Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial

被引:0
作者
Crowell, Michael S. [1 ,2 ]
Florkiewicz, Erin M. [2 ,3 ]
Morris, Jamie B. [2 ]
Mason, John S. [4 ]
Pitt, Will [4 ]
Benedict, Timothy [2 ]
Cameron, Kenneth L. [5 ]
Goss, Donald L. [2 ,6 ]
机构
[1] Univ Scranton, Dept Phys Therapy, Scranton, PA 18510 USA
[2] Baylor Univ, Keller Army Community Hosp, Div Sports Phys Therapy Fellowship 1, West Point, NY 10996 USA
[3] Rocky Mt Univ Hlth Profess, Provo, UT 84606 USA
[4] Army Baylor Univ, Doctoral Program Phys Therapy, Ft Sam Houston, TX 78234 USA
[5] Keller Army Community Hosp, John Feagin Jr Sports Med Fellowship, West Point, NY 10996 USA
[6] High Point Univ, Dept Phys Therapy, High Point, NC 27268 USA
关键词
VISUAL ANALOG SCALES; POSTOPERATIVE PAIN; REHABILITATION; DISLOCATION; INSTABILITY; PLACEBO; PROFILE;
D O I
10.1093/milmed/usae577
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery. Materials and Methods The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d'acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24-48 hours], 72 hours, 1 week, and 4 weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests. Results Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F = 0.70, P = .54), VAS average pain (F = 0.99, P = .39), the POMS (F = 1.04, P = .37), or GROC (F = 0.43, P = 0.63). There was a significant main effect of time for VAS worst pain (F = 159.7, P < .001), VAS average pain (F = 122.4, P < .001), the POMS (F = 11.4, P < .001), and the GROC (F = 78.5, P < .001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4 weeks (t = 0.49, P = .63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy. Conclusion The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting. Clinical Trial Registration ClinicalTrials.gov, NCT04094246. Registered September 16, 2019, http://clinicaltrials. gov/NCT04094246.
引用
收藏
页数:9
相关论文
共 39 条
  • [1] Statistics notes - How to randomise
    Altman, DG
    Bland, JM
    [J]. BRITISH MEDICAL JOURNAL, 1999, 319 (7211) : 703 - 704
  • [2] Placebo, Nocebo, and Expectations: Leveraging Positive Outcomes
    Benz, Laurence N.
    Flynn, Timothy W.
    [J]. JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 2013, 43 (07) : 439 - 441
  • [3] Placebo Mechanisms of Manual Therapy: A Sheep in Wolf's Clothing?
    Bialosky, Joel E.
    Bishop, Mark D.
    Penza, Charles W.
    [J]. JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, 2017, 47 (05) : 301 - 304
  • [4] Posterior Shoulder Instability
    Brelin, Alaina
    Dickens, Jonathan F.
    [J]. SPORTS MEDICINE AND ARTHROSCOPY REVIEW, 2017, 25 (03) : 136 - 143
  • [5] A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients
    Briggs, M
    Closs, JS
    [J]. JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 1999, 18 (06) : 438 - 446
  • [6] Acupuncture: The search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques
    Cho, ZH
    Oleson, TD
    Alimi, D
    Niemtzow, RC
    [J]. JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, 2002, 8 (04) : 399 - 401
  • [7] CLEMENTJONES V, 1980, LANCET, V2, P946
  • [8] Battlefield Acupuncture and Physical Therapy Versus Physical Therapy Alone After Shoulder Surgery
    Collinsworth, Keith M.
    Goss, Donald L.
    [J]. MEDICAL ACUPUNCTURE, 2019, 31 (04) : 228 - 238
  • [9] Modified Battlefield Acupuncture Does Not Reduce Pain or Improve Quality of Life in Patients with Lower Extremity Surgery
    Crawford, Paul
    Moss, David A.
    Crawford, Amanda J.
    Sharon, Danny J.
    [J]. MILITARY MEDICINE, 2019, 184 (3-4) : 545 - 549
  • [10] The effectiveness of battlefield acupuncture in addition to standard physical therapy treatment after shoulder surgery: a protocol for a randomized clinical trial
    Crowell, Michael S.
    Brindle, Richard A.
    Mason, John S.
    Pitt, Will
    Miller, Erin M.
    Posner, Matthew A.
    Cameron, Kenneth L.
    Goss, Donald L.
    [J]. TRIALS, 2020, 21 (01)