Transcript No Slide Title

Acupuncture for Hemophilia Patients in Chronic Pain.
Angela Lambing, MSN, NP-C,1 Dr. Vinay Varma,2 Beth Kohn, LAC, MTOM, Dipl Ac, Dipl CH,1 Dr. Suresh Hanagavadi2
1Henry Ford Health System, Detroit, MI; 2Karnataka Hemophilia Society, India
Statement of the Problem
•Chronic pain due to end stage arthritis for hemophilia patients
presents ongoing issues resulting in exploration of non-standard
therapies for pain management
• Acupuncture has proved successful in osteoarthritis and nonmalignant pain.
•Pain management involves a multimodal approach
Objectives
The aim of this study seeks to:
a) document a decrease in hemarthritic joint pain post acupuncture
treatments
b) prove minimal bleeding risk during acupuncture.
Review of the Literature
•
•
Wallny TA, Brackmann, HH, Gunia G, WIlbertz P, Oldenberg J, Kraft
CN. (2006). Successful pain treatment in arthropathic lower
extremities by acupuncture in haemophilia patients. Haemophilia.
12(5); 500-2.
• 10/12 pts showed improvement
• Average VAS reduced from 6.8/10 to 5/10
• No side effects were observed
Rosted P & Jorgensen V. (2002). Acupuncture used in the
management of pain due to arthropathy in a patient with haemophilia.
Acupuncture medicine. 20(4); 193-5.
• Case report – 38 yr old severe hemophilia A, with joint pain;
knees, elbows, ankles
• On factor prophylaxis; received factor prior to tx
• Previous right knee synovectomy
• 5 tx for the knee with reported significant reduction in pain
• Repeat acupuncture every 3 months
• Close collaboration with hemophilic clinic
• Use of qualified acupuncture specialists
Pain scores (VAS 0-10)Pre & Post Treatment
Method
•Convenience sample
•Prospective study
•Dual study between Twinning partners:
•Henry Ford Health System, Detroit, MI
•Karnataka Hemophilia Society, Karnataka, India
•Utilized certified acupuncturists
•Inclusion Criteria
•> 18 years of age
•Hemophilia
•Reported chronic pain
•Severe Joint hemarthrosis as identified by the HTC
•Michigan subjects – factor replacement > 15% level (per IRB requirements)
•India residents – no factor prior to treatments
Measured pain scores using:
Visual analog scale: 0 – 10
Average daily pain
Highest level
Lowest level
Types of pain medications utilized
Number of pain pills taken/day
•Quality of Life (QOL)
•Standard SF-36
Acupuncture Therapy
Acupuncture treatment plan
•Twice per week x 4 weeks; weekly for remaining 6 weeks
Primary acupuncture points:
•Du 20, LI 4, Liv 3, Gb 34, Sp 6, LI 11, St 35, Kid 3, Shen
Men Ear Point
•Specific Knee pain:
•Secondary points: Xi yan, Heding, Liv 8, Sp 10
•Specific Ankle pain:
•Secondary Points: St 41, Gb 40, Sp5
•Specific Lower back pain:
•Secondary Points: Ub 23, Du 4
•Specific Elbow Pain:
•Secondary Points: Lu 5, Sj 5
Results
Demographics
Ethnicity:
•3 India
•4 Caucasian
• 2 Afr American
Education:
•4 college
•2 secondary school
•2 technical school
•1 grade school: gr 8
Pt
#1
Pre treatment
4.0
Post Treatment
4.0
Pain med pre
Pain med post
1 x week
1 x month
#2
4.0
2.0
1 x week
None
#3
8.0
6.0
3-4 x day
3-4 x day
#4
5.0
1.0
1-2 x day
< 1 x day
#5
6.0
4.0
1-2 x day
1-2 x day
#6
4.0
4.0
1-2 x day
5-6 x day
#7
4.0
4.0
< 1 x day
<1 x day
#8
10.0
5.0
3-4 x day
3-4 x day
#9
4.0
2.0
1 x week
1 x month
SF-36 Quality of Life Scores
Variables
Physical
Functioning
Social functioning
Physical problem
Emotional problem
Mental health
Energy/Fatigue
Pain
Health perception
Health change
Pre acupuncture
23.0
Post acupuncture
30.0
52.50
0
60.0
76.8
42.0
33.3
43.8
50.0
70.0
0
73.3
82.4
43.0
44.4
43.8
65.0
Limitations
•Very small sample size
•Duration of therapy proved a barrier to enrollment
•Additional objective data to confirm improvement
•Joint measurements
•Larger random controlled studies are needed
Marital Status
•7 married
•2 single
Age: 28 – 63 yrs
Ave age 45 years
Work
•4 full time
•3 disabled
•1 student
•1 retired
Conclusions
•No bleeding experienced:
•With any subject
•After every treatment session
•Factor vs no factor pre treatment
•Alternative therapies: acupuncture may provide some benefit to
chronic pain patients with hemophilia in a multimodal approach
•Larger randomized studies are needed