Acupuncture for Hemophilia Patients in Chronic Pain.

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) 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
• gt 18 years of age
• Hemophilia
• Reported chronic pain
• Severe Joint hemarthrosis as identified by the
  HTC
• Michigan subjects factor replacement gt 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
Demographics

• 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

12
Pain level reports VAS 0-10
Pt Pre treatment Post Treatment Pain med pre Pain med post
1 4.0 4.0 1 x week 1 x month
2 4.0 2.0 1 x week None
3 8.0 6.0 3-4 x day 3-4 x day
4 5.0 1.0 1-2 x day lt 1 x day
5 6.0 4.0 1-2 x day 1-2 x day
6 4.0 4.0 1-2 x day 5-6 x day
7 4.0 4.0 lt 1 x day lt1 x day
8 10.0 5.0 3-4 x day 3-4 x day
9 4.0 2.0 1 x week 1 x month
13
SF-36 QOL scores
Variables Pre acupuncture Post acupuncture
Physical Functioning 23.0 30.0
Social functioning 52.50 70.0
Physical problem 0 0
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 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