Acupuncture For Postoperative Pain Management Following Colorectal Surgery: A Pilot Study

Abstract

Background: Acute postsurgical pain is routinely treated with opioid medications that often cause harmful side effects including respiratory depression, nausea, vomiting, itching, decreased gastric motility, and the potential for opioid abuse and addiction. If acute pain following surgery is not adequately addressed it may lead to a prolonged healing process, reduced mobility, and risk of developing chronic pain syndrome. Only about half of postoperative patients receive adequate relief from pain, and as a group those who undergo colorectal surgery use large amounts of opioids in an attempt to provide relief from acute surgical pain. Acupuncture, a modality rooted in Chinese medicine, has been shown to reduce postoperative pain, with little to no side effects, on the first day after surgery with reduced opioid use and a decrease in overall pain scores. Goals of this study were to determine if acupuncture as an adjunct to postoperative pain management protocols was feasible and acceptable in the immediate postsurgical setting, and to test acupuncture’s effectiveness in reducing acute pain and total opioid consumption following colorectal surgery. Methods: This was a quasi-experimental study that recruited participants from the Columbia Surgical Specialists Colorectal Surgery Clinic. Eligible participants signed a consent and were assigned to either the acupuncture or control group (standard of care). The experimental group completed the Acupuncture Expectancy Scale (AES) questionnaire prior to surgery. Both groups were assessed for pain pre-operatively using the Visual Analog Scale (VAS), 12, 18 and 24- hours postoperatively. Both groups were assessed for intravenous opioid use for 24 hours postoperatively in six-hour epochs (i.e., up to six hours postoperative, from six hours to 12 hours, from 12 hours to 18 hours, and then from 18 hours to 24 hours after surgery). 10 Results: A total of five participants took part in the study; two in the acupuncture group and three in the control group. The majority (83%) of participants who were approached did consent to the study. As there were two participants in the acupuncture group, it was not possible to determine whether or not differences between groups were statistically significant (i.e., by way of measures of central tendency, & variation). However, the study did show that acupuncture is feasible and acceptable in the immediate postoperative period in patients recovering from colorectal surgery with support from the colorectal surgeons and hospital clinical staff. Conclusion: Acupuncture is a potential adjunct to pain management protocols in the acute care postoperative setting and has shown to be a credible modality worthy of further exploration with a larger clinical effectiveness trial utilizing a framework for integrative mind-body interventions. This feasibility and acceptability study demonstrated a clinically meaningful signal and showed acupuncture can be applied in a clinical setting with colorectal surgery patients. A larger trial with adequate funding for a dedicated acupuncturist or medical acupuncture provider is necessary.