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Observations regarding battlefield acupuncture to treat low back pain in the emergency department?

      We read with great interest a recent publication on the use of battlefield acupuncture (BFA) to treat low back pain (LBP) in the emergency department [
      • Fox L.M.
      • Murakami M.
      • Danesh H.
      • Manini A.F.
      Battlefield acupuncture to treat low back pain in the emergency department.
      ]. This is a pilot interventional study illustrating the feasibility of using ear acupuncture as a modality to alleviate symptoms of LBP. We would like to highlight a few observations. Although the study has shown a statistically significant difference in the post-intervention numerical rating scale (NRS) for low back pain between the control group and BFA group, it was unclear what were the pre-intervention NRS in these 2 groups and the changes in the pre-and-post intervention NRS between the 2 groups. A statistically significant NRS between the two groups post intervention does not equate a statistically significant reduction in NRS within the group pre-and-post treatment. As a result, it was impossible to comment on the clinical significance between the pre-and-post intervention NRS. A previous study conducted in an emergency department setting involving patients presenting with pain had determined the minimum clinically significant difference for the 11 point NRS to be 1.39 ± 1.05 (95% confidence interval, 1.27–1.51) [
      • Kendrick D.B.
      • Strout T.D.
      The minimum clinically significant difference in patient-assigned numeric scores for pain.
      ]. Hence knowing the magnitude of change in NRS may help to place the significance of the intervention in context.
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      References

        • Fox L.M.
        • Murakami M.
        • Danesh H.
        • Manini A.F.
        Battlefield acupuncture to treat low back pain in the emergency department.
        Am J Emerg Med. 2018 Jun; 36: 1045-1048
        • Kendrick D.B.
        • Strout T.D.
        The minimum clinically significant difference in patient-assigned numeric scores for pain.
        Am J Emerg Med. 2005; 23: 828-832
        • Jan A.L.
        • Aldridge E.S.
        • Rogers I.R.
        • Visser E.J.
        • Bulsara M.K.
        • Niemtzow R.C.
        Does ear acupuncture have a role for pain relief in the emergency setting? A systematic review and meta-analysis.
        Med Acupunct. 2017; 29: 276-289