Acupuncture for Chronic Pain in Urban Primary Care
Acupuncture for Chronic Pain in Urban Primary Care
Purpose: The purpose of this study was to describe outcomes of the Acupuncture to Decrease Disparities in Outcomes of Pain Treatment (ADDOPT) trial, testing acupuncture as an adjunct to usual treatment for chronic pain in urban health centers.
Method: We conducted a quasi-experimental trial. Primary care patients (>21 years old) with chronic pain caused by osteoarthritis or neck or back pain at 4 hospital-owned safety net health centers in the Bronx, New York, received weekly acupuncture treatments provided by supervised acupuncture students for up to 14 weeks. Pain and functional status were assessed during a 6-week run-in period before acupuncture, during treatment, and after treatment.
Results: Of 495 referred patients, 226 (47%) initiated acupuncture. Back pain was the most common referring diagnosis (59.5%) followed by osteoarthritis (16.3%). Patients were older (mean age, 54.3 years), mostly insured by Medicaid (60.4%), often receiving disability (38.3%), and often in poor or fair overall health (46.7%). They had high baseline levels of pain (mean severity per the Brief Pain Inventory, 6.8; mean days with pain, 12.3 of 14). The mean number of treatments was 9.7 (standard deviation, 7.3). Pain severity improved from baseline (6.8 vs. 5.6 at 12 weeks and 5.5 at 24 weeks), as did physical well-being (31.8 vs. 35.7 at 12 weeks and 35.3 at 24 weeks). Using hierarchical linear modeling methods, reduction in pain severity between baseline and the treatment phase was significant (P < .001). Improvements in physical well-being were significant at 12 and 24 weeks after baseline (P < .001).
Conclusions: Referred primary care patients experienced high levels of pain and pain-related disability. Weekly acupuncture was associated with short-term improvements in pain and quality of life.
This article reports the outcomes of the Acupuncture to Decrease Disparities in Pain Treatment (ADDOPT) trial, a recent National Institutes of Health–funded clinical trial of acupuncture for chronic back pain, neck pain, and osteoarthritis offered in the community health center setting to an ethnically diverse and medically underserved patient population in the Bronx, New York.
Chronic pain is a major problem in primary care practice, affecting an estimated 10% to 40% of the population. Minority populations experience disparities in both the prevalence and outcomes of chronic pain. There are strong positive associations between pain and impairment of physical and psychological functioning, lost productivity, and lower socioeconomic status. Particularly in light of recent concerns regarding the abuse of prescription analgesics and the consequent growing pressure to limit prescription of narcotic medications, primary care physicians (PCPs) are in desperate need of more effective strategies for managing patients with chronic pain conditions.
A great deal of evidence now supports the use of acupuncture therapy in the treatment of chronic pain conditions, particularly for 3 common causes of chronic pain: osteoarthritis, neck pain, and low back pain. Although the mechanism of action remains unclear, and although many studies find both "sham" (needles in nonacupuncture points) and real acupuncture to be effective, it is clear that 40% to 50% of patients experience a reduction in pain with acupuncture treatment.
For the most part, patients from lower socioeconomic groups have not had access to acupuncture treatment in the United States because the services are not generally reimbursed by insurers. To examine the effectiveness of acupuncture for chronic pain, we developed a new delivery model that offers care inside the community health center primary care setting using student acupuncturists so that services could be provided at no cost to patients.
The ADDOPT trial sought to demonstrate both the feasibility and acceptability of offering acupuncture in the primary care setting and the effect of this treatment on pain and functional outcomes. The feasibility findings have been reported elsewhere; here we report the effect of acupuncture on pain and functional status.
Abstract and Introduction
Abstract
Purpose: The purpose of this study was to describe outcomes of the Acupuncture to Decrease Disparities in Outcomes of Pain Treatment (ADDOPT) trial, testing acupuncture as an adjunct to usual treatment for chronic pain in urban health centers.
Method: We conducted a quasi-experimental trial. Primary care patients (>21 years old) with chronic pain caused by osteoarthritis or neck or back pain at 4 hospital-owned safety net health centers in the Bronx, New York, received weekly acupuncture treatments provided by supervised acupuncture students for up to 14 weeks. Pain and functional status were assessed during a 6-week run-in period before acupuncture, during treatment, and after treatment.
Results: Of 495 referred patients, 226 (47%) initiated acupuncture. Back pain was the most common referring diagnosis (59.5%) followed by osteoarthritis (16.3%). Patients were older (mean age, 54.3 years), mostly insured by Medicaid (60.4%), often receiving disability (38.3%), and often in poor or fair overall health (46.7%). They had high baseline levels of pain (mean severity per the Brief Pain Inventory, 6.8; mean days with pain, 12.3 of 14). The mean number of treatments was 9.7 (standard deviation, 7.3). Pain severity improved from baseline (6.8 vs. 5.6 at 12 weeks and 5.5 at 24 weeks), as did physical well-being (31.8 vs. 35.7 at 12 weeks and 35.3 at 24 weeks). Using hierarchical linear modeling methods, reduction in pain severity between baseline and the treatment phase was significant (P < .001). Improvements in physical well-being were significant at 12 and 24 weeks after baseline (P < .001).
Conclusions: Referred primary care patients experienced high levels of pain and pain-related disability. Weekly acupuncture was associated with short-term improvements in pain and quality of life.
Introduction
This article reports the outcomes of the Acupuncture to Decrease Disparities in Pain Treatment (ADDOPT) trial, a recent National Institutes of Health–funded clinical trial of acupuncture for chronic back pain, neck pain, and osteoarthritis offered in the community health center setting to an ethnically diverse and medically underserved patient population in the Bronx, New York.
Chronic pain is a major problem in primary care practice, affecting an estimated 10% to 40% of the population. Minority populations experience disparities in both the prevalence and outcomes of chronic pain. There are strong positive associations between pain and impairment of physical and psychological functioning, lost productivity, and lower socioeconomic status. Particularly in light of recent concerns regarding the abuse of prescription analgesics and the consequent growing pressure to limit prescription of narcotic medications, primary care physicians (PCPs) are in desperate need of more effective strategies for managing patients with chronic pain conditions.
A great deal of evidence now supports the use of acupuncture therapy in the treatment of chronic pain conditions, particularly for 3 common causes of chronic pain: osteoarthritis, neck pain, and low back pain. Although the mechanism of action remains unclear, and although many studies find both "sham" (needles in nonacupuncture points) and real acupuncture to be effective, it is clear that 40% to 50% of patients experience a reduction in pain with acupuncture treatment.
For the most part, patients from lower socioeconomic groups have not had access to acupuncture treatment in the United States because the services are not generally reimbursed by insurers. To examine the effectiveness of acupuncture for chronic pain, we developed a new delivery model that offers care inside the community health center primary care setting using student acupuncturists so that services could be provided at no cost to patients.
The ADDOPT trial sought to demonstrate both the feasibility and acceptability of offering acupuncture in the primary care setting and the effect of this treatment on pain and functional outcomes. The feasibility findings have been reported elsewhere; here we report the effect of acupuncture on pain and functional status.
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