Comparative Effectiveness of Acupuncture and Tramadol for Treatment of Acute Ankle Injury


  • Nopmanee Tantivesruangdet, M.D.
  • Chayanin Vejaphuti, M.D.
  • Sukrom Cheechareoan, M.D.


Acute ankle injury, VAS pain score, Acupuncture, Tramadol, Ottawa Ankle Rules


Background : Acute ankle injuries are common musculoskeletal problem in the general population. Acupuncture is an alternative treatment for acute ankle sprain, and the World Health Organization has recommend edits use for relief of musculoskeletal pain.

Objective : The objective of this study was to study the effectiveness of acupuncture compared with intramuscular tramadolin treatment of patients with acute ankle injury within 1 week.

Methods : This was a clinical trial of 72 patients, aged over 14 years, who presented with acute ankle injury or partial tear of tendon without fracture diagnosed by Roentgenogram, who pain score more than 6 were treated by acupuncture or tramadol. Visual analog scale pain score was assessed before and after treatment with acupuncture or tramadol at the time of the first treatment, after 0 minutes, and then after 10, 20, 30 minutes, 1 week and 4 weeks.

Results : The mean age of the patients was 32.15 ± 12.62 years old, 62.5% were female, 66.70% had ankle sprain grade II, 52.80% had left ankle sprain and 70.8% had a non-road traffic injury. The Body Mass Index was 23.52 ± 5.27 Kg/ m2.The effectiveness of acupuncture and tramadol in patients with acute ankle injury within 1 week were different. More pain reduction was seen in patients using acupuncture than in patients using tramadol after 10 minutes, 20 minutes, 30 minutes and 1week. No difference in pain reduction was seen at 4 week. Moreover, the patients who had pain scores less than 4 in acupuncture group were more than tramadol group significantly at 20minutes, 30 minutes and one week.

Conclusion : Treatment of patients with acute ankle injury with acupuncture can relieve pain more than tramadol within 20 minutes with statistical significantly.


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Beal MW. Acupuncture and oriental body work: traditional and biomedical concepts in holistic care: history and basic concepts. Holist Nurs Pract 2000; 14:69-78.

Wang SM, Kain ZN, White P. Acupuncture analgesia: I. The scientific basis. Anesth Analg 2008; 106:602-10.

World Health Organization. MediaCenter[Internet].1995 [cited 2015Feb12].Available from:

Melchart D, Linde K, Fischer P, Berman B, White A, Vickers A, et al. Acupuncture for idiopathic headache.Cochrane Database Syst Rev 2001: CD001218.

Tulder MW VA, Cherkin DC, Berman B, Lao L, Koes BW.Acupuncture for low backpain. Cochrane Database Syst Rev 2000; CD001351.

White AR, Ernst E. A systematic review of randomized controlledtrials of acupuncture for neck pain.Rheumatology 1999; 38:143-7.

Zhang W. Clinical observation on the effect of acupuncture and physiotherapy for ankle sprain. China Foreign Medical Treatment 2012; 7:113.

Moore RA, Derry S, Makinson GT, McQuay HJ. Tolerability and adverse events in clinical trials of celecoxib in osteoarthritis and rheumatoid arthritis: systematic review and meta-analysis of information from company clinical trial reports. Arthritis Res Ther 2005; 7: 644-65.

Longman MJ, weil J, Wainwright P, Lawson DH, Rawlins MD,Logan RF, et al. Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 1994; 343:1075-8.

Tantivesruangdet N. Acupuncture treatment for acute ankle injury in the emergency department: a preliminary case report. J Med Assoc Thai 2016; 99:223-6.

Vanderploeg K, Yi X. Acupuncture in modern society. J Acupunct Meridian Stud 2009; 2:26-33.

Cohen M, Parker S, Taylor D, Smit de V, Ben-Meir M,Cameron P, et al. Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments:study protocol for a randomized controlled trial.Trials 2011; 12: 241.

Park J, Hahn S, Park JY, Park HJ, Lee H. Acupuncture for ankle sprain: systematic review and meta-analysis.BMC Complement Altern Med 2013; 13:55.

Anderson RB, Hunt KJ, McCormick JJ. Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg 2010; 18: 546-56.

Scheiman JM. NSAID-induced Gastrointestinal Injury: A Focused Update for clinicians. J Clin Gastroenterol 2016;50:5-10.

Kim TH, Lee MS, Kim KH, Kang JW, Choi TY, Ernst E.Acupuncture for treating acute ankle sprains in adults.Cochrane Database Syst Rev 2014; 6:CD009065.

Wei BX, Jin CL, Chen WQ. Control observation on treatment of acute ankle joint lateral collateral ligament injury, Chinese Acupuncture and Moxibustion2004; 24:248–50.

Wu ZS. Bloodletting therapy for the acute ankle sprain:clinical research and clinical evaluation Chinese medicine,(Thesis of Master’s Degree). Beijing: Beijing University; 2007.

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I,Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992; 21:384-90.

American Medical Association Committee on the Medical Aspects of Sports: Standard Nomenclature of Athletic Injuries.Chicago, IL, American Medical Association; 1966.

Focks C, English editor. Atlas of Acupuncture. Edinburgh:Churchill Livingstone Elsevier2008:251-314.

Focks C, English editor. Atlas of Acupuncture. Edinburgh:Churchill Livingstone Elsevier2008:399-422.

Marc C, Shefton P. Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments:Study protocol for a randomized controlled trial. J Trials 2011; 12:241.

Cohen MM, Smit V, Andrianopoulos N, Ben-Meir M, Taylor DM,Parker SJ, et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust 2017;206: 494-9.



How to Cite

Tantivesruangdet น, Vejaphuti ช, Cheechareoan ส. Comparative Effectiveness of Acupuncture and Tramadol for Treatment of Acute Ankle Injury. j dept med ser [Internet]. 2021 Mar. 10 [cited 2022 Aug. 14];45(4):202-7. Available from:



Original Article