Acupuncture on chronic pain management:

Hong Kong service model

Dr Regina ChoiAssociate Consultant

Kowloon East Cluster Pain Mangement CentreUnited Christian Hospital

Hong Kong

Hong Kong is a place where the Chinese and Western culture meet and mix

Our beliefs and practice in seeking health care

Our mode of practice of acupuncture

Some service models on acupuncture practice

Any hurdles coming for “integration” of care?

What are the ways forward?

What is

Hong Kong is a mixing bowl for Western and Chinese culture

It is a dynamic, open to world city

what was the attitudes to traditional chinese medicine and western medicine of the people

in hong kong?

Attitudes Of Hong Kong chinese to traditional chinese medicine :survey and cluster analysis

Objectives - determine whether within a cohort of Hong Kong out-patients, any definable subtypes exist based on their attitudes to traditional Chinese medicine and Western medicine

E Mok et al. Complementary Therapies in Medicine 2003 ;11: 103-9

What were the results?

Total of 503 respondents in 3 major clinics while they were in waiting area for clinic service, all are Chinese aged > 18 yrs

67% female , 55% education level college or above,over representation of subjects between ages of 20-29 (43%)

Extent of beliefs and trust to traditional chinese medicine compared to western medicine

Variables Mean SDTCM restorative

effect3.66 0.52

TCM fewer side effect

3.78 0.58

TCM therapeutic effect

3.4 0.69

TCM prioritised 2.89 0.79

Subtotal of TCM superior scores

3.45 0.45

WM quality and facilities

3.68 0.59

WM efficiency of treatment and

effects3.77 0.59

Subtotal of WM superior scores

3.71 0.49

Chinese-Western Medical Beliefs Scale (1-5)

Variables Mean SD

TCM physician

3.4 0.84

WM physician 3.8 0.75

Trust Score (1-5)

Score range 1 ( very disagree) to 5 ( very agree)

Score range from 1(not at all) to 5 ( very much)

Different practitioners practising acupuncture in Hong Kong

Acupuncture practitioners in Hong

Kong

Western

medicine practitioners

with acupuncture

qualifications, practising

“dry needling “

Physiotherapists with recognised

qualifications

Traditional Chinese Medicine

Practitioners- prescribing

herbs, acupuncture

Western medicine practitioners practice

Numerous Western medicine practitioners are qualified Chinese medicine practitioners

Some have certain qualifications on acupuncture/Chinese herbs

Practice acupuncture based on literature, chinese medicine diagnosis

hong kong physiotherapy association ltd -acupuncture & integrative medicine specialty

group (AIMSG)

Conduct lectures and courses regularly on topics on acupuncture

Run diploma course on acupuncture for physiotherapists

Run practical courses in Mainland China

Responsible for accreditation of acupuncture qualifications and experience for physiotherapists

chinese medicine practitioners

According to Chinese Medicine Council of Hong Kong, currently there are > 6000 Chinese Medicine practitioners in Hong Kong ( Data 4/2011)

They take up about 20% of the medical consultations in Hong Kong ( data from Chinese Medicine Council of Hong Kong 2001)

Hospital Authority Chinese Medicine (CM)Department runs 18 CM centres, with bilateral mode of collaboration model with non-government organisations/local universities

Provide different modalities of treatment including chronic pain acupuncture treatment

Integrated Practice Model

INtegrated Chinese and Western Medicine treatment centre

Mission

The medical and health services of Tung Wah aim at providing Western and Chinese health care services to the community, as well as expanding services which fall out of the current public health system to cater for the specific needs of the community through the collaboration with the Government and institutions from both public and private sectors.

TWGHS INtegrated Chinese and Western Medicine treatment centre

It started to operate since 2006

Runs day centre, to provide herbal soup, acupuncture to terminal cancer patients

Runs out-patient clinics

Under planning, to provide service to inpatients with predefined clinical treatment protocols

TWGHS INtegrated Chinese and Western Medicine treatment centre

Disease with predefined treatment protocols -

Stroke

trigeminal neuralgia

Facial Palsy

Parkinson’s Disease

Low Back Pain

Osteoporosis

Asthma (paediatric cases)

TWGHS INtegrated Chinese and Western Medicine treatment centre

There will be chinese medicine practitioners and western medicine practitioners in charge of case

Joint consultation may be facilitated

What about acupuncture and chronic pain management?

Kowloon east cluster(KEC) pain management centre hong kong

Incorporated acupuncture service since year 2000, provided by physiotherapists and pain physicians with appropriate qualification in acupuncture

Chinese Medicine practitioners started to offer acupuncture service since 2009

Our chinese medicine clinic setting

pain managment centreUnited christian hospital hong kong

Free assessment by Chinese medicine

practitioners in multidisciplinary new case

clinic

Case conference after new case session among pain physician,pain nurse, clinical

psychologist and chinese medicine practitioners

patient consented - additional followup to

receive acupuncture /herb

treatment

Patient not consented-To be reviewed

subsequent FU , may be referred back to chinese medicine practitioners or

physiotherapists for acupuncture

Outcome measures on effects of chinese medicine on our pain patients

The survey was carried out from the period of May 2009 to July 2010.

