Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial.

The short version

This randomized trial with 80 emergency department patients explored whether adding acupuncture to a standard painkiller injection brings faster relief from renal colic, the severe cramping flank pain that occurs when a kidney stone blocks or moves through the urinary tract. Renal colic is described by the authors as one of the worst types of pain, and the guideline first-choice drugs, nonsteroidal anti-inflammatory medicines such as diclofenac, take time to work: in an earlier study, 37.5% of patients still had moderate or severe pain 15 minutes after an injection. Acupuncture, a traditional Chinese medicine technique that inserts thin needles at specific body points, had shown quick pain reduction in other settings. Adults aged 18 to 75 with stone-related renal colic and pain of at least 4 out of 10 on a visual analog scale (a line on which patients mark their pain) were treated at a Beijing hospital emergency department in 2020. Everyone received a 50 mg diclofenac injection into the muscle. Half then had 30 minutes of needling at Yaotongdian, a point on the back of each hand, with the needles twisted and lifted until a soreness or heaviness sensation (called De qi) appeared. The other half had shallow needle pricks at forearm spots that are not acupuncture points. Ten minutes after needling, 77.5% of the acupuncture group (31 of 40) had at least halved their pain score, compared with 10.0% of the sham group (4 of 40), a gap of 67.5 percentage points (P < .001, so chance is very unlikely to explain it). Average pain fell to 3.0 versus 5.9 out of 10. Acupuncture also led at 0, 5, 15, 20 and 30 minutes (97.5% vs 80.0% at 30 minutes; P = .03). Patients, assessors and the statistician did not know the group, and patients guessed their group about equally often in both arms (P = .48). The advantage faded as the injection took effect: by 45 and 60 minutes both groups had about 92% to 98% responding (P = .62), and only 1 patient needed stronger rescue medication. No adverse events were recorded. The authors suggest acupuncture may serve as an optional add-on for faster relief, since it uses a single point and needs no individual diagnosis. They attribute the absence of a rescue-medication difference to a possible ceiling effect from the diclofenac. They note limitations plainly: one hospital, treatment given after diagnostic imaging, experienced acupuncturists who could not be blinded, and no follow-up of pain beyond 60 minutes or analysis by stone size. They plan to study acupuncture before imaging.

Key findings

• In a trial of 80 emergency department patients with kidney-stone pain (renal colic), all received a diclofenac painkiller injection, and those who also had 30 minutes of acupuncture at the Yaotongdian point on each hand were far more likely to have their pain at least halved after 10 minutes than those given sham acupuncture (77.5% vs 10.0%; P < .001).
• Average pain on a 0 to 10 scale was 3.0 with acupuncture versus 5.9 with sham at 10 minutes, and the response advantage was gone by 45 and 60 minutes (97.5% vs 92.5%; P = .62), when the injected painkiller had taken effect in both groups.
• Few patients needed stronger rescue medication (1 in the acupuncture group, 0 in the sham group), and the groups did not differ in 72-hour revisit or admission (5.0% vs 10.0%; P = .68).
• No adverse events were reported in either group, and patients could not reliably tell which type of acupuncture they received (P = .48).
• The study was small (80 patients), done at one hospital in Beijing, and followed pain only to 60 minutes; the authors state it is unknown whether practitioners other than experienced acupuncturists would get the same results.

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