Calls for better pain management in EDs

Calls for better pain management in EDs

Sarah Wiedersehn | AAP | June 19 2017

Pain management in hospital emergency departments is inadequate and acupuncture should be considered as a viable option for patients not wanting to use analgesic drugs, say Australian researchers.

Acupuncture was found to be equally effective at treating acute back or ankle pain and pain associated with migraine, according to a study published in the Medical Journal of Australia.

But neither treatment provided adequate pain relief within the first hour.

"As no therapy provided optimal acute analgesia, more effective options are needed," wrote the authors.

Researchers led by Professor Marc Cohen at RMIT University - considered a pioneer of integrative and holistic medicine - assessed the pain relief achieved by acupuncture afforded patients presenting to the emergency department at one of Melbourne's four tertiary hospitals between January 2010 to December 2011.

Of the 528 patients presenting to the ED with acute low back pain, migraine or an ankle sprain, 177 received acupuncture, 178 were treated with traditional pharmaceutical drugs and 173 were administered both.

Overall on a pain scale from 0 to 10, just 16 per cent reported a score below four within the first hour.

Most found their treatment acceptable after 48 hours and 80 per cent of each group stated they would probably or definitely repeat their treatment, according to the study.

Patients in the acupuncture group, however, were almost twice as likely to receive rescue analgesia.

"This may indicate that acupuncture was ineffective and patients sought alternative analgesia or that they were more likely to accept pharmacotherapy because they felt they had missed out on standard care, " the authors wrote.

They also suggested patients who had already received oral opiates were reluctant to accept a subsequent injection of opiates.

Dr Chris Hayes, the Dean of the Faculty of Pain Medicine, who is the Director of the Hunter Integrated Pain Service based at John Hunter Hospital in Newcastle, says the results aren't surprising.

"So if someone is feeling under threat from their injury their distress from that underlying thought pattern is likely not to be particularly responsive to the drugs or the acupuncture," Dr Hayes told AAP.

While acupuncture can relieve some pain, he says introducing it widespread would be problematic.

"There are some challenges around that clearly in terms of training of the right staff, so it is a potential option but as we see in the study it's not a hugely effective option," Dr Hayes said.

Having worked in a busy and stressful emergency room, Dr Hayes believes training existing staff in the value of using reassuring words to a patient would be a more efficient and viable option to improve pain management.

"One of the things that particularly needs to be worked on is the communication between the staff in the ED and the patient," he said.

"A few kind and reassuring words by the emergency department staff I would expect to be very important and perhaps more important than the medication or the acupuncture."

(image credit: © Sergei Primakov | ID 71963996 |

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