Statement of the Problem

1. 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 Hanagavadi21Henry Ford Health System, Detroit, MI; 2Karnataka Hemophilia Society, India Statement of the Problem Method Pain scores (VAS 0-10)Pre & Post Treatment • 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 • 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 Objectives • 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. Review of the Literature SF-36 Quality of Life Scores • 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 Acupuncture Therapy • 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 Limitations • 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 Results Demographics • Marital Status • 7 married • 2 single • Age: 28 – 63 yrs • Ave age 45 years • Work • 4 full time • 3 disabled • 1 student • 1 retired Conclusions • Ethnicity: • 3 India • 4 Caucasian • 2 Afr American • Education: • 4 college • 2 secondary school • 2 technical school • 1 grade school: gr 8 • 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