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Acupuncture for Hemophilia Patients in Chronic Pain.

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 Hanagavadi 2 1 Henry Ford Health System, Detroit, MI 2 Karnataka Hemophilia Society, India. Statement of the Problem.

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Acupuncture for Hemophilia Patients in Chronic Pain.

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  1. Acupuncture for Hemophilia Patients in Chronic Pain. Angela Lambing, MSN, NP-C, 1 Dr. Vinay Varma, 2 Beth KohnL.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); 500-2. • 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). 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

  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: • 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. Ethnicity: 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 Demographics

  12. Pain level reports: VAS 0-10

  13. SF-36; QOL scores

  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

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