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Acupuncture for Pain Control in the Emergency Department

3 december 2015 uppdaterad av: Gi Young Yang, Korean Medicine Hospital of Pusan National University

Acupuncture for Non-emergent Acute Musculoskeletal Pain and Primary Headache in an Emergency Department Setting: a Parallel, Randomized, Controlled Pilot Trial

Acupuncture is widely used for managing acute and chronic pain conditions. In the context of an emergency department (ED), patients often present with non-emergent acute pain symptoms. This may result in a delayed triage process and inefficient emergent management. An integrative patient-care approach in emergency departments has been explored that may improve patient satisfaction and promote efficient use of healthcare resources for non-emergent patients in the ED. This implies there is a potential role for acupuncture in such contexts. The aim of this pilot study is to assess the effectiveness and safety of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headaches in an ED setting.

Hypotheses of this study are as follows:

  1. A single session of add-on acupuncture, with standard ED management, can reduce pain levels in non-emergent acute pain, compared to standard ED management alone.
  2. A single session of add-on acupuncture to standard ED management can reduce additional consumption of healthcare resources for management of non-emergent acute pain, compared to standard ED management alone.

This study aimed to include 40 participants, 20 in the acupuncture plus standard ED management group and 20 in the standard ED management alone group.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Studietyp

Interventionell

Inskrivning (Faktisk)

17

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Korea, Republiken av
    • Kyungsangnamdo
      • Yangsan, Kyungsangnamdo, Korea, Republiken av, 626770
        • Pusan National University Yangsan Hospital

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

19 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Aged over 19 years with acute pain defined as pain occurring within 72 hours of ED presentation
  • Acute neck pain with no evidence of neurological abnormality
  • Acute headache which meets the classification criteria of a primary headache as described by the International Headache Society (code 1 to 4)
  • Acute ankle injury with no evidence of fracture or complete tear of ligaments

Exclusion Criteria:

  • Any suspected non-musculoskeletal cause (neoplasm or neurological complications) for neck or ankle pain
  • Any suspected secondary headaches classified by codes 5 to 12 in the International Classification of Headache Disorders, 2nd edition
  • Pain due to bone fracture or joint dislocation
  • Pain with fever (defined by a temperature above 37.5 °C)
  • Inappropriate at the ED physician's discretion
  • Pain level of less than 4 points of pain intensity on the Numerical Rating Scale (NRS) (range 0 to 10) at the completion of observations after the standard ED management
  • Pregnant women

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Enda

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Aktiv komparator: Standard ED management alone
Radiographic and physical examinations to exclude fractures or other serious conditions will be performed for all patients before considering eligibility in the study. After completion of the examination, patients who have pain of at least a level 4, as measured by the Wong-Baker scale (ranges 0 to 10), will receive intravenous or intramuscular injections of non-steroidal anti-inflammatory drugs (NSAIDs) for immediate pain control. All patients will be observed 30 minutes after the administration of the NSAIDs. In patients with primary headaches who respond poorly to the initial NSAID injection, an intravenous injection of opioid analgesics will be provided. After these initial standard ED management interventions, patients who are still suffering from acute pain will be asked to participate in the trial. During the study, rescue medication for immediate pain control will be allowed for patients allocated to both groups.
Procedur: Standard ED management alone
Experimentell: Acupuncture plus standard ED management
The patients in this group will receive a single session of individualized acupuncture treatment delivered by a certified Korean Medicine Doctor (KMD) specialized (or in-training) in acupuncture and moxibustion medicine and with at least 3 years of clinical experience. The acupuncture formulas will be composed based on the individual patient's symptoms and at the KMD's discretion. Acupuncture treatments will be provided in line with standard ED management, the same as in the control group.
Procedur: Acupuncture plus standard ED management

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Immediate reduction in pain intensity
Tidsram: at ED discharge (within 3 hours from ED admission)
Participant-perceived reduction of pain intensity will be measured by the pain Numerical Rating Scale (NRS) (Range 0 to 10 referring 0 to no pain and 10 to extreme pain)
at ED discharge (within 3 hours from ED admission)

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Short-term reduction in pain intensity
Tidsram: 72 hours after the ED discharge
Participant-perceived reduction of pain intensity will be measured by the the pain NRS (Range 0 to 10 referring 0 to no pain and 10 to extreme pain)
72 hours after the ED discharge
Short-term disability due to neck pain (only for patients with neck pain)
Tidsram: 72 hours after the ED discharge
Participant-perceived reduction of disability due to neck pain will be measured by a 10-item questionnaire. Changes from baseline on the Neck Disability Index (NDI) will be used.
72 hours after the ED discharge
Immediate and short-term patient global assessment for treatment outcomes
Tidsram: at ED discharge (within 3 hours from ED admission) and 72 hours after the ED discharge
Patients' global assessments for overall treatment outcomes will be measured by a single item with a 5-point Likert scale question (much improved, somewhat improved, the same as baseline, somewhat worsened, much worsened)
at ED discharge (within 3 hours from ED admission) and 72 hours after the ED discharge
Use of rescue medication in the ED
Tidsram: at ED discharge (within 3 hours from ED admission)
Use of additional rescue medication for relieving pain will be measured by electronic medical charts
at ED discharge (within 3 hours from ED admission)
Use of additional medication or healthcare resources
Tidsram: 72 hours after the ED discharge
Use of additional medication or healthcare resources (such as hospital admissions and outpatient clinic visits) will be measured by patients' self-reports via telephone interviews.
72 hours after the ED discharge
Length of stay in the ED
Tidsram: at ED discharge (within 3 hours from ED admission)
Length of stay in the ED (from group allocation to the ED discharge) will be measured by electronic medical charts.
at ED discharge (within 3 hours from ED admission)
Proportion of treatment responder
Tidsram: at ED discharge (within 3 hours from ED admission) and 72 hours after the ED discharge
Proportion of treatment responder is defined as patients who have experienced at least a 50% reduction in pain intensity from baseline values; these values will be calculated using the pain intensity VAS scores.
at ED discharge (within 3 hours from ED admission) and 72 hours after the ED discharge
Adverse events
Tidsram: at ED discharge (within 3 hours from ED admission) and 72hours after the ED discharge
All expected or unexpected adverse events in both groups will be measured during the allocated intervention process and during the entire follow-up period. Types and frequency of occurrences of adverse events will be measured.
at ED discharge (within 3 hours from ED admission) and 72hours after the ED discharge

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Patient acceptability of acupuncture treatment
Tidsram: 72 hours after the ED discharge
Participant-perceived acceptability of acupuncture treatment will be measured by a single item with a 5-point Likert scale question (acupuncture was very helpful, somewhat helpful, don't know, somewhat not helpful, very not helpful).
72 hours after the ED discharge

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Korean Medicine Hospital of Pusan National University

Samarbetspartners

Korea Institute of Oriental Medicine

Utredare

  • Huvudutredare: Gi Young Yang, PhD, Korean Medicine Hospital, Pusan National University
  • Huvudutredare: Ji Ho Ryu, PhD, Pusan National University Yangsan Hospital

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 december 2013

Primärt slutförande (Faktisk)

1 november 2015

Avslutad studie (Faktisk)

1 november 2015

Studieregistreringsdatum

Först inskickad

27 november 2013

Först inskickad som uppfyllde QC-kriterierna

11 december 2013

Första postat (Uppskatta)

17 december 2013

Uppdateringar av studier

Senaste uppdatering publicerad (Uppskatta)

7 december 2015

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

3 december 2015

Senast verifierad

1 december 2015

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • ATPED

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