Neurology Headache Team Creates Basic Acupuncture Curriculum
Project changes pain relief options for patients
Systematic reviews and surveys have clarified that acupuncture is safe when performed by appropriately trained practitioners, with infrequent, minor side effects such as feeling relaxed, elated or tired, or having sensation or itching at the point of insertion. Safe use of acupuncture has also been established in pediatrics.1
In addition, there is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.1
Utilizing Acupuncture to Treat Pediatric Headache and Migraine
Children’s Mercy Kansas City implemented an acupuncture clinic to treat pediatric headaches and migraines in October 2015. The program began with one medical acupuncturist, Jennifer Bickel, MD, FAAN, FAHS. Two additional medical acupuncturists, Jennifer Dilts, DO, FAAP, and Anna Esparham, MD, were added to the team to meet increasing demand for acupuncture services. All three were trained at the Helms Medical Institute.
In a retrospective chart review of 154 visits to the Headache Treatment Center from September through November 2018 of patients ages 7-18, average headache intensity scores (measured on an 11-point pain numeric rating scale) decreased after a variety of interventions.
Specifically, acupuncture provided by a board-certified medical acupuncturist at the Headache Treatment Center decreased headache intensity significantly, mean change = 2.07 + 1.90 (n=24), p<.05.2
Demand for Acupuncture in the Emergency Department
Headache accounts for 1% to 4% of all visits to the pediatric emergency department, making headaches the ninth most common reason for all emergency department visits for patients under age 15.
In addition to variable efficacy of headache treatments received in the emergency department, there are other limitations associated with this setting that can make it suboptimal for the acute management of migraine. Such limitations include a lack of headache-trained or -informed providers, limited targeted interventions and comfort measures used for active headaches, a higher rate of treatment with opioids, and unnecessary imaging. Developing alternative viable models for early therapeutic intervention of headaches may be advantageous to improve management and limit disability.2
Expanding Acupuncture Treatment to the Emergency Department and Other Subspecialties
To address the growing demand for acupuncture in the Emergency Department and in other subspecialities, the medical acupuncturists within the Children’s Mercy Headache Treatment Clinic received a 2019 education grant from the American Academy of Pediatrics Section on Integrative Medicine.
As grant winners, the Children’s Mercy acupuncturists created an abbreviated basic acupuncture training curriculum that was implemented at the academic medical center. The 10-hour acupuncture course offered interested clinicians an accessible way to learn two basic acupuncture techniques: battlefield auricular acupuncture (BFA) and Four Gates.
Once learned, both techniques could be integrated into care at the bedside, making it possible for the patient to receive a clinical assessment and acupuncture treatment during the same emergency department visit from the same clinician.
Learning methods included an online module with videos and articles, two live workshops, and additional home practice.
Over a period of approximately 18 months, 38 pediatricians from nine pediatric subspecialties (22 emergency medicine providers, plus specialists in gastroenterology, hospital medicine, palliative care, hematology/oncology, rehabilitation, sleep medicine, developmental and behavioral pediatrics, and neurology) completed the course.
Participants completed pre- and post-tests measuring knowledge and attitudes, and a skills-based exam. Participants earned 10 American Board of Pediatrics Maintenance of Certification Part 2 points and 10 continuing medical education credits for completing the course.
Evaluation of Basic Acupuncture Curriculum
To determine the effectiveness of the acupuncture curriculum, the course instructors surveyed participants. Results included:
- Knowledge regarding acupuncture significantly increased following curriculum completion.
- The course significantly increased participants’ perceived efficacy of acupuncture for acute and chronic pain.
- All participants successfully completed a skills-based exam.
- All participants felt that the course would influence their current medical practice.
- All participants felt confident utilizing basic acupuncture.
- All participants felt that they would recommend the basic acupuncture curriculum to a colleague.
In a separate study on acupuncture from the Children’s Mercy Emergency Department, the researchers found most staff, parents and patients reported willingness to use acupuncture. In fact, patients (60%) and parents (73%) were willing to add 15 to 60 minutes to their Emergency Department length of stay to complete an acupuncture treatment.
AAP Section on Integrative Medicine Awards Acupuncture Research First Place Honor
As the AAP grant winners, the team was invited to present their research abstract at the AAP National Conference & Exhibition in October 2020 at the Section on Integrative Medicine’s joint session on pain with the Section on Pediatric Emergency Medicine.
The project received the best abstract award for the meeting and generated significant interest from other pediatric institutions interested in collaborating to develop and implement similar programs for their physicians and patients.
Collaborate With Children's Mercy to Bring the Basic Acupuncture Curriculum to Your Institution
Jennifer Bickel, MD, FAAN, FAHS, Medical Director, Center for Professional Well-Being, Division of Neurology, Chief Headache Section
Jennifer Dilts, DO, FAAP, Division of Neurology, Headache Section
Anna Esparham, MD, FAAP, Director of Headache Treatment Center, Division of Neurology
For consults, admissions or transport call: 1 (800) GO MERCY / 1 (800) 466-3729.
Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, Ratner E, Lemmon RL, Wayne P, Zador V. Evidence-based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper.
Esparham A, Boorigie M, Ablatt S, Connelly M, Bickel J. Improving Acute Treatment of Pediatric Primary Headache Disorders With a Novel Headache Treatment Center: Retrospective Review of Preliminary Outcomes. Journal of Child Neurology. DOI: 10.1177/0883073820952997journals.sagepub.com/home/jcn.
Children’s Mercy Kansas City is an independent, non-profit, 390-bed pediatric health system, providing over half a million patient encounters each year for children from across the country. Children’s Mercy is ranked by U.S. News & World Report in all ten specialties. We have received Magnet® recognition five times for excellence in nursing services. In affiliation with the University of Missouri-Kansas City, our faculty of nearly 800 pediatric specialists and researchers is actively involved in clinical care, pediatric research and educating the next generation of pediatricians and pediatric subspecialists. The Children’s Mercy Research Institute (CMRI) integrates research and clinical care with nationally recognized expertise in genomic medicine, precision therapeutics, population health, health care innovation and emerging infections. In 2021 the CMRI moved into a nine-story, 375,000-square-foot space emphasizing a translational approach to research in which clinicians and researchers work together to accelerate the pace of discovery that enhances care.