NM-244
The Use of Palliative Acupuncture as a Pain Management Strategy in a Patient with Mucolipidosis Type II
Bhakta A, Reece-Stremtan S
Children's National Medical Center/George Washington University System, WASHINGTON, DC, USA
INTRODUCTION: Acupuncture is a complementary therapy that is being used increasingly in a multi-modal approach to pain management. Despite minimal contraindications and an excellent safety profile, skepticism still exists around efficacy of acupuncture. We present a novel case in which the use of palliative acupuncture was used successfully to manage chronic pain in a medically complex patient.
CASE REPORT: 23 yo with history of mucolipidosis type II, skeletal dysplasia, hypotonia, and severe cervical spinal stenosis with myelomalacia presented to pain clinic for management options for his chronic pain. He presented with chronic radicular neck pain, atypical chest wall pain, neck pain, bilateral osteoarthritic knee pain, and pain related to contractures of his bilateral upper extremities. Patient’s medical history was further complicated by hypertrophic cardiomyopathy, severe AI, OSA on BiPAP, chronic lung disease, and a history of a difficult airway. Initial pharmacotherapy treatment failed secondary to adverse effects and intolerance to medications from different drug classes. Patient experienced significant sedation and varying degrees of respiratory depression which was a major concern in this patient given his poor pulmonary capacity and difficult airway. Patient was recommended for acupuncture to optimize the non-pharmacologic approach. Patient began acupuncture treatment with a pain physician who is trained in acupuncture therapy. After the first session, the patient reported improvement in his chronic pain by >50%. Patient’s response to treatment was evaluated and it was determined that patient had optimal results with weekly treatment sessions which he has now been receiving for >1 year. In addition to improving pain scores, patient has also experienced improvement in participation with physical therapy and his ability to perform ADL/IADL.
DISCUSSION: Acupuncture has been well described and practiced for centuries as a modality for treatment of acute and chronic pain. Although well described, it remains underutilized due to lack of well-designed studies to confirm its utility as a treatment option for many pain diagnoses encountered in the pain clinic. Acupuncture has been postulated to improve pain control through varying mechanisms including increasing concentrations of natural opioid substances, stimulating endogenous corticosteroid release, and increasing local blood flow to initiate or catalyze the healing process. Most commonly, acupuncture as a pain management strategy is considered when all other options have been exhausted or response to other treatments have been suboptimal. We propose strong consideration for incorporating acupuncture into a patient’s pain treatment plan earlier in the course of therapy in order to maximize benefits. This is especially true for patients in which conventional standard of care incurs great risk for the patient, is not acceptable to the patient, or has intolerable side effects.
REFERENCES: 1) Melzack R. (1976). Anaesthesist. 25:204-7. 2) Wilkinson, J. (2007). BJA Education: Continuing Education in Anaesthesia Critical Care and Pain. 7(4):135-8. 3) White P., et. al. (2004). Ann Intern Med. 141:911-9. 4) Kapthuk TJ. (2002). Ann Intern Med. 136:374-82.
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