Part of an article written by Benjamin Kligler, MD, MPH

In the fall of 2014, the Patient-Centered Outcomes Research Institute funded a new study comparing the effectivenDon't Let Yesterday Take Up Too Much Of Today-59ess of individual versus group acupuncture therapy for the treatment of chronic pain, specifically neck pain, back pain and osteoarthritis. The Accupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment (AADDOPT-2) trial launched in March 2015. Led by Diane McKee, MD, and myself of the Albert Einstein College of Medicine, the project is a collaboration between Einstein, Montefiore Medical Center, Mount Sinai Beth Israel and the Pacific College of Oriental Medicine.

In an earlier trial funded by the National Center for Complementary and Integrative Health at NIH, this same team found that individual acupuncture was both acceptable and effective in the ethnically diverse, medically underserved, and socioeconomically challenged population served by these health centers. In the earlier trial, 226 (46%) of 495 referred patients initiated acupuncture. Back pain was the most common referring diagnosis followed by osteoarthritis. Pain severity significantly improved from baseline, as did physical well-being. Overall, 30.3% of participants experienced a 30% or greater improvement in pain.

These results were consistent with a recent meta-analysis published in the Archives of Internal Medicine and Jama finding acupuncture therapy to be “effective for the treatment of chronic pain (back and neck, osteoarthritis, chronic headache, and shoulder pain) and … therefore a reasonable referral option” for chronic pain. Our current “comparative effectiveness” study builds on those findings, testing whether group treatment is as effective as individual treatment in our patient population. Group or “community” acupuncture, in which several patients are treated simultaneously in a group setting by one acupuncturist, is a model that has gained popularity in the US in recent years, but its effectiveness has not been rigorously tested to date. A group model of care might allow acupuncture therapy to be delivered in a more cost-effective manner versus individual treatment.

To date we received more than 540 referrals from health care physicians – demonstrating again the demand for acupuncture services, and have enrolled and provided acupuncture therapy for 215 patients. In addition to evaluating the impact of treatment on pain in our subjects, we are also conducting qualitative interviews with a subset of participants in each study arm to better understand the patients’ experience of acupuncture therapy and to capture information that might not come through easily in our quantitative measures. We are especially interested in how participants’ experience in the group setting resembles or differs from the experience of those getting individual treatment.

Given the mounting pressure to move away from opioids as the first-line treatment for chronic pain, studies examining the “real world” impact of novel treatments like group acupuncture therapy are desperately needed by clinicians and health care organizations across the country.

The Pain Practitioner

June/July 2016

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