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

Number

Physiotherapist

48 = 37%

Orthopaedic surgeon

28 = 22%

Rheumatologist

13 = 10%

Physician

13 = 10%

Counselling

5 = 4%

Neurologist

4 = 3%

Pain consultant

3

Rehabilitation

2

Psychologist

1

Psychiatrist

1

 

Total Investigations = 111. As a % = 86%

 

Breakdown of Investigations

Number

X-Ray

66 = 51%

CT

20 = 16%

MRI

9 = 7%

Serology

16 = 12%

 

Total Scripts = 286. Ie. 2.2 per consult.

 

Breakdown of scripts

Number

Analgesics one or more

129

NSAI one or more

68

Tricyclics one or more

32

Steroids one or more

9

Other

29

 

In House treatment.

  

Breakdown of treatment

Number

Acupuncture

43 = 33%

Re-education

21

TNS

15

Hypnosis

6

Nerve block

6

Other: exercise / mobilisation etc

11

 

Use of Pain assessment Tools.

 

Pain Diagram

10 = 8%

VAS

12

McGill

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

12 = 21%

Orthopaedic surgeon

2 = 4%

Rheumatologist

1 = 2%

Physician

3 = 5%

Counselling

1 = 2%

Neurologist

4 = 2%

Pain consultant

0

Rehabilitation

0

Psychologist

0

Psychiatrist

0

 

Total Investigations = 35. As a % = 61%

 

Breakdown of Investigations

Number

X-Ray

24 = 42%

CT

1 = 2%

IVP

2 = 4%

Serology

5 = 9%

 

Total Scripts = 50. Ie. 0.88 per consult.

 

Breakdown of scripts

Number

Analgesics one or more

29

NSAI one or more

15

Tricyclics one or more

1

Steroids one or more

2

Other

3

 

In House treatment.

 

Breakdown of treatment

Number

Acupuncture

49 = 86%

Re-education

4

TNS

0

Hypnosis

2

Nerve block

1

Other: exercise / mobilisation etc

3

 

 Use of Pain assessment Tools.

 

Pain Diagram

10 = 18%

VAS

12

McGill

3

 

25 per 57patients.

 

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

 

 

Pre-attendance
Whole group

Post-attendance

Referral rate as a %

91%

33%

Investigation rate as a %

86%

61%

Scripts per consult.

2.2

0.88

Acupuncture Rx

33%

86%

Pain Assessment tools

19%

44%

 

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

 

 

Pre-attendance
second response group*

Post-attendance

Referral rate as a %

82%

33%

Investigation rate as a %

92%

61%

Scripts per consult.

1.3

0.88

Acupuncture Rx

51%

86%

Pain Assessment tools

19%

44%

 

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

 

25 per 57patients. Comparison Pre and Post attendance of those completing both pre and post assessments.

 

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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.

A fuller study of Continuing Medical Acupuncture Education's seminar attendees will be attempted in October.

For futher information contact Simon Strauss Telephone (07) 55 313810, Fax (07) 55 326199. 31 Charlton Street, Southport. 4215.