Acupuncture for Acute Musculoskeletal Pain in the Emergency Department and Clinic: A Pragmatic Randomized Trial

Background Acute musculoskeletal pain in emergency department (ED) patients is challenging to treat with medications alone, but adding acupuncture may improve pain outcomes. Methods In this pragmatic randomized controlled trial, acupuncture was delivered by licensed acupuncturists in the ED and twice a week in follow-up clinic for 1 month. From February 10, 2020 to April 19, 2023, 2781 adult patients at an academic ED with acute (≤7 days) musculoskeletal pain in neck, back and/or extremities were screened, and 599 were enrolled and randomized to usual care only (n = 189, 31.6%) or acupuncture plus usual care (n = 410, 68.4%). Results Acupuncture and control arms had similar demographics (mean age 45.2, SD 15.8; 57.7% female) and baseline pain scores (control 7.1, SD 2.2; acupuncture 7.1, SD 2.3). At 1 month, pain scores were similar between arms (control 3.8, SD 3.2; acupuncture 3.2, SD 3.0). However, 178 (43.4%) participants in the acupuncture arm were unable to attend acupuncture clinic and reported time and financial constraints. Exploratory analysis of pain score by number of clinic sessions attended showed that patients attending 6 or more acupuncture sessions (n = 121, 20.2%) experienced significant pain improvements compared to those with fewer sessions (n = 478, 79.8%). Conclusion Improving access and availability of acupuncture in outpatient settings may be needed for more effective pain management.