Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue and Peter A Cameron
Med J Aust 2017; 206 (11): 494-499. || doi: 10.5694/mja16.00771


Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.

Design: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department.

Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.

Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.

Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.

Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

Please login with your free MJA account to view this article in full

  • Marc M Cohen1
  • De Villiers Smit2
  • Nick Andrianopoulos3
  • Michael Ben-Meir4
  • David McD Taylor5
  • Shefton J Parker1
  • Chalie C Xue1
  • Peter A Cameron2,6

  • 1 RMIT University, Melbourne, VIC
  • 2 The Alfred Hospital, Melbourne, VIC
  • 3 Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC
  • 4 Cabrini Hospital, Melbourne, VIC
  • 5 Austin Health, Melbourne, VIC
  • 6 Monash University, Melbourne, VIC



The trial was supported by a grant from the National Health and Medical Research Council (#555427).

Competing interests:

No relevant disclosures.

  • 1. Grant PS. Analgesia delivery in the ED. Am J Emerg Med 2006; 24: 806-809.
  • 2. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Undertreatment of acute pain in the emergency department: a challenge. Int J Qual Health Care 2005; 17: 173-176.
  • 3. Taylor DM, Fatovich DM, Finucci DP, et al. Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial. Emerg Med Australas 2015; 27: 549-557.
  • 4. Shergis JL, Parker S, Coyle ME, et al. Key considerations for conducting Chinese medicine clinical trials in hospitals. Chin Med 2013; 8: 3.
  • 5. Cohen M, Pirotta M, Da Costa C. The integration of complementary therapies in Australian general practice: results of a National Survey. J Altern Complement Med 2005; 11: 995-1004.
  • 6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012; 172: 1444-1453.
  • 7. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009; 338: a3115.
  • 8. Hopton A, MacPherson H. Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract 2010; 10: 94-102.
  • 9. Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 2011; 152: 755-764.
  • 10. eTG complete [website]. Melbourne: Therapeutic Guidelines, 2014. (accessed Dec 2016).
  • 11. Macintyre PE, Schug SA, Scott DA, et al; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute pain management: scientific evidence. 3rd edition. Melbourne: ANZCA and FPM, 2010. (accessed Dec 2016).
  • 12. Zhang AP, Parker SJ, Smit de V, et al. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupuncture Med 2014; 32: 250-256.
  • 13. Fleckenstein J, Schottdorf J, Kreimeier U, Irnich D. Acupuncture in emergency medicine: results of a case series. Anaesthetist 2011; 60: 854-862.
  • 14. Reinstein AS, Erickson LO, Griffin KH, et al. Acceptability, adaptation, and clinical outcomes of acupuncture provided in the emergency department: a retrospective pilot study. Pain Med 2016; 18:169-178.
  • 15. Goertz C, Niemtzow R, Burns SM, et al. Auricular acupuncture in the treatment of acute pain syndromes: a pilot study. Mil Med 2006; 171: 1010-1014.
  • 16. Wong A, Leong CP, Su TY, et al. Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003; 1: 21-27.
  • 17. Grillo CM, Wada RS, da Luz Rosário de Sousa M. Acupuncture in the management of acute dental pain. J Acupunct Meridian Stud 2014; 7: 65-70.
  • 18. Cohen M, Parker S, Taylor D, et al. Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments: study protocol for a randomized controlled trial. Trials 2011; 12: 241.
  • 19. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med 2003; 10: 390-392.
  • 20. Holdgate AK, Kelly, AM. Management of acute migraine (Emergency care evidence in practice series). Melbourne: National Institute of Clinical Studies, 2006. (accessed Dec 2016).
  • 21. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain: a guide for clinicians. Brisbane: Australian Academic Press, 2003. (accessed Dec 2016).
  • 22. Fairbank J, Couper J, Davies JB, O’Brian JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980; 8: 271-273.
  • 23. Santanello NC, Hartmaier SL, Epstein RS, Silberstein SD. Validation of a new quality of life questionnaire for acute migraine headache. Headache 1995; 35: 330-337.
  • 24. Petrella R, Ekman E, Schuller R, Fort J. Efficacy of celecoxib, a COX-2-specific inhibitor, and naproxen in the management of acute ankle sprain: results of a double-blind, randomized controlled trial. Clin J Sport Med 2004; 14: 225-231.
  • 25. Vase L, Baram S, Takakura N, et al. Specifying the nonspecific components of acupuncture analgesia. Pain 2013; 154: 1659-1667.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.