صفحه 1:
LUA
en] ae
صفحه 2:
Acupuncture for
Hemophilia Patients in
Chronic Pain
Angela Lambing, MSN, NP-C, 1
Dr. Vinay Varma, ?
Beth Kohn L.Ac., M.T.O.M, DipI.Ac, DipI.CH
a
7
Dr. Suresh Hanagavadi?
1Henry Ford Health System, Detroit, MI
?Karnataka Hemophilia Society, India
صفحه 3:
Statement of the Problem
= Chronic pain due to end stage arthritis
for hemophilia patients presents
ongoing issues resulting in exploration
of non-standard therapies for pain
management
= Acupuncture has proved successful in
osteoarthritis and non-malignant pain.
= Pain management involves a
multimodal approach
صفحه 4:
Objectives
= This study seeks to:
= a) Document a decrease in hemarthritic
joint pain after acupuncture treatments
= b) Demonstrate minimal bleeding risk
during acupuncture.
صفحه 5:
Review of the Literature
Minimal literature related to hemophilia
= Wallny TA, Brackmann, HH, Gunia G, Wilbertz
P, Oldenberg J, Kraft CN. (2006). Successful
pain treatment in arthropathic lower
extremities by acupuncture in haemophilia
patients. Haemophilia. 12(5); 500-2.
= 10/12 pts showed improvement
= Average VAS reduced from 6.8/10 to 5/10
= No side effects were observed
صفحه 6:
= Rosted P & Jorgensen V. (2002).
Acupuncture used in the management
of pain due to arthropathy in a patient
with haemophilia. Acupuncture
medicine. 20(4); 193-5.
= Case report - 38 yr old severe hemophilia
A, with joint pain; knees, elbows, ankles
= On factor prophylaxis; received factor prior to
ine
= Previous right knee synovectomy
= 5 tx for the knee with reported significant
reduction in pain
= Repeat acupuncture every 3 months
= Close collaboration with hemophilic clinic
= Use of qualified acupuncture specialists
صفحه 7:
Method
= Convenience sample
= Prospective study
= Dual study between Twinning partners:
= Henry Ford Health System, Detroit, MI
= Karnataka Hemophilia Society, Karnataka, India
™ Utilized certified acupuncturists
Inclusion Criteria
= > 18 years of age
= Hemophilia
= Reported chronic pain
= Severe Joint hemarthrosis as identified by the HTC
Michigan subjects - factor replacement > 15%
۱3 (ae IRB requirements)
India residents - no factor prior to treatments
صفحه 8:
Acupuncture points
= Acupuncture treatment plan
= Twice per week x 4 weeks; weekly for remaining 6
weeks
Primary acupuncture points:
= Du 20, LI 4, Liv 3, Gb 34, Sp 6, LI 11, St 35, Kid 3,
5۱6۲0 ۲۵۱ ۶۵۲ ۲
= Specific Knee pain:
= Secondary points: Xi yan, Heding, Liv 8, Sp 10
= Specific Ankle pain:
= Secondary Points: St 41, Gb 40, Sp5
= Specific Lower back pain:
= Secondary Points: Ub 23, Du 4
= Specific Elbow Pain:
= Secondary Points: Lu 5, Sj 5
صفحه 9:
Method
= Measured pain scores using:
= Visual analog scale: 0 - 10
= Average daily pain
= Highest level
= Lowest level
= Types of pain medications utilized
= Number of pain pills taken/day
= Quality of Life (QOL)
= Standard SF-36
صفحه 10:
Method
= Signed consent per IRB protocol
= Cost of acupuncture sessions covered
= Mileage covered for travel to each
session
= Patients were instructed to report any
bleeding issues
= Acupuncturists identified any post
procedural bleeding issues.
صفحه 11:
Results
= 19 HFH hemophilia pts signed up to
participate
= Only 6 completed the study citing travel &
work restrictions
= 3 hemophilia pts completed study in
India
= Total of 9 pts completed study
= 6 severe hemophilia
= 2 moderate hemophilia
= 1 mild hemophilia
صفحه 12:
Demographics
= Ethnicity: = Marital Status
0 1 = 7 married
3 India Pts ots
= 4 Caucasian
= Age: 28 - 63 yrs
= Ave age 45 years
= 2 Afr American
= Education: = Work
۶ 4 6 « 4 ۱۱ ۵
= 2 secondary school = 3 disabled
= 2 technical school = 1 student
= 1 grade school: gr 8 = 1 retired
صفحه 13:
Pain level reports: VAS 0-10
Pain
med
post
1 ۷۲
None
3-4 x day
<1x day
1-2 x day
5-6 x day
<1x day
3-4 x day
ولك ۱
وت
med pre
1 x week
۱۳ کت
3-4 x day
1-2 x day
1-2 x day
1-2 x day
<1x day
3-4 x day
1 ۶
Post
Treatmen
1
4.0
2.0
6.0)
LO
0)
4.0
4.0
5.0)
2.0
82م
treatme
nt
4.0
4.0
8.0)
5.0
6.0
4.0
4.0
10,0
4.0
ae
#1
#2
#3
74
#5
#6
#7
#8
#9
صفحه 14:
SF-36; QOL scores
Post acupuncture
30.0
70.0
0
درد
52.4
4366
44.4
43.8
65.0
Pre acupuncture
23.0
52.50
0
60.0
76.8
42.0
ae}
43.8
50.0
Variables
Physical
Functioning
Social functioning
Physical problem
Emotional problem
لاقعلا أقأمع الا
Energy/Fatigue
Pain
Health perception
Health change
صفحه 15:
ad كف
صفحه 16:
۳
۳۳
صفحه 17:
Limitations
= Very small sample size
= Duration of therapy program proved
a barrier to enrollment
= Additional objective data to confirm
improvement would have been
helpful
= Joint measurements
صفحه 18:
Conclusions
= No bleeding experienced:
= With any subject
= After every treatment session
= Factor vs no factor pre treatment
= 6/8 pts reported decrease in VAS pain scores
= 7/9 QOL domains improved
= Alternative therapies: acupuncture may
provide some benefit to chronic pain patients
with hemophilia in a multimodal approach
= Larger randomized studies are needed