Do Short Courses on Acupuncture - Pain Management Provoke Changes in Pain Patient Management?

A Pilot Study by Simon Strauss M.D. for Continuing Medical Acupuncture Education.

General practitioners were asked to fill out a formal assessment survey of 10 pain related consultations before attendance at a forty hour Pain Management - Acupuncture seminar. The assessment form was designed by Simon Strauss in conjunction with the RACGP. On return to their practices the attendees were asked to repeat the process.

The results of the pre and post attendance assessments were then analysed and seemed to show changes in pain patient management including less referrals, scripts issued and investigations ordered following attendance. Along with increased utilisation of Acupuncture treatment and pain assessment tools. The results have been presented below.

Results
Before Course Attendance
14 General practitioners
129 pain related consultations.

Total referrals generated = 118. Referral rate as % = 91%

Breakdown of referrals
Physiotherapist
Orthopaedic surgeon
Rheumatologist
Physician
Counselling
Neurologist
Pain consultant
Rehabilitation
Psychologist
Psychiatrist

Number
48 = 37%
28 = 22%
13 = 10%
13 = 10%
5 =4%
4 = 3%
3
2
1
1

Total Investigations = 111. As a % = 86%

Breakdown of Investigations
X-Ray
CT
MRI
Serology

Number
66 = 51%
20 = 16%
9 = 7%
16 = 12%

Total Scripts = 286. Ie. 2.2 per consult.

Breakdown of scripts
Analgesics one or more
NSAI one or more
Tricyclics one or more
Steroids one or more
Other

Number
129
68
32
9
29

In House treatment.

Breakdown of treatment
Acupuncture
Re-education
TNS
Hypnosis
Nerve block
Other: exercise/mobilisation etc

Number
43 = 33%
21
15
6
6
11

Use of Pain assessment Tools.

Pain Diagram
VAAS
McGill

10=8%
12
3

No patient had all three tools used.
2 patients had VAS and McGill. 25 tools used per 129.

Post Course Attendance
Six participating GP's ( Second response group*)
57 Pain related consultations.

Total referrals = 19. Referral rate as % =33%

Physiotherapist
Orthopaedic surgeon
Rheumatologist
Physician
Counselling
Neurologist
Pain consultant
Rehabilitation
Psychologist
Psychiatrist

12 = 21%
2 = 4%
1 = 2%
3 = 5%
1 = 2%
4 = 2%
0
0
0
0

Total Investigations = 35. As a % = 61%

Breakdown of Investigations
X-Ray
CT
IVP
Serology

Number
24 = 42%
1 = 2%
2 = 4%
5 = 9%

Total Scripts = 50. Ie. 0.88 per consult.

Breakdown of scripts
Analgesics one or more
NSAI one or more
Tricyclics one or more
Steroids one or more
Other

Number
29
15
1
2
3

In House treatment.

Breakdown of treatment
Acupuncture
Re-education
TNS
Hypnosis
Nerve block
Other: exercise/mobilisation etc

Numbr
49 = 86%
4
0
2
1
3

Use of Pain assessment Tools 

Pain Diagram
VAS
McGill

10 = 18%
12
3

25 per 57 patients.

Comparison Pre and Post attendance (Whole group V post attendance)

Referral rate as a %
Investigation rate as a %
Scripts per consult.
Acupuncture Rx
Pain Assessment tools

Pre-attendance Whole group
91%
86%
2.2
33%
19%

Post-attendance
33%
61%
0.88
86%
44%

Comparison Pre and Post attendance of those completing both pre and post assessments.

Referral rate as a %
Investigation rate as a %
Scripts per consult.
Acupuncture Rx
Pain Assessment tools

Pre-attendance second response group*
82%
92%
1.3
51%
19%

Post-attendance

33%
61%
0.88
86%
44%

* This group completed both the before and after attendance assessments.

As can be seen from the tables and graphs above marked changes in General Practitioner's pain patient management have followed attendance at a Continuing Medical Acupuncture Education Basic Acupuncture - Pain Management seminar. These include marked decreases in referral rates, script generation and investigations in conjunction with a marked increase of Acupuncture utilisation and a smaller increase in the usage of pain assessment tools.
It would appear that our educational objectives are being met.