The Assessment and Treatment of Inpatient Cancer-Related Pain with Acupuncture: Development of a Manual.

Background and Objective: Pain is a highly prevalent and distressing experience of hospitalized patients with cancer, and undertreatment is a challenging issue. Adding nonpharmacologic treatments such as acupuncture to conventional pain management may help address a patient's total pain experience. A dearth of acupuncture treatment guidelines exists, leaving individual practitioners to develop treatments themselves. The aim of the work described in this report was to develop a standardized clinical reference manual for East Asian Medicine (EAM) assessment, diagnosis, and acupuncture treatment of cancer-related pain in hospitalized patients with cancer. Design: The acupuncture manual was developed based on: (1) a narrative review of existing literature on acupuncture and cancer pain; (2) a review of acupuncture charting notes of more than 200 treatments provided in an inpatient setting; and (3) meetings of an expert panel of senior acupuncturists to reach consensus on a manual protocol. Results: The resulting manual described diagnosis of patients based on EAM constitution, symptoms and signs, and channel location of the cancer-related pain symptoms. The resulting point selections for acupuncture treatment enables adaptability, reproducibility, and individualized acupuncture treatment of cancer-related pain in hospitalized patients with cancer. Conclusions: The manual fills a vital gap in the current literature, and supports community- and hospital-based acupuncturists as a standardized clinical reference. The manual provides guidance for cancer-related pain management, using EAM acupuncture in hospitalized patients.

Effectiveness guidance document (EGD) for Chinese medicine trials: a consensus document.

BACKGROUND: There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making. METHODS: The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document. RESULTS: Recommendations were developed for "using available data" and "future clinical studies". The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. CONCLUSION: The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design.

A prospective patient-centered data collection program at an acupuncture and oriental medicine teaching clinic.

OBJECTIVE: Large-scale patient-reported outcomes research investigating the role of acupuncture and Oriental medicine (AOM) in general practice is limited, despite the growing use of AOM in the United States. This article describes the development and refinement of a prospective, patient-centered outcomes data collection program at an Oriental medicine college and presents demographic and clinical data. SETTING/LOCATION: Individualized acupuncture treatment at the Oregon College of Oriental Medicine teaching clinic in Portland, Oregon. METHODS: A prospective patient-centered data collection program was implemented in 2007 using the Measure Your Medical Outcomes Profile (MYMOP) questionnaire and college-developed demographic and conditions forms. The forms were completed by patients on the first and fifth clinic visit. The program was revised after two years to streamline the data entry process and to include three Patient Reported Outcome Measurement Information System (PROMIS) questionnaires measuring pain, general health, and physical functioning. OUTCOME MEASURES: Outcome measures were patient demographics, chief complaints, MYMOP, and PROMIS data collected at first visit. RESULTS: Demographics were similar to those reported in other AOM settings. The majority of patients were Caucasian females and expressed confidence in acupuncture treatment. The most common chief complaint was joint and muscle pain. Additionally, we found that mean scores at baseline for global physical and mental health and physical functioning were all lower than U.S. averages. In contrast to some studies, we found that the majority of patients had previous experience with acupuncture. CONCLUSIONS: An ongoing, prospective data collection program can be successfully developed and implemented at an AOM college. The program will ultimately provide large-scale, patient-reported outcomes on patients seeking AOM treatment at the student clinic.