Background & Aims

Musculoskeletal pain is one of the most common pain conditions for which people seek care in an emergency department (ED).1 Complementary and integrative health therapies such as acupuncture have strong evidence as adjuvants to usual pain care2, 3 and can lead to reduced opioid use and improved pain outcomes. Our team has been studying the use of two types of acupuncture (peripheral & auricular) for treating acute musculoskeletal pain in the ED.4 Both types of acupuncture reduce pain during the ED visit; however, the biological mechanisms by which acupuncture reduces pain in the acute care setting remain elusive. The purpose of this exploratory study was to examine differences in inflammatory biomarkers before and after receiving an acupuncture intervention for musculoskeletal pain in the ED. Understanding biological factors (inflammatory biomarkers) can provide insights for understanding and predicting responses to acupuncture to promote equitable pain management in this population.

Methods

This exploratory study used data collected in a pragmatic, adaptive randomized controlled trial that evaluated the effects of acupuncture for acute musculoskeletal pain in the ED.4 Adults (?18 years) with an acute onset of pain (?7 days) in the neck, back, arms, and/or leg received standardized peripheral or auricular acupuncture by a licensed acupuncturist. Pain measures and biospecimens were collected at baseline and 1-hour post-acupuncture treatment. Only participants with biospecimens collected at the pre- and 1-hour post treatment time points were included. Inflammatory markers were analyzed using the Inflammation 20-plex ProcartaPlexTM Assay (Thermo Fisher, Waltham, MA) per manufacturer’s protocol. Differences and percent change relative to baseline concentrations for each of the inflammatory markers at pre to 1-hour post treatment were calculated. Wilcoxon rank-sum tests assessed changes in pre-to-post treatment values. P-values were adjusted using Bonferroni’s method.

Results

Among the 181 participants included in this analysis, 57% (N = 103) are female, with a mean age of 47.5 (SD 15.7) years, and a mean baseline pain of 7.2 (2.3) on a 0-10 numeric rating scale. Our results indicated statistically significant changes in 3 inflammatory biomarkers (intercellular adhesion molecule 1 [ICAM-1]; interleukin 8 [IL-8]; monocyte chemoattractant protein-1 [MCP-1]). There was a median ICAM-1 increase of 938.7 pg/mL (3.1% change, p=0.05), IL-8 increase of 0.1 pg/mL (13.5% change, p<.001), and MCP-1 increase of 2.2 pg/mL (11.7% change, p<.001).

Conclusions

This study is among the first to evaluate clinical changes in inflammatory biomarkers before and after receiving acupuncture for acute musculoskeletal pain in an ED setting. Data generated provides support that acute inflammatory changes in response to acupuncture are detectable and may mediate treatment effects. Interestingly, while acupuncture has strong anti-inflammatory mechanisms, findings suggest acupuncture may increase circulating inflammatory markers initially. Future research should parse out these relationships and distinguish between mechanisms of injury and mechanisms of acupuncture in the acute musculoskeletal pain period.

References

1.Weiss, A, Jiang, H. Most frequent reasons for emergency department visits, 2018. In: Quality, AfHRa, ed. HCUP Statistical Brief 286. Rockville, MD; 2021.
2.Baroncini, A, Maffulli, N, Eschweiler, J, et al. Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis. J Orthop Surg Res 2022;17(1):319.
3.Vickers, AJ, Vertosick, EA, Lewith, G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The journal of pain : official journal of the American Pain Society 2018;19(5):455-474.
4.Eucker, SA, Glass, O, Staton, CA, et al. Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial. BMJ Open 2022;12(9):e061661.

Presenting Author

Stephanie Eucker

Poster Authors

Mitchell Knisely

PhD

Duke University

Lead Author

Alexander Gordee

M.A.

Duke University, Department of Biostatistics & Bioinformatics

Lead Author

Maragatha Kuchibhatla

Ph.D.

Duke University, Department of Biostatistics & Bioinformatics

Lead Author

Stephanie Eucker

Duke University

Lead Author

Topics

  • Treatment/Management: Complementary and Alternative therapies