Adjuvant acupuncture for youth with sickle cell pain: A proof of concept study

Background: Sickle cell disease (SCD) is a common hemoglobinopathy characterized by debilitating vaso-occlusive crises (VOCs) that can require hospitalization for treatment. Despite optimization of multimodal allopathic inpatient treatment, pain burden remains high. Narcotics, the mainstay of therapy, incur adverse side effects, tolerance, and the potential for addiction. Adjunctive treatments are sorely needed and patients' families have reported openness to complementary modalities to fill this need. Objectives: The aim of this pilot study was to assess initial feasibility and acceptability of inpatient adjuvant acupuncture and its potential impact on pediatric VOC-related pain. Materials and Methods: This prospective, single-center study at an urban children's center sought to recruit 13-17-year-old patients with either HbSS (2 mutated sickle hemoglobin copies, each denoted HbS, are inherited, one from each parent) or HbSC (1 sickle hemoglobin variant, or HbS, is inherited from one parent and another hemoglobin variant, HbC, from the other) disease being admitted for VOC management. The patients were recruited within 24 hours of admission. Upon enrollment, a trained acupuncturist evaluated and treated patients according to Worsley Classical Five-Element Acupuncture daily while they required patient-controlled analgesia pumps. Results: Over a 9-month period in 2004, ∼40 patients were identified for possible participation. Of 13 patients interested in the study and eligible, 2 (5% of total; 15% of eligible and interested) ultimately completed it. Both patients conveyed openness to acupuncture, achieved some pain reduction and/or relaxation through it, and indicated that they would want repeated treatments. Care providers were also impressed favorably with the pain attenuation and functional gains achieved. Conclusions: In the total sample, there were some barriers to feasibility and acceptability. However, the 2 patients who received adjuvant acupuncture treatment, their families, and providers alike perceived clinical benefit. Adjuvant inpatient acupuncture for pediatric SCD VOC pain control merits further study.