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Acupuncture for Hemophilia Patients in Chronic Pain.

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Haemophilia. 12(5); 500-2. 10/12 pts showed improvement Average VAS reduced from 6.8/10 to 5/10 No side effects were observed Rosted P & Jorgensen V. (2002). – PowerPoint PPT presentation

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Title: Acupuncture for Hemophilia Patients in Chronic Pain.


1
Acupuncture for Hemophilia Patients in Chronic
Pain.
  • Angela Lambing, MSN, NP-C, 1
  • Dr. Vinay Varma, 2
  • Beth Kohn L.Ac., M.T.O.M, Dipl.Ac, Dipl.CH , 1
  • Dr. Suresh Hanagavadi2
  • 1Henry Ford Health System, Detroit, MI
  • 2Karnataka Hemophilia Society, India

2
Statement of the Problem
  • Chronic pain due to end stage arthritis for
    hemophilia patients presents ongoing issues
    resulting in exploration of non-standard
    therapies for pain management
  • Acupuncture has proved successful in
    osteoarthritis and non-malignant pain.
  • Pain management involves a multimodal approach

3
Objectives
  • This study seeks to
  • a) Document a decrease in hemarthritic joint pain
    after acupuncture treatments
  • b) Demonstrate minimal bleeding risk during
    acupuncture.

4
Review of the Literature
  • Minimal literature related to hemophilia
  • Wallny TA, Brackmann, HH, Gunia G, WIlbertz P,
    Oldenberg J, Kraft CN. (2006). Successful pain
    treatment in arthropathic lower extremities by
    acupuncture in haemophilia patients.
    Haemophilia. 12(5) 500-2.
  • 10/12 pts showed improvement
  • Average VAS reduced from 6.8/10 to 5/10
  • No side effects were observed

5
  • Rosted P Jorgensen V. (2002). Acupuncture used
    in the management of pain due to arthropathy in a
    patient with haemophilia. Acupuncture medicine.
    20(4) 193-5.
  • Case report 38 yr old severe hemophilia A, with
    joint pain knees, elbows, ankles
  • On factor prophylaxis received factor prior to
    tx
  • Previous right knee synovectomy
  • 5 tx for the knee with reported significant
    reduction in pain
  • Repeat acupuncture every 3 months
  • Close collaboration with hemophilic clinic
  • Use of qualified acupuncture specialists

6
Method
  • Convenience sample
  • Prospective study
  • Dual study between Twinning partners
  • Henry Ford Health System, Detroit, MI
  • Karnataka Hemophilia Society, Karnataka, India
  • Utilized certified acupuncturists
  • Inclusion Criteria
  • gt 18 years of age
  • Hemophilia
  • Reported chronic pain
  • Severe Joint hemarthrosis as identified by the
    HTC
  • Michigan subjects factor replacement gt 15
    level (per IRB requirements)
  • India residents no factor prior to treatments

7
Acupuncture points
  • Acupuncture treatment plan
  • Twice per week x 4 weeks weekly for remaining 6
    weeks
  • Primary acupuncture points
  • Du 20, LI 4, Liv 3, Gb 34, Sp 6, LI 11, St 35,
    Kid 3, Shen Men Ear Point
  • Specific Knee pain
  • Secondary points Xi yan, Heding, Liv 8, Sp 10
  • Specific Ankle pain
  • Secondary Points St 41, Gb 40, Sp5
  • Specific Lower back pain
  • Secondary Points Ub 23, Du 4
  • Specific Elbow Pain
  • Secondary Points Lu 5, Sj 5

8
Method
  • Measured pain scores using
  • Visual analog scale 0 10
  • Average daily pain
  • Highest level
  • Lowest level
  • Types of pain medications utilized
  • Number of pain pills taken/day
  • Quality of Life (QOL)
  • Standard SF-36

9
Method
  • Signed consent per IRB protocol
  • Cost of acupuncture sessions covered
  • Mileage covered for travel to each session
  • Patients were instructed to report any bleeding
    issues
  • Acupuncturists identified any post procedural
    bleeding issues.

10
Results
  • 19 HFH hemophilia pts signed up to participate
  • Only 6 completed the study citing travel work
    restrictions
  • 3 hemophilia pts completed study in India
  • Total of 9 pts completed study
  • 6 severe hemophilia
  • 2 moderate hemophilia
  • 1 mild hemophilia

11
Demographics
  • Ethnicity
  • 3 India
  • 4 Caucasian
  • 2 Afr American
  • Education
  • 4 college
  • 2 secondary school
  • 2 technical school
  • 1 grade school gr 8
  • Marital Status
  • 7 married
  • 2 single
  • Age 28 63 yrs
  • Ave age 45 years
  • Work
  • 4 full time
  • 3 disabled
  • 1 student
  • 1 retired

12
Pain level reports VAS 0-10
Pt Pre treatment Post Treatment Pain med pre Pain med post
1 4.0 4.0 1 x week 1 x month
2 4.0 2.0 1 x week None
3 8.0 6.0 3-4 x day 3-4 x day
4 5.0 1.0 1-2 x day lt 1 x day
5 6.0 4.0 1-2 x day 1-2 x day
6 4.0 4.0 1-2 x day 5-6 x day
7 4.0 4.0 lt 1 x day lt1 x day
8 10.0 5.0 3-4 x day 3-4 x day
9 4.0 2.0 1 x week 1 x month
13
SF-36 QOL scores
Variables Pre acupuncture Post acupuncture
Physical Functioning 23.0 30.0
Social functioning 52.50 70.0
Physical problem 0 0
Emotional problem 60.0 73.3
Mental health 76.8 82.4
Energy/Fatigue 42.0 43.0
Pain 33.3 44.4
Health perception 43.8 43.8
Health change 50.0 65.0
14
Pre Acupuncture
Post Acupuncture
15
Pre Acupuncture
Post Acupuncture
16
Limitations
  • Very small sample size
  • Duration of therapy program proved a barrier to
    enrollment
  • Additional objective data to confirm improvement
    would have been helpful
  • Joint measurements

17
Conclusions
  • No bleeding experienced
  • With any subject
  • After every treatment session
  • Factor vs no factor pre treatment
  • 6/8 pts reported decrease in VAS pain scores
  • 7/9 QOL domains improved
  • Alternative therapies acupuncture may provide
    some benefit to chronic pain patients with
    hemophilia in a multimodal approach
  • Larger randomized studies are needed
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