Lu Kit, Cheng Mok-Chung Jennifer, Ge Xiaoying, Berger Ann, Xu Dihua, Kato Gregory J, Minniti Caterina P
*Hematology Branch ‡Office of Biostatistics Research §Sickle Cell Vascular Disease Section, Hematology Branch, National Heart, Lung, and Blood Institute †Pain and Palliative Care, Clinical Center, National Institutes of Health, Bethesda, MD.
Clin J Pain. 2014 Sep;30(9):825-30. doi: 10.1097/AJP.0000000000000036.
This retrospective study describes the use of acupuncture for adult sickle cell patients in a single institution.
We identified 47 sickle cell disease patients referred for acupuncture at the National Institutes of Health between January 2005 and September 2011. All patients were enrolled in a Study of the Natural History of sickle cell disease and signed consent. We reviewed patient demographics, location of acupuncture treatment sessions (inpatient vs. outpatient), number of sessions received, sites of pain, patient pain reporting, and the use of other complementary therapies.
Of the 47 patients (60% women, median age 36 y) referred for acupuncture, 42 had homozygous SS disease (89%) and 5 had SC disease (11%). Over half of the patients (51%) reported >3 sites of pain. Only 24 patients (51%) underwent acupuncture treatment. Of those who elected not to receive acupuncture, a majority (87%) accepted some other forms of complementary therapies. Nine patients underwent only inpatient acupuncture for acute vaso-occlusive crisis. Eleven patients received only outpatient acupuncture treatment for chronic pain, and 4 patients received both inpatient and outpatient treatments. For the patients who received inpatient acupuncture treatment for acute vaso-occlusive crisis, there was a significant reduction of reported pain score immediately after acupuncture treatment with an average pain reduction of 2.1 points on the numeric pain scale (P<0.0001). Excluding the 2 outliers, 75% of patients (n=13) in the outpatient setting described their pain as improved compared with prior session.
To our knowledge, this is the largest retrospective review of acupuncture use in the sickle cell population. This analysis describes the use of acupuncture and raises the possibility of its use as an adjuvant for pain management in this population. Future clinical trials are needed to evaluate acupuncture's efficacy and effectiveness for pain management in different treatment settings and for various types of pain etiologies among the sickle cell population.
本回顾性研究描述了在单一机构中对成年镰状细胞病患者使用针灸治疗的情况。
我们确定了2005年1月至2011年9月期间在美国国立卫生研究院接受针灸治疗转诊的47例镰状细胞病患者。所有患者均纳入镰状细胞病自然史研究并签署了知情同意书。我们回顾了患者的人口统计学资料、针灸治疗的地点（住院患者与门诊患者）、接受治疗的次数、疼痛部位、患者疼痛报告以及其他辅助治疗方法的使用情况。
在转诊接受针灸治疗的47例患者中（60%为女性，中位年龄36岁），42例患有纯合子SS病（89%），5例患有SC病（11%）。超过半数的患者（51%）报告有3个以上的疼痛部位。只有24例患者（51%）接受了针灸治疗。在那些选择不接受针灸治疗的患者中，大多数（87%）接受了其他形式的辅助治疗。9例患者仅因急性血管闭塞性危象接受住院针灸治疗。11例患者仅因慢性疼痛接受门诊针灸治疗，4例患者同时接受了住院和门诊治疗。对于因急性血管闭塞性危象接受住院针灸治疗的患者，针灸治疗后报告的疼痛评分立即显著降低，数字疼痛量表上的平均疼痛减轻2.1分（P<0.0001）。排除2例异常值后，门诊环境中75%的患者（n = 13）表示与上一次就诊相比疼痛有所改善。
据我们所知，这是对镰状细胞病患者使用针灸治疗的最大规模回顾性研究。本分析描述了针灸的使用情况，并提出了将其用作该人群疼痛管理辅助手段的可能性。未来需要进行临床试验，以评估针灸在不同治疗环境中以及针对镰状细胞病患者各种疼痛病因进行疼痛管理的疗效和有效性。
