Acupuncture on chronic pain
management:
Hong Kong service model
Dr Regina Choi
Associate Consultant
Kowloon East Cluster Pain Mangement Centre
United 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?
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
Chinese-Western Medical Beliefs Scale
(1-5)
Variables
Mean
SD
TCM restorative effect
3.66
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 effects
3.77
0.59
Subtotal of WM
superior scores
3.71
0.49
Score range 1 ( very disagree) to 5 ( very agree)
Trust Score (1-5)
Variables
Mean
SD
TCM physician
3.4
0.84
WM physician
3.8
0.75
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
Practitionersprescribing
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 nongovernment 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 centre
United 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 consentedTo 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
A survey on out-patient chinese medicine service in
KEC pain management centre
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 posttreatment ( 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
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 perceived by patients on a
numerical rating scale of 0 to 10
Pain
intensity
Mean pain
Median pain
score
score
(S.D.)
Highest over
past 4
7.23 (1.813)
weeks
Lowest over
past 4
4.3 (1.950)
weeks
Average
over past 4 5.86 (1.866)
weeks
Now
5.97 (2.195)
Effect of pain on various aspects of functioning
on numerical rating scale of 0 to 10
Item
Mean 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
8
4
6
6
comparision on Pain intensity perceived by patients before and
after acupuncture treatment
Pain intensity
Mean pain
Median
Median pain Mean pain
p-value for
score (SD)
pain score
score after score (SD)
paired
after
before
acupunctur
before
Student’s
acupunctur
acupunctur
e
acupuncture
t-test
e
e
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
p-value
Mean score
Median
Mean score (
Median
for paired
(SD) after
score after SD) before score before
Student tacupuncture acupuncture acupuncture acupuncture
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......