Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update

A. Nielsen, J. Dusek, L. Taylor-Swanson, H. Tick
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引用次数: 13

Abstract

Abstract Background A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department. Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials for “acupuncture” and “acupuncture therapy” and “acute pain,” “surgery,” “peri-operative,” “trauma,” “emergency department,” “urgent care,” “review(s) ,” “systematic review,” “meta-analysis,” with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance. Future multicenter trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the emergency department. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.
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针灸治疗作为综合急性疼痛护理的循证非药物策略:学术联盟疼痛工作组白皮书更新
背景疼痛管理的危机持续存在,阿片类药物过量死亡、成瘾和转移的流行也是如此。疼痛医学正在通过回归其起源来应对这些挑战:博尼卡多学科疼痛护理模式。2018年学术联盟白皮书详细介绍了疼痛危机的历史背景和规模以及非药物策略的证据基础。50%以上的慢性阿片类药物使用始于急性疼痛护理环境。针灸可以降低这种风险。目的通过对阿片类药物保留的术后/围手术期疼痛和急性非手术/创伤疼痛(包括急诊科的急性疼痛)的系统回顾和荟萃分析,更新针刺治疗急性疼痛的证据基础。方法:为了更新2018年白皮书中引用的综述,我们在PubMed、MEDLINE、CINAHL和Cochrane中央对照试验注册库中对“针灸”、“针灸治疗”和“急性疼痛”、“手术”、“围手术期”、“创伤”、“急诊科”、“紧急护理”、“综述”、“系统综述”、“荟萃分析”进行了电子检索,并对标题、链接和参考文献列表进行了额外的人工检索。结果有22篇系统综述,17篇荟萃分析了针刺治疗急性疼痛的情况,1篇综述了重症监护病房的急性疼痛。还有关于针刺治疗急性疼痛的其他研究。结论:大多数综述发现针灸治疗是治疗急性疼痛的有效策略,有可能避免或减少对阿片类药物的依赖。未来的多中心试验需要明确针灸治疗急诊科急性疼痛的剂量和推广。由于具有极低的风险,针灸治疗是综合急性疼痛治疗的重要策略。
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