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Research ArticleOriginal Research

Outcomes of Acupuncture for Chronic Pain in Urban Primary Care

M. Diane McKee, Benjamin Kligler, Jason Fletcher, Francesca Biryukov, William Casalaina, Belinda Anderson and Arthur Blank
The Journal of the American Board of Family Medicine November 2013, 26 (6) 692-700; DOI: https://doi.org/10.3122/jabfm.2013.06.130003
M. Diane McKee
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
MD, MS
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Benjamin Kligler
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
MD, MPH
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Jason Fletcher
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
PhD
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Francesca Biryukov
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
LAc
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William Casalaina
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
LAc
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Belinda Anderson
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
PhD, LAc
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Arthur Blank
From the Department of Family and Social Medicine, lbert Einstein College of Medicine, Bronx, NY (MDM, JF, AB); the Department of Integrative Medicine, Beth Israel Medical Center, New York, NY (BK); the Swedish Institute, New York, NY (FB, WC); and the Pacific College of Oriental Medicine, New York, NY (BA).
PhD
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  • Article
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Article Figures & Data

Figures

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    Figure 1.

    Recruitment and study participation. PCP, primary care physician.

  • Figure 2.
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    Figure 2.

    Average physical function using the 12-item Short Form (SF12; left) and pain severity using the Brief Pain Inventory (BPI; right) over time.

Tables

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    Table 1. Demographics of Participants Who Initiated Treatment (n = 226)
    Demographics
    Mean age, years (SD)54.3 (14)
    Born in the United States107 (47.3)
    Language spoken most frequently
        English160 (70.8)
        Spanish60 (26.5)
        Other6 (2.7)
    Marital status
        Married48 (21.2)
        Living with a partner12 (5.3)
        Divorced30 (13.3)
        Widowed30 (13.3)
        Separated27 (11.9)
        Never married1 (0.4)
        Single75 (33.2)
        Other1 (0.4)
    Race/Ethnicity
        Hispanic121 (53.5)
        Non-Hispanic black61 (27)
        Non-Hispanic white9 (4)
        Non-Hispanic other34 (15)
    Working status
        Unemployed23 (10.2)
        Full time52 (23)
        Part time13 (58)
        Disabled87 (38.5)
    Insurance
        Fee-for-service Medicaid7 (3.1)
        Managed care Medicaid129 (57.1)
        Private insurance52 (23)
        No insurance13 (5.8)
    Household Income ($)
        <20,00095 (42)
        20,000–29,00027 (11.9)
        30,000–39,00018 (8)
        40,000–49,0006 (2.7)
        >50,0007 (3.1)
        Don't know/refused to answer67 (29.6)
    Education
        Some HS or less79 (34.9)
        HS graduate55 (24.3)
        Some college57 (25.2)
        College graduate or more31 (13.7)
    • Data are n (%) unless otherwise indicated.

    • SD, standard deviation; HS, high school.

    • View popup
    Table 2. Pain, Disability, and Functional Status
    Brief Pain Inventory*12-Item Short Form†CPGSPFD: Days With Pain in the Past 2 Weeks (0–14)PIQ-6 (40–78)
    Pain Severity (0–10)Pain Interference (0–10)Physical Health (0–100)Mental Health (0–100)Fair/Poor General Health, n (%)Disability Score (0–100%)Characteristic Pain Intensity (0–100%)
    Before baseline
        6 weeks6.9 (6.6–7.1)6.9 (6.6–7.3)———72.6 (69.1–76.1)78.6 (76.8–80.3)13.0 (12.6–13.3)68.4 (67.5–69.2)
        4 weeks6.9 (6.6–7.2)6.6 (6.2–7)—————12.5 (12–12.9)—
        2 weeks7.0 (6.6–7.4)6.5 (6–7)—————12.5 (11.9–13)—
    Baseline6.7 (6.5–7)6.4 (6–6.8)31.7 (30.4–33.1)38.2 (36.2–40.1)107 (46.7)66.8 (62.8–70.8)77.3 (75.2–79.3)12.3 (11.9–12.8)67.4 (66.4–68.3)
    Follow-up
        2 weeks6.2 (5.8–6.5)5.5 (5–5.9)—————11.1 (10.5–11.8)63.9 (62.7–65.2)
        4 weeks5.7 (5.3–6.1)5.0 (4.5–5.6)—————10.7 (10–11.4)62.3 (60.9–63.7)
        8 weeks5.6 (5.2–6)5.0 (4.4–5.6)—————10.7 (9.9–11.4)61.5 (59.9–63.1)
        12 weeks5.6 (5.2–6.1)4.9 (4.3–5.5)35.7 (33.8–37.6)43.7 (41–46.4)52 (40.63)43.7 (37.7–49.8)65.1 (61.2–69.1)10.1 (9.3–10.9)61.8 (60.1–63.4)
        16 weeks5.7 (5.2–6.3)5.0 (4.4–5.7)—————10.6 (9.7–11.5)61.7 (59.9–63.5)
        24 weeks5.5 (4.9–6.1)5.0 (4.4–5.7)35.3 (33–37.5)45.2 (42.5–47.8)36 (33.64)45.2 (38.2–52.2)64.7 (59.9–69.5)10.9 (10–11.7)62.2 (60.2–64.1)
    • Data are mean (standard deviation) unless otherwise indicated.

