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09:49 AM

Acupuncture in the ED: Offering Patients Safe and Effective Pain Treatment

Acupuncture is now being offered to patients in the Children’s Mercy Emergency Department (ED) to treat chronic and recurrent pain symptoms, which is a growing problem in the pediatric population.

More than 30 ED physicians and hospitalists have been trained on how to administer two acupuncture protocols. Acupuncture is an ancient Chinese technique that stimulates points in the body through a series of tiny needles and strengthens the body’s ability to stop pain.

According to the National Institute of Health, studies show acupuncture works particularly well on chronic pain and headaches.

“Acupuncture gives us a non-pharmaceutical way to relieve pain,” said Dr. Denise Dowd, Interim Director, Division of Emergency Medicine. “That makes it perfect for children in our department and consistent with other modalities such as mindfulness and distraction techniques.”

Headache specialists at Children’s Mercy have used acupuncture to treat patients that suffer from migraines since 2015, which has proved to be successful treatment for pain relief.

Dr. Jennifer Bickel, Chief of the Headache Section and board certified in medical acupuncture, oversees the new acupuncture program, which is designed to treat any kind of pain, not just headaches.

“It's important our patients have access to safe and effective pain treatment in both traditional and nontraditional ways. This training provides more options for doctors that want to treat pain, but don't always have the tools,” said Dr. Bickel.

Acupuncture Training and Protocols

The ED physicians and hospitalists earned basic acupuncture privileges and the skills to administer two basic acupuncture protocols. The first is Battlefield Acupuncture (BFA), which is used in military medical facilities and on battlefields around the world because it’s simple to administer, easily transportable and provides immediate pain relief to service members.

“The military has really led the way with BFA, developed by Dr. Niemtzow, which consists of needles being placed in five ear points on the external ear to help treat problematic and acute pain,” said Dr. Bickel.

The second technique is Four Gates where a needle is placed at one designated point on each hand and foot, which may help treat acute and chronic pain as well as distress associated with pain.

Trained physicians are only able to administer these two protocols and are not certified in medical acupuncture, which requires 300 hours of training over the course of six months and a financial commitment of more than 10-thousand dollars.

“It’s not feasible to send hundreds of ER doctors to train to be medical acupuncturists, so by offering this program we’re making it possible to provide basic acupuncture as an option in the emergency department,” said Dr. Bickel. “I like to say you don't have to be a surgeon to lance a boil, but lancing a boil doesn't make you a surgeon. That's kind of the idea of this.”

Dr. Bickel along with Dr. Anna Esparham and Dr. Jennifer Dilts, board certified medical acupuncturists, provide the 10-hour training, which consists of online modules, in-person workshops, a skills-based competency exam, hands-on practice, and teaching physicians how to present the treatment to patients and families.

“We can teach the technique in an hour, so a lot of our focus is spent on training physicians how to address the topic of acupuncture with families, how to talk about it with the kids, how to provide patients with realistic expectations and provide next steps if a patient likes it,” said Dr. Dilts.

Dr. Dilts received the American Academy of Pediatrics Section on Integrative Medicine Education Grant Award this year for the Basic Acupuncture Curriculum.

Non-Traditional Pain Treatment in the ED

Pediatricians that completed the training started administering the two acupuncture protocols earlier this year, which is patient-driven and not mandated first line treatment.

“Doctors still prescribe analgesics for the pain, but ask if the patients would like acupuncture as well. If the family wants to try just the acupuncture than we go that route.” said Dr. Esparham.

Dr. Bickel added, “It would be completely irresponsible to start treating every kid with acupuncture. But if a child comes into the ED and they’ve tried other pain treatments before that didn’t work, acupuncture may be an option.”

Offering acupuncture is also a safe alternative to using opioids.

“Historically, we haven't been the best at treating pain and often reach for opioids before we need to,” said Dr. Bickel. “Opioids are often one of the most common treatments, but opioids are often over-prescribed and misused.”

Dr. Esparham agrees, “As a result, we must offer a way that physicians can be trained to help patients in pain, and acupuncture is one modality that can be a solution beyond opioid regulation. As physicians, it’s our responsibility to help our colleagues find non-pharmacologic ways to provide pain treatment.”

Dr. Jeffrey Michael, medical director for evidence based practice and attending physician for pediatric emergency medicine, views acupuncture as an adjunct to compliment the pharmacologic treatment in the ED, “Providers in the ED treat both acute and chronic pain in children, and learning new non-drug related techniques is exciting and a great opportunity. Perhaps it will help reduce the dosing requirements of some of the drugs we use and help inform families of alternatives to medication as the sole treatment for pain in their child.”

The alternative pain treatment can also help decrease a patient’s ED stay.

“An acupuncture procedure typically takes less than 30 minutes, while starting an IV and administering IV medication often takes a couple of hours,” said Dr. Dilts.

Interest in Acupuncture

The demand for acupuncture is great. Currently, the headache team treats about 30 acupuncture patients a week and they can’t keep up.

“When I originally went through the training I thought we'd have a few children that would want to have it done,” said Dr. Bickel. “I’ve continually been proven wrong about how much people are open and want it. Eventually, I’d like to see us roll this to other areas of the hospital.”

Patients aren’t the only ones interested in acupuncture. There is so much interest from physicians that the course is now offered twice a year and there’s a waitlist.

“I'm excited to increase the access to basic acupuncture and to provide more physicians with this tool,” said Dr. Dilts. “My hope is if patients love the initial introduction then some of them will be able to find a way to continue acupuncture and continue to look for non-pharma options.”

Dr. Bickel added, “It's been amazing to see the amount of Children’s Mercy pediatricians who want to embrace this new introduction of ancient techniques.”


Learn more about the Emergency Department at Children's Mercy.

Learn more about Headache Services at Children's Mercy.

Learn more about acupuncture at Children's Mercy.