Battlefield Acupuncture and Physical Therapy Versus Physical Therapy Alone After Shoulder Surgery

Abstract

Objective: Opioid pain medications are commonly prescribed postsurgically for pain. Few studies have investigated the effects of Battlefield Acupuncture (BFA) on postsurgical pain and pain-medication use. To date, no studies have investigated BFA's effectiveness for reducing postoperative shoulder pain and pain-medication use post surgery. The objective of this study was to determine if adding BFA to a rehabilitation protocol was effective for reducing pain and use of prescribed pain medications, compared to that protocol alone after shoulder surgery. Materials and Methods: Forty Department of Defense beneficiaries (ages 17-55) were randomized to either a standard-of-care group or a standard-of-care + BFA group prior to shoulder surgery. The standard BFA protocol was administered with semipermanent acupuncture needles emplaced on the subjects' ears for 3-5 days within 24 hours after shoulder surgery in an outpatient physical therapy setting. BFA was reapplied, as needed, up to 6 weeks postsurgically for pain management in the intervention group. The primary outcomes were visual analogue scale (VAS) pain rating and daily pain medication use by each subject. Secondary outcome measures were the Global Rating of Change and Patient Specific Functional scale. Outcome measures were obtained at 24 hours, 72 hours, 1 week, 2 weeks, and 6 weeks post surgery. Results: Significant differences in average and worst VAS pain change scores were noted between baseline and 7 days (P < 0.05). The main effect for time was significant (average and worst VAS pain) at all timepoints (P < 0.05), without time-group interactions seen. No significant differences between the groups in pain-medication use were observed (P > 0.05) Conclusions: BFA reduced postsurgical shoulder pain significantly between the groups' average and worst pain change scores between baseline and 7 days despite similar opioid and nonsteroidal anti-inflammatory drug use between the groups.

Keywords: Battlefield Acupuncture; opioids; pain medication; postsurgical medications; shoulder surgery.

FIG. 1.

Study Consolidated Standards Of Reporting Trials (CONSORT; 2010) diagram of subject allocation. Recruitment was goal N = 40; some subjects were withdrawn from the study (1 for medical complications).

FIG. 2.

Battlefield Acupuncture points in order (from bottom to top): Cingulate Gyrus; Thalamus; Omega 2; Point Zero; And Shen Men.

FIG. 3.

Sedatelec Aiguille Semipermanente^® gold stainless-steel needles and applicator. Source for image from http://www.fiveelementtcm.com

FIG. 4.

Main effect for time with Greenhouse Geisser correction significant (P < 0.001) for the mixed-model analysis of variance for the average pain score (visual analogue scale [VAS]).

FIG. 5.

Main effect for time observed between all timepoints for worst pain (visual analogue scale; P < 0.001).

FIG. 6.

Subjects' (both groups) average daily opioid intakes, postsurgical days 1–14. No opioid use after day 14 was reported. Mean days of opioid use = 5.82 (± 2.72) postsurgery (error bars = standard deviations).