    • ↵* Higher Brief Pain Inventory score indicates more severe pain.

    • ↵† Higher 12-item Short Form score indicates better function.

    • —, Not measured; CPGS, Chronic Pain Grading Scale; PFD, pain-free days; PIQ-6, 6-item Pain Impact Questionnaire.

    • View popup
    Table 3. Adjusted Regression Coefficients (Hierarchical Linear Modeling) for Pain Severity and Physical Function
    SF-12 Physical FunctioningP ValueBPI Pain SeverityP Value
    Estimate95% Confidence IntervalEstimate95% Confidence Interval
    Treatment period3.034.811.24<.001−0.71−0.40−1.03<.001
    Posttreatment period2.614.470.77.006−0.410.77−1.59.496
    Time (weeks centered around baseline)————−0.04−0.130.04.117
    Time × treatment period————−0.020.04−0.08.554
    Time × after treatment period————−0.010.07−0.08.854
    Site.44.744
        Site A−0.55−3.682.580.12−0.360.60
        Site B2.00−1.505.50−0.20−0.740.35
        Site C−0.66−3.452.130.00−0.430.43
        Site DReferenceReferenceReferenceReferenceReferenceReference
    CPGS disability score−0.14−0.18−0.10<.0010.040.030.04<.001
    Treatments received0.230.080.38.003————
    Age−0.18−0.26−0.10<.001————
    Medicaid————0.500.850.15.005
    • BPI, Brief Pain Inventory; CPGS, Chronic Pain Grading Scale; SF12, 12-item Short Form.

    • View popup
    Table 4. Correlation Between Global Assessment of Change and Observed Change in Outcomes
    CGICΔBPIΔSF12
    Patient global impression of change*0.1320.293†−0.249‡
    CGIC*0.1660.001
    Change in BPI (4 month after baseline)−0.277‡
    • ↵* Lower scores indicate greater improvement.

    • ↵† <.01.

    • ↵‡ <.05.

    • BPI, Brief Pain Inventory; CGIC, clinical global assessment of change; SF12, 12-item Short Form.

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The Journal of the American Board of Family     Medicine: 26 (6)
The Journal of the American Board of Family Medicine
Vol. 26, Issue 6
November-December 2013
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Outcomes of Acupuncture for Chronic Pain in Urban Primary Care
M. Diane McKee, Benjamin Kligler, Jason Fletcher, Francesca Biryukov, William Casalaina, Belinda Anderson, Arthur Blank
The Journal of the American Board of Family Medicine Nov 2013, 26 (6) 692-700; DOI: 10.3122/jabfm.2013.06.130003

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Outcomes of Acupuncture for Chronic Pain in Urban Primary Care
M. Diane McKee, Benjamin Kligler, Jason Fletcher, Francesca Biryukov, William Casalaina, Belinda Anderson, Arthur Blank
The Journal of the American Board of Family Medicine Nov 2013, 26 (6) 692-700; DOI: 10.3122/jabfm.2013.06.130003
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