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- Title
Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial.
- Authors
Tu, Jian-Feng; Cao, Ying; Wang, Li-Qiong; Shi, Guang-Xia; Jia, Lian-Cheng; Liu, Bao-Li; Yao, Wei-Hai; Pei, Xiao-Lu; Cao, Yan; Li, He-Wen; Yan, Shi-Yan; Yang, Jing-Wen; Qu, Zhi-Cheng; Liu, Cun-Zhi
- Abstract
This randomized clinical trial evaluates the effect of adjunctive acupuncture on pain relief among emergency department patients with acute renal colic due to urolithiasis. Key Points: Question: Can acupuncture, as an adjunctive treatment to analgesics, accelerate pain relief in patients with acute renal colic better than sham acupuncture? Findings: In this randomized clinical trial of 80 individuals, acupuncture plus intramuscular injection of diclofenac was safe and provided fast and substantial pain relief for patients with renal colic compared with sham acupuncture plus diclofenac in the emergency setting. However, no difference in rescue analgesia was found. Meaning: These findings suggest that acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic. Importance: Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance. Objectives: To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic. Design, Setting, and Participants: This single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score ≥4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022. Interventions: After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture. Main Outcomes and Measures: The primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events. Results: A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P <.001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI −8.8% to 13.2%; P >.99). No adverse events occurred during the trial. Conclusions and Relevance: These findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic. Trial Registration: Chinese Clinical Trial Registry: ChiCTR1900025202
- Subjects
CHINA; COLIC treatment; HOSPITAL emergency services; CONFIDENCE intervals; ACUPUNCTURE; ANALGESICS; DICLOFENAC; SODIUM; COLIC; PATIENTS; FISHER exact test; TREATMENT effectiveness; PRE-tests &; post-tests; COMPARATIVE studies; EMERGENCY medical services; CHI-squared test; DESCRIPTIVE statistics; COMBINED modality therapy; STATISTICAL sampling; DATA analysis software; PAIN management; URINARY calculi; ACUTE diseases; DISEASE complications; EVALUATION
- Publication
JAMA Network Open, 2022, Vol 5, Issue 8, pe2225735
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.25735