI: .CrossrefPubMedGoogle Scholar

  • [19]

    Melchart D, Linde K, Fischer P, White A, Allais G, Vickers A, et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia. 1999;19:779–86.PubMedCrossrefGoogle Scholar

  • [20]

    Wang S-M, Caldwell-Andrews AA, Kain ZN. The use of complementary and alternative medicines by surgical patients: a follow-up survey study. Anesth Analg. 2003;97:1010–15. DOI: .CrossrefPubMedGoogle Scholar

  • [21]

    Zhang J, Shang H, Gao X, Ernst E. Acupuncture-related adverse events: A systematic review of the Chinese literature. Bull World Health Organ. 2010;88:915–21. DOI: .CrossrefWeb of SciencePubMedGoogle Scholar

  • [22]

    El-Rakshy M, Clark SC, Thompson J, Thant M. Effect of intraoperative electroacupuncture on postoperative pain, analgesic requirements, nausea and sedation: a randomised controlled trial. Acupunct Med. 2009;27:9–12. DOI: .CrossrefWeb of SciencePubMedGoogle Scholar

  • [23]

    Ntritsou V, Mavrommatis C, Kostoglou C, Dimitriadis G, Tziris N, Zagka P, et al. Effect of perioperative electroacupuncture as an adjunctive therapy on postoperative analgesia with tramadol and ketamine in prostatectomy: a randomised sham-controlled single-blind trial. Acupunct Med. 2014;32:215–22. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [24]

    Langenbach MR, Aydemir-Dogruyol K, Issel R, Sauerland S. Randomized sham-controlled trial of acupuncture for postoperative pain control after stapled haemorrhoidopexy. Color Dis. 2012;14:486–91. DOI: .CrossrefGoogle Scholar

  • [25]

    Wu M-S, Chen K-H, Chen I-F, Huang S-K, Tzeng P-C, Yeh M-L, et al. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PLoS One. 2016;11:e0150367. DOI: .CrossrefWeb of ScienceGoogle Scholar

  • [26]

    Cargill FF, Alarcon LB. Acupuncture for postoperative pain, a literature review. Rev Med Chile. 2016;144:325–32.Web of ScienceGoogle Scholar

  • [27]

    Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ. 2009;338:a3115. DOI: .CrossrefWeb of ScienceGoogle Scholar

  • [28]

    Chao MT, Chang A, Reddy S, Harrison JD, Acquah J, Toveg M, et al. Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness- implementation study. J Integr Med. 2016;14:228–38. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [29]

    Witt CM, Manheimer E, Hammerschlag R, Lüdtke R, Lao L, Tunis SR, et al. How well do randomized trials inform decision making: systematic review using comparative effectiveness research measures on acupuncture for back pain. PLoS One. 2012;7:2.Web of ScienceGoogle Scholar

  • [30]

    Fønnebø V, Grimsgaard S, Walach H, Ritenbaugh C, Norheim AJ, MacPherson H, et al. Researching complementary and alternative treatments--the gatekeepers are not at home. BMC Med Res Methodol. 2007;7:7. DOI: .CrossrefWeb of ScienceGoogle Scholar

  • [31]

    Cobb WJ. The physiology of acupuncture analgesia in surgery: considering the endogenous opioid peptides as major candidates for roles in acupuncture's analgesic actions. Open Access J Surg. 2017;4:1–2.Google Scholar

  • [32]

    Wilkinson J, Faleiro R. Acupuncture in pain management. Contin Educ Anaesthesia, Crit Care Pain. 2007;7:135–8.CrossrefGoogle Scholar

  • [33]

    Gen-Cheng DG, Xia Y. Current research in acupuncture. Springer-Verlag New York. 2012.Google Scholar

  • [34]

    Lovatsis D, Jose JB, Tufman A, Drutz HP, Murphy K. Assessment of patient satisfaction with postoperative pain management after ambulatory gynaecologic laparoscopy. J Obstet Gynaecol Canada. 2007;29:664–7. DOI: .CrossrefGoogle Scholar

  • [35]

    Ananth S. Complementary and alternative medicine survey of hospitals. 2010. http://www.samueliinstitute.org/File%20Library/Our%20Research/OHE/CAM_Survey_2010_oct6.pdf

  • [36]

    Schiff E, Attias S, Hen H, Kreindler G, Arnon Z, Sroka G, et al. Integrating a complementary medicine service within a general surgery department: from contemplation to practice. J Altern Complement Med. 2012;18:300–05.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [37]

    Jones DB. A call for more comparative and basic science acupuncture research. Med Acupunct. 2018;30:2. DOI: .CrossrefWeb of ScienceGoogle Scholar

  • [38]

    Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11:1859–71. DOI: .CrossrefPubMedWeb of ScienceGoogle Scholar

  • [39]

    White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture : prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ. 2001;323:485–6.CrossrefPubMedGoogle Scholar

  • [40]

    MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ. 2001;323:486–7. DOI: .CrossrefPubMedGoogle Scholar

About the article

Ilana Levy and Samuel Attias contributed equally.


Received: 2018-02-28

Accepted: 2018-07-19

Published Online: 2018-10-12


Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Disclosure: The authors declare that there is no conflict of interest regarding the publication of this paper.

Trial registration number: NCT01733771 (clinicaltrials.gov).


Citation Information: Journal of Complementary and Integrative Medicine, 20180028, ISSN (Online) 1553-3840, DOI: https://doi.org/10.1515/jcim-2018-0028.

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