Background: Inpatient pain management for oncology patients relies predominantly on pharmacologic strategies, particularly opioids, which are associated with various side effects and potential complications. Structural and resource differences between university and public hospitals may contribute to inequities in pain control, yet these disparities remain understudied. Acupuncture has emerged as a safe and effective integrative therapy for cancer-related pain, but most evidence comes from university hospitals, with limited data from public hospital settings. This study evaluates whether incorporating acupuncture into inpatient care reduces differences in pain outcomes between a university hospital and a public safety-net hospital.
Methods: We performed a secondary analysis of the Pragmatic Research of Acupuncture and pain Counseling eXtended to Inpatient Services (PRACXIS) randomized controlled trial evaluating acupuncture and pain counseling for hospitalized adults with cancer pain. The study was conducted at a university hospital (UH) and a public hospital (PH) from January 2019 to May 2021. A total of 447 participants (UH n=338; PH n=109) receiving usual care were randomized to acupuncture, pain counseling, neither, or both daily for up to 4 hospital days in a 2×2 factorial design. Primary outcomes included average daily change in worst pain, pain relief, emotional distress, symptom severity, symptom burden, and health-related quality of life. Patient-reported outcomes were collected via surveys. We used intent-to-treat linear mixed models to examine heterogeneity of treatment effects. This analysis focuses on acupuncture versus no-acupuncture groups.
Results: PH patients were more racially and linguistically diverse than UH patients (Latino 36.7% vs 21.4%; Asian/Pacific Islander 18.3% vs 8.0%; Black/African American 13.8% vs 4.4%) and had higher metastatic disease rates (31.2% vs 19.2%) (Table 1). Differences in treatment outcomes varied by hospital (Table 2). In the no-acupuncture group, UH patients demonstrated significantly greater improvement in pain relief (–0.44 [95% CI –0.85, –0.03]), symptom severity (0.26 [95% CI 0.06, 0.46]), and symptom burden (0.43 [95% CI 0.17, 0.69]) than PH patients. Among those who received acupuncture, between-hospital differences were reduced for pain relief (0.03 [95% CI –0.36, 0.43]), symptom severity (0.00 [95% CI –0.20, 0.20]), and symptom burden (0.15 [95% CI –0.11, 0.41]).
Conclusions: Acupuncture reduced disparities in patient-reported outcomes between university and public hospital settings, suggesting that incorporating nonpharmacologic approaches may help mitigate inequities in inpatient pain management.
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