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Abbott Pioneers Acupuncture in the ER

Abbott Northwestern Hospital is reporting success using acupuncture in its emergency room to treat conditions ranging from car accident injuries to migraines to kidney stones, and hoping to prove that the traditional Chinese treatment can reduce doctors’ reliance on addictive opioids to manage patients’ pain.

The Minneapolis hospital was the first in the nation to staff its ER with an acupuncturist two years ago, as part of a broader campaign to promote Eastern remedies as complements to Western mainstream medicine.

After tracking 182 patients, it reported this month that pain scores in those who received acupuncture alone dropped by the same amount as those who also received analgesic painkillers.

“No matter what I’m treating them for, many patients report feeling calmer, more relaxed, less anxious,” said Adam Reinstein, the acupuncturist in Abbott’s ER.

Coordinating with doctors and nurses on weekdays, Reinstein finds patients willing to receive acupuncture. He then places needles strategically in their skin to provide overall pain relief and relaxation, or to target pain in specific body parts.

The free service is designed to supplement whatever other care patients receive, but Reinstein said there have been cases when it pre-empted the need for prescription painkillers and shortened patients’ ER stays. Now the goal is to measure just how much acupuncture in and of itself makes a difference.

The study published by Reinstein and Jeffery Dusek of the Penny George Institute for Health and Healing this month in the journal Pain Medicine found equivalent pain relief in patients who received acupuncture alone, but also reductions in their anxiety. The “observational” study had limits, though, including the chance that the acupuncture recipients might have been more likely to recover faster in the first place, and that there was no comparison group who only received painkillers.

Now Dusek is pursuing a federal grant for a more definitive study of 750 patients.

Proving acupuncture could sometimes replace opioids would be meaningful because there is growing evidence that the drugs are being overused and causing addictions and overdose deaths, said Dr. Chris Kapsner, the medical director of Abbott’s ER.

Minnesota overdose deaths have risen sixfold, according to state death records, a trend that has corresponded with rising prescription rates.

“We’re cognizant that there is a huge epidemic” of opioid overuse, Kapsner said, “and we’re doing our best not to be part of the problem, but to be part of the solution.”

Five Slender Needles

Reinstein had already provided acupuncture for a car accident victim last week when he knocked on the door of Julia Valley’s ER room. The breast cancer patient from Bloomington reported crushing pain and swelling in her left shoulder — a side effect of chemotherapy treatments that caused veins to collapse and become clogged.

Awaiting painkillers, Valley gladly agreed to acupuncture; the hospital’s research shows that nine of 10 such ER patients agree to the treatment.

Reinstein selected the hand opposite from Valley’s injured shoulder, cleansed it, and nimbly placed five needles between her wrist and thumb.

“Is that it?” asked Valley, who was anticipating stings. “Wow!”

“That’s it,” Reinstein replied. “We try not to do anything that causes more pain.”

American views on acupuncture have changed over the past 30 years, from deeming it quackery to embracing its place in health care — even if its mechanisms are loosely understood. Studies nationally have proved it effective at reducing nausea from chemotherapy and addressing certain types of chronic pain.

Acupuncture is usually provided in meditative outpatient clinics rather than emergency departments full of bright lights, beeping alarms and anxious patients. Reinstein said the goal of ER treatment is different as well: immediate relief rather than long-term recovery or healing.

‘I can feel it!’

Acupuncture involves the shallow insertion of needles to stimulate junctures in the body — often nerves, muscles or connective tissues. Traditional whole-body teaching holds that “meridian” lines along the body possess therapeutic value for specific organs; the line of pressure points connected to the heart, for example, is said to extend from the shoulders down the arms.

Reinstein said he is conservative and targets “distal” edges of the body such as hands, ears or ankles — away from injury sites — because ER patients aren’t always familiar with acupuncture or are agitated.

Valley, 34, was surprised by the calm she felt after treatment. “I can feel it!” she exclaimed.

“A lot of patients fall asleep during treatment,” Reinstein replied, “though not so much in the emergency room.”

In addition to proving that acupuncture relieves pain, Reinstein and colleagues hope to prove that it reduces ER costs and that insurers should cover it.

Insurers such as Blue Cross and Blue Shield of Minnesota generally cover acupuncture, but only for nausea related to chemotherapy and surgery, or treatment of pain once traditional efforts have failed.

Reinstein said placebo effects could explain some of his results; simply listening to patients and attending to them could reduce anxiety. It’s also unclear why some patients benefit and others don’t.

But acupuncture has few side effects — unless the needles aren’t clean or are pushed in too far — so ER doctors have encouraged its use while awaiting data that proves its value, Reinstein said.

“It’s not about Western medicine” vs. Eastern medicine, he said. “It’s not about the medication. It’s not about acupuncture. It’s about, what can we do to make the patient feel better?”

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