Information sourced from NEJM Journal Watch:Acupuncture vs. Morphine for Emergency Department Patients with Pain

A large randomized trial finds acupuncture to be superior.

Acupuncture has been studied for a variety of conditions and has been found to be effective for some. Now, investigators in Tunisia have conducted a randomized trial comparing acupuncture [with] morphine for treatment of pain in 300 emergency department (ED) patients with moderate to severe pain from a variety of causes.
Morphine was administered at an initial dose of 0.1 mg/kg, followed by 0.05 mg/kg every 5 minutes until reaching a maximum dose of 15 mg or a 50% or greater reduction in pain score on a visual analog pain scale (the main outcome). Acupuncture was performed according to a semi-standardized protocol.
A reduction in pain score ≥50% was achieved more often in the acupuncture group compared with the morphine group (92% vs. 78%) and was achieved faster (mean time, 16 vs. 28 minutes). Minor adverse events were more common in the morphine group (57%) than in the acupuncture group (3%).
COMMENT
Prior studies suggest that sham acupuncture is more effective than true acupuncture (NEJM JW Gen Med Oct 15 2007 and BMJ 2007; 335:436). Acupuncture may work via a combination of placebo effect and social desirability bias. Nevertheless, in the midst of an opioid epidemic, we should be open-minded about exploring alternatives to opioids. Perhaps ED patients with painful conditions not well managed by Western medicine (such as lumbago) could be referred for acupuncture. And perhaps how it works is not as important as whether it works, and whether it causes harm.
Daniel J. Pallin, MD, MPH reviewing Grissa MH et al. Am J Emerg Med 2016 Jul 20.
CITATION(S):
Grissa MH et al. Acupuncture vs intravenous morphine in the management of acute pain in the ED. Am J Emerg Med 2016 Jul 20; [e-pub].

[PubMed® abstract]