Patients received acupuncture treatment by chinese medicine practitioners

2 sets of questionnaires, pre-treatment and post-treatment ( after 10 sessions and sent by mail ), based on Brief Pain Inventory (BPI) were collected

A survey on out-patient chinese medicine service in KEC pain management centre

A survey on out-patient chinese medicine service in KEC pain management centre

37 patients completed the 1st set of questionnaire , with response rate of 84% on 2nd set .

Regions of pain complaint include LBP, neck, limbs, TMJ.

They may receive physiotherapy at the same time

Pain intensity and effects

Pain intensity

Mean pain score (S.D.)

Median pain score

Highest over past 4

weeks

7.23 (1.813)

8

Lowest over past 4

weeks4.3 (1.950) 4

Average over past 4

weeks

5.86 (1.866)

6

Now5.97

(2.195)6

ItemMean score (S.D.)

Median score

Daily activities 5.83(2.679) 7

Mood 5.97 (2.125) 6

Walking 5.52 (2.706) 5

Physical exertion 6.42 (2.446) 7

Interpersonal relationship

4.45 (3.150) 5

Sleep 6.45 (2.488) 7

Enjoyment of life 6.10 (3.045) 7

Concentration 5.90 (2.587) 5

Appetite 4.16 (3.067) 4

Pain intensity perceived by patients on a numerical rating

scale of 0 to 10

Effect of pain on various aspects of functioning on numerical rating scale of 0

to 10

comparision on Pain intensity perceived by patients before and after acupuncture treatment

Pain intensity

Mean pain score

(SD) after acupunct

ure

Median pain score

after acupunctu

re

Mean pain score (SD)

before acupunctu

re

Median pain score before

acupuncture

p-value for paired Student’s

t-test

Highest over past 4 weeks

6.29 (2.224) 7 7.23 (1.813) 8 0.045

Lowest over past 4 weeks

3.90 (2.587) 4 4.30 (1.950) 4 0.487

Average over past 4 weeks

5.22 (2.217) 5 5.86 (1.866) 6 0.200

Now 5.26 (2.516) 5 5.97 (2.195) 6 0.235

COmparision on effects of pain on various aspects of functioning before and after

acupuncture

Item

Mean score (SD) after

acupuncture

Median score after acupunctu

re

Mean score ( SD)

before acupunctur

e

Median score before

acupuncture

p-value for

paired Student

t-test

Daily activities 5.00 (2.933) 5 5.83 (2.679) 7 0.118

Mood 4.68 (3.092) 5 5.97 (2.125) 6 0.034

Walking 4.42 (2.975) 5 5.52 (2.706) 5 0.038

Physical exertion 5.48 (2.682) 6 6.42 (2.446) 7 0.026

Interpersonal relationship 4.01 (3.609) 3 4.45 (3.150) 5 0.511

Sleep 5.16 (3.216) 5 6.45 (2.488) 7 0.017

Enjoyment of life 5.48 (3.305) 6 6.10 (3.045) 7 0.233

Concentration 4.94 (3.076) 5 5.90 (2.587) 5 0.057

Appetite 3.84 (2.979) 3 4.16 (3.067) 4 0.541

All respondents( n= 37) had acupuncture as mainstay of treatment

3 patients also use herbs on top of acupuncture

Satisfaction score (0-10) rated after 10 sessions of treatment (mean 7.322, SD 2.372)

CAn we “integrate” Chinese medicine and western medicine ?

attitudes to traditional Chinese Medicine amongst western trained doctors in China

Survey conducted in Shenyang, Northern China

177 respondents from 4 major centres.

98% respondents have some theoretical and practical Chinese medicine training

Consensus that TCM ( mainly herbal medicine ) was useful and safe in treating chronic and intractable disease

Harmsworth K et al. Soc. Sci Med 2001 ; 52(1) : 149-53

Current Situation in Hong kong

Majority of western medicine trained doctors are not familiar with theories and practice of chinese medicine

Fear of potential interactions of herbs, complications of acupuncture

Chinese medicine comprise different philosophy , but researches lay ground on its practice

Way forward ......

Promotion & governing of Chinese Medicine by various levels

Hospital Authority Chinese Medicine Service

Hong Kong Association for Integration of Chinese-Western Medicine / Hong Kong Chinese Medicine Council

Targets

Quality Service delivery

Information & Research (computerised Chinese Medicine Information System)

Training & Education

Pharmacology & toxicology

Collaboration between Western Medicine & Chinese Medicine, with protocol based practice

Chinese medicine hospital

We are going ahead......