Physician Perspectives on Acupuncture Use in the Pediatric Emergency Department

Acupuncture has been gaining increasing prominence as a non-pharmacological alternative for pain treatment, especially at a time when the world is facing a serious opioid crisis. In the United States, this crisis has cost an estimated $504 billion in a single year, with nearly 50,000 opioid-related deaths in 2019. Approximately 28% of these deaths were linked to physician-prescribed opioids, a number four times higher than in 1999. Against this alarming backdrop, there is a growing search for non-pharmacological methods of pain control, and acupuncture is emerging as a promising option, especially for children and adolescents seen in emergency services.

The National Institutes of Health (NIH) already recognizes acupuncture as a safe and effective treatment for acute and chronic pain. Emerging research shows that pediatric patients tolerate acupuncture well and may experience significant pain relief with this treatment. Previous studies have demonstrated that acupuncture may be useful for various painful conditions in children, including sickle cell pain crises, costochondritis, migraines, and even appendicitis. However, most of this research has focused only on treatment efficacy without exploring the factors that facilitate or hinder the implementation of acupuncture in healthcare services.

This study aimed to fill that gap by investigating the experiences of pediatric emergency physicians trained to use two specific acupuncture techniques: Battlefield Acupuncture and the Four Gates procedure. The researchers sought to understand both these clinicians' experiences applying these techniques and the factors influencing the feasibility of implementing acupuncture in a pediatric emergency department. The study was conducted within a Midwestern U.S. children's hospital system that serves more than 99,000 patients annually across its two emergency departments.

The study methodology was qualitative, using individual semi-structured interviews with eight pediatric emergency physicians who had completed basic acupuncture training. To obtain credentialing, these physicians had to complete the hospital's basic acupuncture course and demonstrate competency by performing at least one procedure of each technique as part of clinical care. The interviews, which lasted up to 65 minutes each, explored the physicians' positive and negative experiences, factors contributing to barriers and successes in implementation, and their perspectives on the future use of acupuncture in the emergency department. To elicit more honest and unbiased responses, interviews were conducted by a staff member who was not well known to the participants and did not work clinically with them.

The data analysis revealed four main themes emerging from these clinicians' experiences. First, multiple factors promoted the use of acupuncture in clinical practice. Physicians reported that acupuncture offers a more integrative and holistic approach to pain management, complementing standard treatment strategies and potentially limiting medication use. This was considered particularly important for patients who did not respond well to conventional treatments or for families who preferred to limit medication use.

Participants also noted that acupuncture fit well within the emergency workflow without causing significant delays. Notably, physicians were more likely to offer acupuncture for patients with headaches, including migraines, compared with other chief complaints.

The second theme identified barriers at multiple levels that impacted acupuncture implementation. At the individual level, barriers included patients' perception that acupuncture would be painful, lack of prior knowledge about the procedure, and satisfaction with conventional therapies. Parents raised similar concerns, plus anxiety about the additional time that acupuncture might add to the emergency department stay. Among medical staff, barriers included limited awareness of acupuncture availability, time constraints during periods of high demand, and difficulty recognizing patients who might benefit from the procedure.

At the systemic level, participants identified the unpredictability of the emergency environment, the fact that not all physicians were credentialed in acupuncture, lack of standardization in the process, and occasional supply issues.

The third theme revealed solutions at multiple levels to overcome these barriers. Participants recommended increasing acupuncture education for patients, parents, medical staff, and community physicians. This education should address both general acupuncture awareness and broadcasting that the treatment is available in the emergency department. A strong recommendation was that all emergency physicians should be credentialed in acupuncture to ensure more standardized and equitable care for all patients.

Participants also suggested mechanisms to improve recognition of patients who might benefit from acupuncture, including visual reminders in the emergency setting and clinicians who advocate for acupuncture use during their shifts.

The fourth and final theme demonstrated that all acupuncture-credentialed participants were in favor of continuing the program. They felt that having acupuncture available as a treatment option improved overall patient care. Physicians expressed enthusiasm about their positive experiences, including both professional satisfaction and patient satisfaction and pain improvement. Importantly, participants considered acupuncture a low-risk procedure, with potential benefits outweighing minimal risks of complications.

For patients and families, this study offers valuable insights into how acupuncture can be safely and effectively integrated into pediatric emergency care. The research suggests that adequate education may help overcome common fears about acupuncture, particularly the concern that the procedure is painful. For clinicians, the study indicates that implementing acupuncture in pediatric emergency departments is feasible but requires careful planning, comprehensive staff education, and adequate support systems. Creating standardized educational materials such as explanatory videos and informational pamphlets may facilitate both patient education and clinicians' work.

It is important to acknowledge the limitations of this study. The sample size was small, although the researchers reached data saturation consistent with standard qualitative methods. The study focused only on physicians who completed acupuncture training; future work should explore the perceptions of physicians who choose not to receive this training, as well as the perspectives of other team members such as nurses. Exploring the perspectives of caregivers and patients may identify additional facilitators and barriers to consider when implementing acupuncture in pediatric emergency departments.

In conclusion, this pioneering study demonstrates that physicians providing acupuncture in