ACUPUNCTURE IN PALLIATIVE CARE

EVIDENCE BASED MEDICINE

Sara Bowling, MDFamily Medicine and Medical AcupunctureFamily Care Network

INTEGRATIVE MEDICINE

CONVENTIONAL CARE

Symptom A

Symptom D

Symptom C

Symptom B

THE PILL BURDENAverage elderly patient is on 8-13 medications

Anorexia

Anxiety

Constipation

Delirium

Depression

Diarrhea

SYMPTOMS IN END OF LIFEDyspnea

Fatigue

Nausea and Vomiting

Pain

Respiratory tract secretions

Dexamethasone

Diazepam and Lorazepam

Docusate and Senna

Haloperidol

Amitriptyline and Fluoxetine

WORLD HEALTH ORGANIZATION ESSENTIAL MEDICATIONS LIST FOR PALLIATIVE CARE

Loperamide

Morphine

Metoclopramide

Ibuprofen

Hyoscine butyl-bromide

Dexamethasone - A

Diazepam/ Lorazepam- D

Docusate and Senna-D

Haloperidol - A

Amitriptyline and Fluoxetine

EVIDENCE BEHIND MEDICATIONS

Loperamide - D

Morphine - A

Metoclopramide

Ibuprofen

Hyoscine butyl-bromide

SIDE EFFECTS

Dexamethasone

Anaphylactic reactions, acute myopathy, perineal irritation, psychiatric disturbances

HaloperidolQT prolongation, anticholinergic effects, leukopenia, CNS depression, extrapyramidal symptoms, esophageal dysmotility, orthostatic hypotension

Morphine

Constipation, CNS depression, hypotension, hypersensitivity reaction, respiratory depression

ACUPUNCTURESAFE & EFFECTIVE

ACUPUNCTURE IS SAFE

Rare Adverse Events

Dizziness

Subcutaneous bleeding

Mild burn

ACUPUNCTURE IS SAFESpecial Considerations

Never placed in tumor or ulcerated area

Never placed in limbs prone to lymphedema

Care when treating over chest wall in cachectic patients

No electroacupuncture if pacemaker

IS ACUPUNCTURE PAINFUL?

WHAT IS ACUPUNCTURE?

Originated 2000 years ago

North America in the 1970s as useful for anesthesia

A series of meridians through which energy flows

THE SCIENCE OF ACUPUNCTURE?

PAIN MODULATION

ENDOGENOUS OPIOIDS

Stimulates release of dynorphin, enkephalin, beta-endorphin.

Increases endogenous cannabinoid receptors

Up-regulates opioids in inflamed tissues

ENDOGENOUS OPIOIDSOpioid antagonists such as naloxone, can reverse the analgesic

effects of acupuncture.

NATIONAL INSTITUTE OF HEALTH CONSENSUS STATEMENT, 1997

“Acupuncture is an effective treatment modality for adult postoperative and chemotherapy nausea and vomiting.”

“There is sufficient evidence of acupuncture’s value to expand its use into conventional medicine and encourage

further studies of its physiology and clinical value”

ACUPUNCTURE ISEVIDENCE BASED MEDICINE

Research / DataClinical Expertise

Patient Values & Expectations

The challenges of the acupuncture control: SHAM acupuncture

SYSTEMATIC REVIEWSFatigue*

Nausea-Vomiting**

Pain*

Hot flashes*

Xerostomia

Dyspnea

Anxiety

Anorexia

Constipation

Paresthesia

Insomnia

Limb edema

WHO’S 3- STEP LADDER FOR CANCER PAIN RELIEF

PAIN

PAIN

NAUSE AND VOMITING

FATIGUE

HOT FLASHES

INTEGRATIVE EVIDENCE BASED MEDICINE

Research / DataClinical Expertise

Patient Values & Expectations

Acupuncture is effective forPain control

Nausea and vomitingFatigue

Hot flashes

It is best used alongside conventional medicine early on in treatment, rather than as last resort

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