Acute musculoskeletal pain in emergency department (ED) patients is frequently severe and challenging to treat with medications alone. The purpose of this study was to determine the feasibility, acceptability, and effectiveness of adding ED acupuncture to treat acute episodes of musculoskeletal pain in the neck, back, and extremities. In this pragmatic 2-stage adaptive open-label randomized clinical trial, Stage 1 identified whether auricular acupuncture (AA; based on the battlefield acupuncture protocol) or peripheral acupuncture (PA; needles in head, neck, and extremities only), when added to usual care was more feasible, acceptable, and efficacious in the ED. Stage 2 assessed effectiveness of the selected acupuncture intervention(s) on pain reduction compared to usual care only (UC). Licensed acupuncturists delivered AA and PA. They saw and evaluated but did not deliver acupuncture to the UC group as an attention control. All participants received UC from blinded ED providers. Primary outcome was 1-hour change in 11-point pain numeric rating scale. Stage 1 interim analysis found both acupuncture styles similar, so Stage 2 continued all 3 treatment arms. Among 236 participants randomized, demographics and baseline pain were comparable across groups. When compared to UC alone, reduction in pain was 1.6 (95% confidence interval [CI]: 0.7 to 2.6) points greater for AA+UC and 1.2 (95% CI: 0.3 to 2.1) points greater for PA+UC patients. Participants in both treatment arms reported high satisfaction with acupuncture. ED acupuncture is feasible and acceptable and can reduce acute musculoskeletal pain better than UC alone.

中文翻译：

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急诊科针灸治疗急性肌肉骨骼疼痛的适应性实用随机对照试验


急诊科 （ED） 患者的急性肌肉骨骼疼痛通常很严重，并且难以单独使用药物治疗。本研究的目的是确定增加 ED 针灸治疗颈部、背部和四肢肌肉骨骼疼痛急性发作的可行性、可接受性和有效性。在这项实用的 2 阶段适应性开放标签随机临床试验中，第 1 阶段确定了耳针 （AA;基于战场针灸方案） 或外周针灸 （PA;仅在头部、颈部和四肢的针头）在急诊科中加入常规护理时是否更可行、更可接受和更有效。第 2 阶段评估了与仅常规护理 （UC） 相比，所选针灸干预对减轻疼痛的有效性。有执照的针灸师提供 AA 和 PA。他们看到并评估了针灸，但没有将针灸作为注意力控制提供给 UC 组。所有参与者都从盲法 ED 提供者那里接受了 UC。主要结果是 11 点疼痛数字评定量表的变化 1 小时。第 1 阶段中期分析发现两种针灸风格相似，因此第 2 阶段继续所有 3 个治疗组。在随机分配的 236 名参与者中，各组之间的人口统计学和基线疼痛具有可比性。与单独 UC 相比，AA+UC 患者的疼痛减轻高 1.6 （95% 置信区间 [CI]： 0.7 至 2.6） 分，PA+UC 患者的疼痛减轻高 1.2 （95% CI： 0.3 至 2.1） 分。两个治疗组的参与者都报告了对针灸的高满意度。ED 针灸是可行且可接受的，并且比单独使用 UC 更能减轻急性肌肉骨骼疼痛。