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......