PICOT Question
Does treatment with acupuncture decrease the amount of pain in older adults with rheumatoid arthritis and osteoarthritis during flare-ups as compared to standard medical therapy?
Significance to Nursing Practice
The investigation on the effectiveness of acupuncture in managing pain in older adults with rheumatoid arthritis and osteoarthritis during flare-ups is relevant to nursing practice since RA and OA are considered the leading causes of disability among non-institutionalized older adults across the globe. Additionally, other interventions associated with both RA and OA such as exercising are only effective in controlling the severity of the diseases rather than pain management (Manyanga, et al., 2014) . Pharmaceutical solutions such as non-steroidal anti-inflammatory drugs (NSAIDS) and acetaminophen are only effective for a limited time frame and are associated with various side effects such as stomach upsets (Casimiro, et al., 2005) . Therefore, since it is the solemn duty of a nurse a s a medical provider to ensure the comfort of the patients including increasing their quality of life through pain management the assessment of the effectiveness of acupuncture is valid.
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Summary of Findings
Research illustrates that it is a daunting activity to provide a conclusive statement on the effectiveness of acupuncture in pain management in patients suffering from rheumatoid arthritis and osteoarthritis. The results differ from study to study where some maintain that the procedure has no substantial benefit to patients with RA and OA (Casimiro, et al., 2005) . However, it is important to note that many conventional studies often relied on the simplicity of randomized studies a factor that ignores the complexity associated with experiments on acupuncture. A case in point is research that utilized one needle and another one that applied six standard points showcasing the researchers’ ignorance on activities associated with acupuncture, particularly the fact that simplistic point formulas do not encompass the entire acupuncture procedure (Tam, Leung, Zhang, Li, & Li, 2007) . Greenwood and Smith (2012) ; Manyanga et al., (2014) , on the other hand, argue that acupuncture is effective in reducing the intensity of pain and increasing functional mobility. Other researchers have gone to the extent of arguing that acupuncture is effective in medical professionals’ effort to reverse the occurrence of RA (Manyanga, et al., 2014) . Moreover, many of the studies focused on the application of the acupuncture in general practice in pain management b ut did not consider the use and effectiveness of the procedure during flare-ups.
Nursing Practice
In RA, the main reason for pain is the systemic inflammation in addition to peripheral and central pain processing techniques including the loss of analgesic activity. In the case of OA, the main cause of pain is wear and tear of muscles and joints. One practice associated with acupuncture that can be applied in the management of the pain in both RA and OA is the simple acupuncture, where the procedure involving inserting needles in the Traditional Chinese Medicine (TCM) located in the meridian can be conducted in the extra-meridian acupoints (Chou & Chu, 2018) . Indeed, instead of relying on the distinct points mentioned in TCM, a nurse can insert needles in the extra-meridian points and still cause a response in the nervous system of either an RA or OA patient.
It is important to acknowledge that many western medical providers do not recognize the concepts of qi and meridian that are postulated in TCM. However, scientific evidence illustrates there is a valid explanation of how acupuncture, particularly, simple acupuncture, provides for pain relief. Inserting needles in the extra-meridian points influences various physiological mechanisms in the nerves system that controls pain in the body (Seca, et al., 2016) . Undeniably, a well-placed needle in the extra-meridian points will result to cascade of events including the provision of a signal that moves along the spinal cord to the brain as such triggering the release of neurotransmitters such as endorphins and encephalin which result to reduction in pain in both RA and OA (Manyanga, et al., 2014) . Additionally, simple acupuncture can be further facilitated through utilizing electrical stimulation where the impulse is provided through a needle that acts as an electric conductor that is attached to an external cable of the needle. Considering the extensive application of electric and electronic devices in the provision of health in the current society, it is deductible the application of the electrical stimulation in acupuncture is feasible. Additionally, since the main cause of pain in RA is swelling, simple acupuncture works to reduce inflammation through inducing the production of cortisol a hormone involved in the management of inflammation.
Strategy of Disseminating the Evidence-based Practice
The implementation of simple acupuncture in general practice as an intervention involved in pain management in patients with OA and RA involves extensive efforts in showcasing the benefits of the technique. Initially, after conducting research that illustrates the efficacy of simple acupuncture in pain relief in patients with OA and RA, I will present the study and the proposed change to the hospital administration. The presentation will involve both theoretical and practical knowledge on “how and how well” acupuncture works in pain relief (Chou & Chu, 2018) . Upon convincing the board and the hospital administration, the hospital administration will proceed to make an investment in the procedure by providing the necessary resources. Considering the simplicity of acupuncture and its characterization as an alternative medicine intervention it is likely that the financial investment in the intervention will be manageable.
However, human resource is the most expensive aspect associated with acupuncture due to the precision associated with acupuncture. Therefore, efforts of managing resistance to change from the healthcare providers involve assuring the nurses that acupuncture continues to prove effective in many illnesses associated with chronic pain. Additionally, voicing the ineffectiveness of other intervention such as side effects of pharmaceutical drugs will persuade the healthcare providers to embrace the change as their solemn duty to ensure the utmost comfort of their patients (Manyanga, et al., 2014) . Ultimately, embracing the change involves illustrating the effectiveness of acupuncture as proven by research in addition to showcasing the disadvantages associated with other interventions currently applied in pain management in older adults with RA and OA.
References
Casimiro, L., Barnsley, L., Brosseau, L., Milne, S., Robinson, V. A., Tugwell, P., & Wells, G. (2005). Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database System Review .
Chou, P.-C., & Chu, H.-Y. (2018). Clinical efficacy of acupuncture on rheumatoid arthritis and associated mechanisms: A systematic review. Evidence-based Complementary and Alternative Medicine , 1-21.
Greenwood, M. T., & Smith, C. L. (2012). Rheumatoid arthritis: An integrated acupuncture and energetic approach. Medical Acupuncture, 24 (2), 113-122.
Manyanga, T., Froese, M., Zarychanski, R., Abou-setta, A., Friesen, C., Tennenhouse, M., & Shay, B. (2014). Pain management with acupuncture in osteoarthritis: A systematic review and meta-analysis. BMC Complementary and Alternative Medicine .
Seca, S., Miranda, D., Cardoso, D., Greten, H., Cabrita, A., & Rodrigues, M. A. (2016). The effectiveness of acupuncture on pain. physical function and health-related quality of life in patients with rheumatoid arthritis: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 14 (5), 18-26.
Tam, L. S., Leung, P. C., Zhang, L., Li, T. K., & Li, E. K. (2007). The effect of acupuncture in patients with rheumatoid arthritis: A double-blind controlled pilot study. BMC Complementary Alternative Medicine., 3 (7), 35.
