Ellen Silver Highfield

Acupressure-Acupuncture Antiemetic Prophylaxis in Children Undergoing Tonsillectomy

BACKGROUND Acupuncture or acupressure at the Nei-Guan (P.6) point on the wrist produces antiemetic effects in awake but not anesthetized patients. The authors studied whether a combined approach using preoperative acupressure and intra- and postoperative acupuncture can prevent emesis following tonsillectomy in children. METHODS Patients 2-12 yr of age were randomly assigned to study or placebo groups. Two Acubands with (study) and two without (placebo) spherical beads were applied bilaterally on the P.6 points; non-bead- and bead-containing Acubands, respectively, were applied on the sham points. All Acubands were applied before any drug administration. After anesthetic induction, acupuncture needles were substituted for the beads and remained in situ until the next day. All points were covered with opaque tape to prevent study group identification. A uniform anesthetic technique was used; postoperative pain was managed initially with morphine and later with acetaminophen and codeine. Emesis, defined as retching or vomiting, was assessed postoperatively. Ondansetron was administered only after two emetic episodes at least 2 min apart. Droperidol was added if emesis persisted. RESULTS One hundred patients were enrolled in the study. There were no differences in age, weight, follow-up duration, or perioperative opioid administration between groups. Retching occurred in 26% of the study patients and in 28% of the placebo patients; 51 and 55%, respectively, vomited; and 60 and 59%, respectively, did either. There were no significant differences between the groups. Redness occurred in 8.5% of acupuncture sites. CONCLUSION Perioperative acupressure and acupuncture did not diminish emesis in children following tonsillectomy.

Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain in Adolescents and Young Women: Results of a Randomized Sham-Controlled Trial

STUDY OBJECTIVE To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. DESIGN Randomized, sham-controlled trial. SETTINGS Tertiary-referral hospital. PARTICIPANTS Eighteen young women (13-22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. INTERVENTIONS A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. MAIN OUTCOME MEASURES Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. RESULTS Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control groups (n = 5) average reduction of 1.4 (SD = 2.1) points (P = 0.004). Reduction in pain in the active group persisted through a 6-month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported. CONCLUSION Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.

Massage Therapy and Acupuncture for Children With Chronic Pulmonary Disease

Increasing numbers of patients use complementary and alternative medical therapies. Use is particularly common in those with chronic diseases such as asthma and cystic fibrosis. Patients and families typically seek such therapies to relieve symptoms and to know they have explored all reasonable, safe options. Abandoning conventional therapies is rare when physicians support families’ values and goals. At the Childrens Hospital in Boston, massage and acupuncture have become standard treatments for patients admitted to hospital with cystic fibrosis. Our experience and clinical studies support the use of both massage and acupuncture to help decrease pain, anxiety, and dyspnea and to improve sleep in patients with chronic lung disease. Awareness of existing data may enhance availability and provision of acupuncture and massage services for appropriate patients. Additional research is needed to determine the optimal type, timing, duration, and frequency of these services in combination with standard therapies for patients with chronic pulmonary conditions.

If You Build It, Will They Come? A Free-Care Acupuncture Clinic for Minority Adolescents in an Urban Hospital

OBJECTIVE To describe the establishment and integration of a free-care acupuncture clinic within an urban hospital with an underserved minority adolescent population and to study patient utilization. BACKGROUND Surveys often show low use of acupuncture among underserved non-Asian minority populations. We hypothesized that it would be possible to integrate an acupuncture clinic into a biomedical setting. We also hypothesized that the removal of economic and logistical barriers would increase usage of an acupuncture service among minority adolescent and pediatric populations, who may otherwise have had little cultural exposure to the modality. METHODS A review of the process involved in establishing a free acupuncture clinic, and an analysis of visit data. RESULTS A free faculty-supervised student acupuncture clinic was successfully integrated into an urban hospital-based adolescent clinic serving predominantly low-income minorities. During 2004-2006, the acupuncture clinic had 544 visits for a wide range of conditions. Visits increased 65% from the first to the third year of operation. CONCLUSIONS An acupuncture service can be successfully integrated into care provided by an urban hospital that serves low-income minority and immigrant patients. Strategic removal of barriers to access can result in patients previously unfamiliar with acupuncture choosing to access the modality.

Pediatric Health Care Providers’ Attitudes and Referral Predictors for Therapeutic Massage and Acupuncture

The objective of this study was to assess pediatric health providers’ attitudes, experience, and referral patterns with respect to therapeutic massage and acupuncture (TM&A). A written survey of experience with and attitudes about TM&A was distributed to a convenience sample of pediatric health care providers attending a regional postgraduate course in April 2002. Bivariate analyses were performed using Fisher’s exact test and the chisquare statistic. Pediatric care providers’ practices of referring patients to TM&A were associated with their own familiarity with and prior use of TM&A as well as their professed comfort level in discussing these modalities. There were no significant differences by professional status, gender, or years in practice in 42% of the respondents who reported making TM&A referrals. Pediatric health care providers’practices in referring patients for TM&A are positively associated with their familiarity with and personal use of TM&A.

A preliminary comparison of primary care use by refugees before and after acupuncture

Abstract Background: Limited research exits on utilization and cost-effectiveness of acupuncture among underserved communities, and virtually no evidence has been published with respect to refugee populations. In this study, we examined the relationship between acupuncture and the total utilization of primary care services in a cohort of refugee patients with chronic pain. Methods: We retrospectively reviewed the medical records of 16 refugee patients with chronic pain at Boston Medical Center (BMC). The research was IRB-approved. Demographics and total charges associated with primary care over 18 months were collected. Results: Total charges associated with primary care services decreased by 50.2% in our refugee cohort in the 12 months following acupuncture treatment, equivalent to a savings of

Pediatric faculty development in integrative medicine.

691 per patient per month. Conclusions: This preliminary review demonstrated a statistically significant decrease in total charges associated with primary care following acupuncture treatment (p=0.0308). This study suggests the need for further investigation of the relation between acupuncture and refugees with chronic pain, as well as the financial implications of this relationship. It is unclear why refugees may seek fewer primary care services after acupuncture treatment. Additional study is needed to further explore whether this relationship is generalizable to other hospital services and to other patient populations.