Cohen, M., Ben Meir, M., Andrianopolus, N. (2018) mja17.00735 – Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial Medical Journal of Australia March 5, 208(4): (DOI) 10.5694/mja17.00735 [Paper]
Cohen, M., Parker, S., Taylor, D., Smit, D., Ben Meir, M., Cameron, P., Xue, C., (2017) Acupuncture alone or in conjunction with pharmacotherapy for analgesia in common emergency department presentations: A pragmatic, multicentre, randomised, controlled trial. Medical Journal of Australia
OBJECTIVES:
This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.
DESIGN:
A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.
MAIN OUTCOME MEASURES:
The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.
RESULTS:
1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.
CONCLUSION:
The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.
Cohen M. Acupuncture in Australia:- A Review of its Current Position. Journal of the Australian Medical Acupuncture Society. 12 No 1: 1994. 8-15
A Review of its Current Position of Acupuncture in Australia.
Cohen M., Voumard, P., Birch, S., Jenvey, S., and Cosic, I. Low Resistance Pathways along Acupuncture Meridians have Dynamic Characteristics. Biomedical Engineering -Applications, Basis and Communication. Vol 7, No 2 April 1995 p137- 142.
N/A
Cohen M., Kwok, G., and Cosic, I., Acupuncture Needles and the Seebeck Effect: Do Temperature Gradients Produce Electro-stimulation? Acupuncture and Electro-therapeutics Research. 22 No 1: 1997; 9-15.
Acupuncture may act through modifying bioelectric events and this may occur through different mechanisms including the application of external currents. According to the Seebeck effect which produces a potential difference when a temperature gradient is placed across a conductor, the physical properties of acupuncture needles may produce internal currents due to the temperature gradient across the needle when placed insitu. Such currents were detected when needles were differentially heated and these currents were found to be in the range capable of producing biological effects. The traditional design of acupuncture needles and traditional needle manipulations seem to maintain a temperature gradient across the needle and thus enhance the Seebeck effect.
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