Transcript Acupuncture for Hemophilia Patients in Chronic Pain.

Acupuncture for Hemophilia
Patients in Chronic Pain.
Angela Lambing, MSN, NP-C, 1
Dr. Vinay Varma, 2
Beth Kohn L.Ac., M.T.O.M, Dipl.Ac, Dipl.CH , 1
Dr. Suresh Hanagavadi2
1Henry
Ford Health System, Detroit, MI
2Karnataka Hemophilia Society, India
Statement of the Problem
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Chronic pain due to end stage arthritis for
hemophilia patients presents ongoing
issues resulting in exploration of nonstandard therapies for pain management
Acupuncture has proved successful in
osteoarthritis and non-malignant pain.
Pain management involves a multimodal
approach
Objectives
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This study seeks to:
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a) Document a decrease in hemarthritic joint
pain after acupuncture treatments
b) Demonstrate minimal bleeding risk during
acupuncture.
Review of the Literature
Minimal literature related to hemophilia
 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.
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10/12 pts showed improvement
Average VAS reduced from 6.8/10 to 5/10
No side effects were observed
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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.
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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
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Method
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Convenience sample
Prospective study
Dual study between Twinning partners:
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Inclusion Criteria
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Henry Ford Health System, Detroit, MI
Karnataka Hemophilia Society, Karnataka, India
Utilized certified acupuncturists
> 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
Acupuncture points
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
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Method
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Measured pain scores using:
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Visual analog scale: 0 – 10
Average daily pain
 Highest level
 Lowest level
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Types of pain medications utilized
Number of pain pills taken/day
Quality of Life (QOL)
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Standard SF-36
Method
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Signed consent per IRB protocol
Cost of acupuncture sessions covered
Mileage covered for travel to each session
Patients were instructed to report any
bleeding issues
Acupuncturists identified any post
procedural bleeding issues.
Results
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19 HFH hemophilia pts signed up to
participate
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Only 6 completed the study citing travel &
work restrictions
3 hemophilia pts completed study in India
Total of 9 pts completed study
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6 severe hemophilia
2 moderate hemophilia
1 mild hemophilia
Demographics
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Ethnicity:
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3 India
4 Caucasian
2 Afr American
Education:
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4
2
2
1
college
secondary school
technical school
grade school: gr 8
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Marital Status
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Age: 28 – 63 yrs
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7 married
2 single
Ave age 45 years
Work
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4
3
1
1
full time
disabled
student
retired
Pain level reports: VAS 0-10
Pt
#1
#2
#3
#4
#5
#6
#7
#8
#9
Pre
Post
treatment Treatment
4.0
4.0
4.0
2.0
8.0
6.0
5.0
1.0
6.0
4.0
4.0
4.0
4.0
4.0
10.0
5.0
4.0
2.0
Pain med Pain med
pre
post
1 x week
1 x month
1 x week
None
3-4 x day
3-4 x day
1-2 x day
< 1 x day
1-2 x day
1-2 x day
1-2 x day
5-6 x day
< 1 x day
<1 x day
3-4 x day
3-4 x day
1 x week
1 x month
SF-36; QOL scores
Variables
Pre acupuncture
Post acupuncture
Physical Functioning
23.0
30.0
Social functioning
52.50
70.0
Physical problem
0
0
Emotional problem
60.0
73.3
Mental health
76.8
82.4
Energy/Fatigue
42.0
43.0
Pain
33.3
44.4
Health perception
43.8
43.8
Health change
50.0
65.0
Pre Acupuncture
Post Acupuncture
Pre Acupuncture
Post Acupuncture
Limitations
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Very small sample size
Duration of therapy program proved a
barrier to enrollment
Additional objective data to confirm
improvement would have been helpful
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Joint measurements
Conclusions
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No bleeding experienced:
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With any subject
After every treatment session
Factor vs no factor pre treatment
6/8 pts reported decrease in VAS pain scores
7/9 QOL domains improved
Alternative therapies: acupuncture may
provide some benefit to chronic pain patients
with hemophilia in a multimodal approach
Larger randomized studies are needed