Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial

Figures & data

Figure 1 Patient flowchart.

Figure 2 Visual analog scale (VAS) score over time in patients with renal colic.

Notes: Repeated VAS score analysis showed a significant and greater reduction of pain intensity in the acupuncture group compared to the morphine group from the 10-minute to the 60-minute time points.

Table 1 Baseline characteristics of patients

Characteristics	Acupuncture, n=54	Morphine, n=61	P
Age, years	42±14.8	41.8±13.21	0.82
Sex, female/male	28/26	26/35	0.32
Medical history, n (%)
Diabetes	7 (12.9)	7 (11.4)	0.8
Hypertension	8 (14.8)	7 (11.4)	0.59
Gastrointestinal ulcer	2 (3.7)	4 (6.5)	0.49
Previous renal colic	13 (24)	11 (18)	0.42
History of urolithiasis	5 (9.2)	8 (13.1)	0.51
Physical examination findings
Heart rate, bpm	83±12	81±14	0.51
Systolic blood pressure, mmHg	136±27	133±20	0.42
Diastolic blood pressure, mmHg	80±21	78±12	0.62
Oxygen saturation, %	98±1	98±1	0.94
Temperature, °C	36.9±0.3	36.9±0.3	0.24

Table 2 Main outcomes in the two study groups

Outcome criteria	Acupuncture, n=54	Morphine, n=61	P
VAS at admission, median (IQR)	83 (77–92)	85 (75–96)	0.5
VAS at 60 minutes, median (IQR)	10 (6–15)	22 (14–26)	0.002
Success rate* at 60 minutes, n (%)	47 (87)	51 (83)	0.6
Resolution time** (minutes), mean ± SD	14.5±7.8	28.2±12.4	<0.001

Notes:

* Decrease in admission VAS of at least 50%;

** time to obtain decrease in VAS of at least 50%.

Abbreviation: IQR, interquartile range; VAS, visual analog scale.

Table 3 Adverse effects

Outcome criteria	Acupuncture, N=54	Morphine, N=61	P
Minor, n
Drowsiness	0	1	0.356
Dizziness	0	26	<0.001
Nausea and vomiting	0	13	<0.001
Rash	0	1	0.356
Hypotension	0	1	0.356
Needle blockage	1	0	0.376
Itching/rash/bleeding at insertion point	2	0	0.179
Major, n	0	0	–
Total, n	3	42	<0.001

Table S1 Quality report of acupuncture intervention

Style of acupuncture	Local and distal points
Technique	Bilateral and unilateral
Number of needles	Left to the discretion of the physician, perhaps 2–16
Needling depth	As we felt the deqi, we stopped, as described in traditional texts
Deqi	Mentioned
Type of stimulation	Manual only
Needle retention time	20 minutes
Needle gauge and length	0.25×50 mm
Rationale of acupuncture	TCM diagnosis-based
Practitioner’s background	GP registered with Tunisian medical acupuncture society, with >3 years’ acupuncture treatment experience
Treatment regimen	For kidney colic only, one session
Control intervention	Conventional treatment (morphine)
Cointervention	None

Note: Assessed by the standards for reporting interventions in controlled trials of acupuncture.

Abbreviations: GP, general practitioner; TCM, traditional Chinese medicine.