2. Acupuncture for Hemophilia Patients in Chronic Pain. Angela Lambing, MSN, NP-C, 1 Dr. Vinay Varma, 2 Beth Kohn, LAC, MTOM, Dipl Ac, Dipl CH, 1 Dr. Suresh Hanagavadi 2 1 Henry Ford Health System, Detroit, MI; 2 Karnataka Hemophilia Society, India Statement of the Problem Acupuncture Therapy Limitations Review of the Literature Results The aim of this study seeks to: a) document a decrease in hemarthritic joint pain post acupuncture treatments b) prove minimal bleeding risk during acupuncture. Objectives 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 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 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 tx 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 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% level (per IRB requirements) India residents – no factor prior to treatments 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 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, Shen Men Ear Point 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 Very small sample size Duration of therapy proved a barrier to enrollment Additional objective data to confirm improvement Joint measurements Larger random controlled studies are needed No bleeding experienced: With any subject After every treatment session Factor vs no factor pre treatment Alternative therapies: acupuncture may provide some benefit to chronic pain patients with hemophilia in a multimodal approach Larger randomized studies are needed Marital Status 7 married 2 single Age: 28 – 63 yrs Ave age 45 years Work 4 full time 3 disabled 1 student 1 retired PtPre treatmentPost TreatmentPain med prePain med post #14.0 1 x week1 x month #24.02.0 1 x weekNone #38.06.0 3-4 x day #45.01.0 1-2 x day< 1 x day #56.04.0 1-2 x day #64.0 1-2 x day5-6 x day #74.0 < 1 x day #810.05.0 3-4 x day #94.02.0 1 x week1 x month Ethnicity: 3 India 4 Caucasian 2 Afr American Education: 4 college 2 secondary school 2 technical school 1 grade school: gr 8 Demographics Pain scores (VAS 0-10)Pre & Post Treatment VariablesPre acupuncturePost acupuncture Physical Functioning 23.030.0 Social functioning52.5070.0 Physical problem00 Emotional problem60.073.3 Mental health76.882.4 Energy/Fatigue42.043.0 Pain33.344.4 Health perception43.8 Health change50.065.0 SF-36 Quality of Life Scores Conclusions