A recent randomized controlled trial conducted at Duke University investigated the efficacy of acupuncture in managing acute musculoskeletal pain in an emergency department (ED) setting. The study, published in the Annals of Emergency Medicine, evaluated two acupuncture techniques—auricular acupuncture (AA) and peripheral acupuncture (PA)—in comparison to standard emergency care (UC) for acute pain relief.
The trial included 236 patients presenting to the ED with acute musculoskeletal pain in the neck, back, or extremities. Participants were randomized into three groups: auricular acupuncture with usual care (AA+UC), peripheral acupuncture with usual care (PA+UC), and usual care alone (UC). The acupuncture treatments were administered by licensed acupuncturists and documented according to STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) guidelines.
Auricular acupuncture followed the battlefield acupuncture protocol, where press needles were placed in up to five bilateral ear sites [1]. Peripheral acupuncture involved needling of select head, neck, and extremity sites based on the acupuncturist’s clinical discretion [2]. The UC group received no acupuncture but underwent an evaluation with study acupuncturists as an attention control.
Participants were recruited over a one-year period, with screening conducted during eight-hour shifts from Monday through Friday [3]. Inclusion criteria required patients to have acute (<7 days) musculoskeletal pain that was assessed by emergency physicians. Exclusion criteria included severe infections, active COVID-19, or contraindications to acupuncture, such as skin infections at needle sites [4].
The primary outcome was pain reduction at one hour post-treatment, measured on an 11-point Numeric Rating Scale (NRS). The AA+UC group demonstrated a mean pain reduction of 2.1 points (95% CI: 1.6 to 2.6), while the PA+UC group showed a 1.6-point reduction (95% CI: 1.1 to 2.1) [5]. Both groups outperformed the UC group, which exhibited a reduction of 0.5 points (95% CI: -0.1 to 1.0) [6, 7]. There were no serious adverse events recorded [8, 9].
Researchers noted that acupuncture’s analgesic effects may be linked to its ability to modulate neuroinflammatory responses. Previous studies have shown that acupuncture can reduce pro-inflammatory cytokines such as IL-6 and TNF-α, which contribute to pain perception [10]. Additionally, functional MRI studies indicate that acupuncture activates the periaqueductal gray (PAG) and anterior cingulate cortex, areas involved in endogenous opioid release and pain modulation [11].
The findings underscore the feasibility of integrating acupuncture into emergency medicine. The study demonstrated that acupuncture can be effectively delivered within the constraints of an ED setting using short-duration protocols such as auricular and peripheral acupuncture [12]. Given the increasing need for non-opioid pain management strategies, these results suggest that licensed acupuncturists could play a critical role in EDs by offering effective, low-risk interventions for acute pain. The study authors recommend future research to explore acupuncture’s long-term benefits, including its potential to reduce chronic pain development following acute injuries [13].
Acupuncture was well-tolerated by participants, and those in the AA+UC and PA+UC groups reported high levels of satisfaction, with mean satisfaction scores of 4.4 out of 5 on a Likert scale [14]. Additionally, opioid administration and prescribing rates were similar across all groups, suggesting that acupuncture did not increase the need for pharmacologic interventions [15].
Future studies should examine longer follow-up periods to assess whether acupuncture reduces the likelihood of chronic pain development [16]. Further research may also explore acupuncture’s effects on other ED patient populations, including individuals with neuropathic pain or postoperative pain following trauma [17].
This trial provides strong evidence that auricular and peripheral acupuncture significantly reduce acute musculoskeletal pain in an ED setting. The integration of acupuncture into emergency care protocols could enhance patient outcomes, reduce reliance on opioid analgesics, and support broader efforts to incorporate evidence-based complementary medicine into mainstream healthcare [18].
Future implementation strategies could focus on training ED personnel in acupuncture techniques to increase accessibility, as well as integrating acupuncture into standardized pain management protocols for musculoskeletal injuries [19].
References:
[1] Duke University Acupuncture Research Team, Annals of Emergency Medicine, 2024. Durham, North Carolina.
[2] Ibid.
[3] Clinical trial protocol, Duke University, 2020.
[4] Study eligibility criteria, Annals of Emergency Medicine, 2024.
[5] Primary outcome analysis, Duke University Acupuncture Trial.
[6] Statistical findings, Annals of Emergency Medicine, 2024.
[7] Ibid.
[8] Reported adverse events, Duke University Acupuncture Trial.
[9] Safety monitoring results, Annals of Emergency Medicine, 2024.
[10] Acupuncture and cytokine modulation, Duke University findings.
[11] Functional MRI studies cited in the trial discussion.
[12] Feasibility study for ED acupuncture, Duke University.
[13] Potential long-term effects, Annals of Emergency Medicine, 2024.
[14] Patient satisfaction results, Duke University Acupuncture Trial.
[15] Opioid prescription analysis, Annals of Emergency Medicine, 2024.
[16] Future research directions, Duke University Research Team.
[17] Exploration of acupuncture for neuropathic pain, Annals of Emergency Medicine, 2024.
[18] Study conclusion, Duke University Acupuncture Trial.
[19] Recommended implementation strategies, Duke University findings.
This study was funded by the Duke University Health System and supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) Emergency Department Alternatives to Opioids Demonstration Program (ED-ALT).
