Acupuncture in Spinal Cord Injury Subjects
Condition: Spinal Cord Injuries
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      Of the more than 250,000 Americans with severe spinal cord injury (SCI), 42,000 are military
      veterans. The Department of Veterans Affairs is the largest single network of SCI care
      providers in the nation. Patients with SCI experience functional disabilities as well as
      chronic pain. Studies show that individuals with SCI report pain refractory to conventional
      treatments. Civilian and veteran patients with SCI have associated pain with impairments in
      physical and cognitive function, sleep, employment, social relationships, community
      re-integration and quality of life. In a survey of individuals with SCI, those who used
      acupuncture experienced a reduction of pain symptoms lasting hours after treatment, with
      27.3% reporting pain relief for days. A pilot study on the use of auricular acupuncture for
      neuropathic pain associated with SCI showed a greater reduction of pain as measured by the
      Numerical Rating Scale (NRS). A recent review of randomized controlled trials regarding the
      use of acupuncture in SCI found that only two of sixteen included studies were of high
      quality. There was limited evidence for the use of acupuncture in motor functional recovery,
      bladder function recovery, and in pain control related to SCI. Further high quality studies
      are needed. This proposal is for a phase II randomized clinical trial.
    

Detailed description: 
      Objective/Hypothesis:

      Our overarching hypothesis is that acupuncture is beneficial following acute traumatic SCI
      with respect to severity of neuropathic pain syndromes, patient-perceived quality of life
      measures, and functional outcomes. The current literature suggests that acupuncture may
      improve upon traditional pharmacological treatment results for SCI related pain, and that
      patients are seeking improved pain management in order to improve their quality of life.
      While data is limited, there may also be improvement in motor functional recovery with the
      use of acupuncture. We do know that SCI related pain limits patient participation in
      rehabilitation, thus advances in the management of SCI related pain is a priority in SCI
      research in order to improve outcomes after SCI.

      Specific Aims:

      Specific Aim 1: To determine whether patients treated with acupuncture started during acute
      care have better immediate and long-term pain scores and decreases in self-reported pain
      interference.

      Specific Aim 2: To determine whether patients treated with acupuncture started during acute
      care will have better overall quality of life measurements and improvements in self-reported
      well-being and resilience.

      Specific Aim 3: To determine whether patients treated with acupuncture started during acute
      care will have improvement in functional recovery in comparison to the control group.

      Study Design:

      This trial will compare pain scores and patient-perceived quality of life for individuals who
      receive early and regular acupuncture therapy to a control group. Patients with blunt or
      penetrating traumatic SCI will be included. The Investigators will enroll 100 subjects over a
      36-month period from the R Adams Cowley Shock Trauma Center (STC). Once consent is obtained,
      enrolled patients will be evaluated using the ISNCSCI examination. Information about
      neuropathic pain and quality of life will be scored using NIH CDE recommended validated
      instruments within 72 hours of injury, during the 8-week treatment period, and at 3 and 6
      months. The primary outcome is the improvement in NRS. The secondary outcomes are
      improvements in quality of life and functional recovery. Statistical analyses will involve
      constructive repeated measures mixed models to estimate the effect of treatment.

      Clinical Impact:

      The proposed trial will investigate the promising intervention of acupuncture for the
      management of neuropathic pain related to SCI. Improvement in neuropathic pain management is
      crucial in improving patients' rehabilitation, quality of life and ultimate outcome.
    

Intervention name(s): Acupuncture
Intervention type(s): Other
Intervention description(s): Participants within the acupuncture treatment group will receive traditional body acupuncture with electrical stimulation for 30 minutes three times a week, additionally participants will also receive auricular acupuncture once a week with the needles retained in both ears for seven days and replaced the following week, for a total of eight weeks (24 treatments of conventional acupuncture and 8 treatments of auricular acupuncture). Relative pain levels will be measured via the NRS by a member of the research staff before and after each treatment. All participants will then be reevaluated with the described assessment tools at three months and again at six months. Acupuncturists will not participate in the three and six month evaluations of subjects.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Chronic pain; Acupuncture