Acupuncture for Hemophilia Patients in Chronic Pain
اسلاید 1: www.tabaye.ir
اسلاید 2: Acupuncture for Hemophilia Patients in Chronic PainAngela Lambing, MSN, NP-C, 1Dr. Vinay Varma, 2Beth Kohn L.Ac., M.T.O.M, Dipl.Ac, Dipl.CH , 1Dr. Suresh Hanagavadi21Henry Ford Health System, Detroit, MI2Karnataka Hemophilia Society, India
اسلاید 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
اسلاید 4: ObjectivesThis study seeks to: a) Document a decrease in hemarthritic joint pain after acupuncture treatmentsb) Demonstrate minimal bleeding risk during acupuncture.
اسلاید 5: Review of the LiteratureMinimal literature related to hemophiliaWallny 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 5/10No side effects were observed
اسلاید 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, anklesOn factor prophylaxis; received factor prior to txPrevious right knee synovectomy5 tx for the knee with reported significant reduction in painRepeat acupuncture every 3 monthsClose collaboration with hemophilic clinicUse of qualified acupuncture specialists
اسلاید 7: MethodConvenience sampleProspective studyDual study between Twinning partners:Henry Ford Health System, Detroit, MIKarnataka Hemophilia Society, Karnataka, IndiaUtilized certified acupuncturistsInclusion Criteria> 18 years of ageHemophiliaReported chronic painSevere Joint hemarthrosis as identified by the HTCMichigan subjects – factor replacement > 15% level (per IRB requirements)India residents – no factor prior to treatments
اسلاید 8: Acupuncture pointsAcupuncture treatment planTwice per week x 4 weeks; weekly for remaining 6 weeksPrimary acupuncture points:Du 20, LI 4, Liv 3, Gb 34, Sp 6, LI 11, St 35, Kid 3, Shen Men Ear Point Specific Knee pain:Secondary points: Xi yan, Heding, Liv 8, Sp 10Specific Ankle pain:Secondary Points: St 41, Gb 40, Sp5Specific Lower back pain:Secondary Points: Ub 23, Du 4Specific Elbow Pain:Secondary Points: Lu 5, Sj 5
اسلاید 9: MethodMeasured pain scores using:Visual analog scale: 0 – 10Average daily painHighest levelLowest levelTypes of pain medications utilizedNumber of pain pills taken/dayQuality of Life (QOL)Standard SF-36
اسلاید 10: MethodSigned consent per IRB protocolCost of acupuncture sessions coveredMileage covered for travel to each sessionPatients were instructed to report any bleeding issuesAcupuncturists identified any post procedural bleeding issues.
اسلاید 11: Results19 HFH hemophilia pts signed up to participateOnly 6 completed the study citing travel & work restrictions3 hemophilia pts completed study in IndiaTotal of 9 pts completed study6 severe hemophilia2 moderate hemophilia1 mild hemophilia
اسلاید 12: DemographicsEthnicity: 3 India4 Caucasian 2 Afr AmericanEducation:4 college2 secondary school2 technical school1 grade school: gr 8Marital Status7 married2 singleAge: 28 – 63 yrsAve age 45 yearsWork4 full time3 disabled1 student1 retired
اسلاید 13: Pain level reports: VAS 0-10
اسلاید 14: SF-36; QOL scores
اسلاید 15: Pre AcupuncturePost Acupuncture
اسلاید 16: Pre AcupuncturePost Acupuncture
اسلاید 17: LimitationsVery small sample sizeDuration of therapy program proved a barrier to enrollmentAdditional objective data to confirm improvement would have been helpfulJoint measurements
اسلاید 18: ConclusionsNo bleeding experienced:With any subjectAfter every treatment sessionFactor vs no factor pre treatment6/8 pts reported decrease in VAS pain scores7/9 QOL domains improvedAlternative therapies: acupuncture may provide some benefit to chronic pain patients with hemophilia in a multimodal approachLarger randomized studies are needed
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