Comprehensive Summary
This adaptive, pragmatic, two-stage, open-label randomized trial evaluated the feasibility, acceptability and effectiveness of adding emergency department (ED) acupuncture to usual care (UC) for treatment of acute musculoskeletal pain of the neck, back and extremities. Licensed acupuncturists delivered the treatment, with 236 patients randomized to auricular acupuncture (AA) plus UC, peripheral acupuncture (PA) plus UC, or UC alone. Stage 1 primary outcomes were feasibility (recruitment and retention), acceptability (patient satisfaction ≥4/5) and safety; Stage 2 primary outcome was change in 11-point numeric pain rating from baseline to 1 hour post-treatment (minimal clinically important difference (MCID) ≥1.3). Secondary measures included ED medication use such as opioid and discharge prescriptions. Compared with UC, pain reduction from baseline to 1 hour post-treatment was greater with AA (mean difference 1.6; 95% CI 0.7-2.6) and PA (1.2; 95% CI 0.3-2.1); only the AA arm met the MCID ≥1.3. Both acupuncture interventions achieved mean patient satisfaction scores of 4.4/5, demonstrating high feasibility and acceptability.
Outcomes and Implications
Pain management with medications, particularly opioids, poses substantial risks. Therefore, acupuncture offers a promising nonpharmacologic adjunct. This trial demonstrated that ED acupuncture yields modest short-term pain reduction beyond UC. Feasibility in the ED was supported by consistently high recruitment, retention, and satisfaction rates. Limitations include the single-center U.S. setting, exclusion of non-English speakers, delivery by licensed acupuncturists, and open-label design, which may introduce performance bias. Nevertheless, the findings indicate ED acupuncture can successfully be implemented, and may help to reduce opioid reliance, although this trial failed to show significant differences in opioid use. Multisite randomized trials are necessary to confirm acupuncture efficacy across diverse ED settings and evaluate long-term pain and opioid outcomes.