1. Acupuncture for Hemophilia Patients in Chronic Pain
Angela Lambing, MSN, NP-C, 1
Dr. Vinay Varma, 2
Beth Kohn L.Ac., M.T.O.M, Dipl.Ac, Dipl.CH , 1
Dr. Suresh Hanagavadi2
1Henry Ford Health System, Detroit, MI
2Karnataka Hemophilia Society, India

2. 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

3. Objectives This study seeks to:
a) Document a decrease in hemarthritic joint pain after acupuncture treatments
b) Demonstrate minimal bleeding risk during acupuncture.

4. 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);
10/12 pts showed improvement
Average VAS reduced from 6.8/10 to 5/10
No side effects were observed

5. Rosted P & Jorgensen V. (2002)
Rosted P & Jorgensen V. (2002). Acupuncture used in the management of pain due to arthropathy in a patient with haemophilia. Acupuncture medicine. 20(4);
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

6. 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

7. 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, 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

8. Method Measured pain scores using: Quality of Life (QOL)
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

9. 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.

10. 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

11. Demographics Ethnicity: Education: Marital Status Age: 28 – 63 yrs
3 India
4 Caucasian
2 Afr American
Education:
4 college
2 secondary school
2 technical school
1 grade school: gr 8
Marital Status
7 married
2 single
Age: 28 – 63 yrs
Ave age 45 years
Work
4 full time
3 disabled
1 student
1 retired

12. Pain level reports: VAS 0-10Pt
Pre treatment
Post Treatment
Pain med pre
Pain med post #1
4.0
1 x week
1 x month #2
2.0
None #3
8.0
6.0
3-4 x day #4
5.0
1.0
1-2 x day
< 1 x day #5 #6
5-6 x day #7
<1 x day #8
10.0 #9

13. SF-36; QOL scores Variables Pre acupuncture Post acupuncture
Physical Functioning
23.0
30.0
Social functioning
52.50
70.0
Physical problem
Emotional problem
60.0
73.3
Mental health
76.8
82.4
Energy/Fatigue
42.0
43.0
Pain
33.3
44.4
Health perception
43.8
Health change
50.0
65.0

14. Pre Acupuncture
Post Acupuncture

15. Pre Acupuncture
Post Acupuncture

16. 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

17. 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