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16th August 2022
The addition of acupuncture to intramuscular diclofenac for emergency department patients with renal colic gave rise to a rapid and substantial reduction in pain according to the findings of a sham-controlled, randomised trial by Chinese researchers.
Renal or ureteric colic describes the acute and severe loin pain caused when urinary stones (urolithiasis) move from the kidney or obstruct the flow of urine. In fact, according to the European Association of Urology (EAU) guidelines, renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. The EAU recommends the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain management in renal colic and in a 2018 systematic review, the authors concluded that treatment of renal colic with NSAIDs offers effective and sustained pain relief, with fewer side effects, when compared with opioids or paracetamol. The use of traditional Chinese medicine and, in particular, acupuncture has been practised for several thousand years and there is evidence that it is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Moreover, treatment effects persist over time and cannot be explained solely in terms of placebo effects. Furthermore, acupuncture has been used for the management of renal colic and was found to provide a higher rate of pain relief than intravenous morphine. In a further comparative trial, it was found that acupuncture provided a similar level of pain relief to intravenous diclofenac after 2 hours.
However, while the available data demonstrates the value of acupuncture in comparison to other analgesics used in renal colic, the benefit of acupuncture as an adjunctive therapy with NSAIDs has not been explored and was the subject of the present Chinese study. The researchers performed a sham-controlled, randomised trial at the emergency department of Beijing Hospital and recruited patients with acute renal colic and which had been confirmed by radiography or ultrasound examination within the previous 24 hours. Participants who had moderate to severe colic (a score of 4 or more on a 10-point visual analogue scale (VAS) were enrolled and all received 25mg diclofenac given intramuscularly. They were then equally randomised to 30 minutes of either sham or genuine acupuncture. The primary outcome was the response rate at 10 minutes after needle manipulation, defined as the proportion of participants whose VAS pain score reduced by at least 50%. The researchers also examined the change in pain relief after 20, 30, 45 and 60 minutes of needle manipulation as well as the proportion requiring rescue medication with intravenous morphine.
Acupuncture and pain relief
A total of 80 participants with a mean age of 45.8 years (82.5% male) were given intravenous diclofenac and randomised to acupuncture or sham procedure.
After 10 minutes, 77.5% of those receiving acupuncture compared to 10% receiving sham treatment achieved the primary outcome and this difference of 67.5% was significant (p < 0.001). A difference in pain relief favouring acupuncture was evidence up to 30 minutes although by 45 and 60 minutes, the two groups were similar. Moreover, there were no adverse reactions in the sham or acupuncture groups.
Despite the fast and substantial improvement associated with the use of acupuncture, there were no differences in the need for rescue medication. The researchers concluded that acupuncture provides fast and effective pain relief of renal colic and should be considered as an optional adjunctive therapy for the condition.
Tu JF et al. Effect of Adjunctive Acupuncture on Pain Relief Among Emergency Department Patients With Acute Renal Colic Due to Urolithiasis: A Randomized Clinical Trial JAMA Netw Open 2022