 Traditional Chinese Medicine  Background  Conceptual ba sis  Acupuncture  Acupuncture for Pain Management: an evidence based review  Purpose  Review of Literature  Nursing Theory

Traditional Chinese Medicine  Acupuncture  Massage  Traditional Herbal Remedies  Moxibustion (heat application)  Tai chi, qi gong

The vital energy force Qi: The vital life force

~361 acupoints along 12 meridians ~

Acupuncture: An Option for Pain Management in Primary Care

Purpose Review acupuncture studies found in the literature Examine theoretical frameworks that support acupuncture Review cultural, ethical & legal issues surrounding acupuncture Consider incorporation of acupuncture into advanced nursing practice

Review of Literature CINAHL & Proquest databases searched Search narrowed with keywords: Acupuncture & Pain Management 8 studies selected and analyzed

Review of Literature AUTHORSSTUDY SUBJECTSMETHODSRESULTS Martin, Sletten, Williams, & Berger, Fibromyalgia patients: (25 in control group, 25 in acupuncture group) Sham acupuncture vs. true acupuncture(6 bilateral points) FIQ score improved with acupuncture group (p=.01) & MPI scores improved, (most in fatigue & anxiety scales) Spira, sailors in IraqAcupuncture offered w/ medical treatments for sprains, fractures, etc. Return to duty 2 days (avg) sooner than conventional therapy group Tam, Leung, Li, Zhang, & Li, patients from Prince of Wales Hospital w/ RA Randomized, double- blind, placebo- controlled trial analyzing effects of EA, TCA, & sham acupuncture EA group: Reduced physician global assess. scores (p=0.04) & # of tender joints (p=0.03); TCA group: reduced pt global assess. scores & # of tender joints (p=0.01)

Review of Literature AUTHORSSTUDY SUBJECTSMETHODSRESULTS Prady, Thomas, Esmonde, Crouch, & MacPherson, of 239 original ‘back pain trial’ participants 36-item quality of life questionnaire addressing pain No significant differences after 7 years, although 90.8% (treatment group) would recommend acupuncture (62.1% of control group) White, Foster, Cummings, & Barlas, patients with chronic knee pain Meta-analysis of 13 randomized control studies Suggests that acupuncture is superior to sham treatment, but need more large, quality trials Vas, Aguilar, Perea-Miller, Mendez, 2007 Pain Treatment Unit in Spain (wide variety of non-onc pain complaints) Retrospective review of 5981 records of patient treatment programs Overall favorable responses; no severe adverse events, reduced analgesic & anti- inflammatory drug consumption

Review of Literature AUTHORSSTUDY SUBJECTSMETHODSRESULTS Lind et al, patients with migraine headaches in Germany Randomized control trial: acupuncture vs. sham acupuncture vs. none # of days with HA decreased in acupuncture group (from 5.2 to 3 days) and sham group (from 5 to 2.2 days) Reynolds, Bland & MacPherson, IBS patients: (20 in control group & 10 in acupuncture group) Exploratory randomized control trial: general practitioner care w/ & w/o acupuncture treatment No acupuncture group: scores down 322 to 287 Acupuncture group: scores down 343 to 128.

Nursing Theory & Acupuncture Simultaneity Paradigm: Human being as unitary whole Mutual, simultaneous, non-linear human- environment interaction Health=pattern of the whole Nursing: attempts to stimulate re-patterning

Nursing Theory & Acupuncture Examples: Martha Rogers’ Science of Unitary Human Beings Rosemarie R. Parses’ Theory of Human Becoming Susan K. Leddy’s Theory of Energetic Patterning

Cultural, Legal & Ethical Considerations Cultural: Understand individual beliefs & needs; understand the philosophy behind healing Legal: Referrals should be to practitioners who are board certified Ethical: Balancing beneficence & patient autonomy

Incorporation into ANP TypeIndication RespiratoryAllergic rhinitis GI Biliary colic, dysentery, epigastralgia (in peptic ulcer, acute and chronic gastritis and gastrospasm Pain Facial Pain, headache, knee pain, low back pain, neck pain, dental and TMJ pain, periarthritis of the shoulder, postoperative pain, rheumatoid arthritis, sciatica, sprain, tennis elbow Gynecological and Renal Renal colic, primary dysmenorhhea, induction of labor, correction of malposition of fetus CardiovascularHypertension, hypotension, stroke GeneralAdverse reactions to radiotherapy and/or chemotherapy, depression (including depressive neurosis and depression following stroke), leukopenia, morning sickness, nausea and vomiting

Contraindications Patients on anti- coagulation therapy should not participate in acupuncture due to risk of bleeding Acute emergency cases should seek Western medical attention (ex. Shock, septicemia, hemorrhage, MI, surgical emergencies)

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