Early acupuncture intervention for pain relief in emergency department patients with suspected acute renal colic caused by urinary calculi: a randomized clinical trial.

The short version

This randomized trial with 84 emergency department patients explored whether acupuncture started right away, before a diagnosis is confirmed, eases the pain of suspected renal colic, the sudden, severe cramping pain in the back or abdomen that usually comes from a kidney or urinary stone. Imaging to confirm a stone takes time while patients are in extreme pain, and the authors note that the usual painkillers have drawbacks: anti-inflammatory drugs can raise heart risk with higher doses and longer use, and opioids cause side effects including nausea, drowsiness and dependence concerns. Acupuncture, a traditional Chinese medicine technique that places thin needles at specific body points, had already been reported by this group to reduce pain in confirmed cases. Adults aged 18 to 80 with one-sided colicky pain and tenderness over the kidney area, and pain of at least 4 on a 0 to 10 scale, were treated at a Beijing hospital emergency department. Half received needles in the back of both hands at Yaotongdian, a point the authors use for lumbar pain, with the needles lifted and rotated until a soreness or heaviness sensation appeared and then left in for 30 minutes. The other half had very shallow needling with tiny short needles at spots that are not acupuncture points, with no manipulation. Ten minutes after needling, 64.3% of the acupuncture group (27 of 42) had at least halved their pain, versus 16.7% of the sham group (7 of 42), a 47.6 percentage point gap (P < 0.01, so chance is very unlikely to explain it). By 30 minutes the figures were 85.7% versus 31.0%. Average pain scores at 10 minutes were 3.38 versus 6.00. Fewer acupuncture patients needed an analgesic injection by 30 minutes (33.3% vs 59.5%; P = 0.03) and satisfaction scores were higher (4.69 vs 3.69). Patients, outcome assessors and statisticians did not know the group, and patients guessed their group at similar rates, so the blinding held. Surgery and return visits did not differ between groups, and each group had one adverse event (bleeding with acupuncture; nausea and vomiting with sham). The authors suggest that early acupuncture is a safe option for pain relief while a diagnosis is awaited and that it did not appear to interfere with later care. The authors also note that a single acupuncture point may give limited improvement in critically ill patients. They state plainly that the study was done at one center with experienced acupuncturists, included only 3 acupuncture-group patients who turned out not to have a urinary stone, and did not analyze results by stone size. They call for multicenter confirmation.

Key findings

• In a trial of 84 emergency department patients with suspected renal colic (severe stone-type pain whose cause was not yet confirmed), 64.3% of those given acupuncture at the Yaotongdian point on both hands had their pain at least halved after 10 minutes, compared with 16.7% given sham acupuncture (P < 0.01).
• By 30 minutes the pain-relief response was 85.7% with acupuncture versus 31.0% with sham, and fewer acupuncture patients needed an analgesic (painkiller) injection (33.3% vs 59.5%; P = 0.03).
• Patient satisfaction was higher with acupuncture (4.69 vs 3.69; P < 0.01), while surgery and return-visit rates did not differ between groups.
• Only two adverse events were recorded, one per group (bleeding with acupuncture; nausea and vomiting with sham), and the authors judged the blinding successful.
• The study was done at one hospital in Beijing by experienced acupuncturists, and 3 of the 42 acupuncture patients turned out not to have a urinary stone, so the authors state that multicenter confirmation and larger samples are needed.

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