Return to Increase Access to Alternative Therapies to Treat Pain

Research on Acupuncture for Acute Pain

Acupuncture is a type of complementary medicine that involves using needles to prick the skin or tissues in order to alleviate pain as well as treat other various conditions that may be physical, mental, and emotional in nature. It has been studied for its effect on pain reduction. In a 2016 study , acupuncture and morphine were used to treat acute onset moderate to severe pain in an emergency department. The success rate of acupuncture was significantly higher than that of morphine (92% in the acupuncture group and 78% in the morphine group). The pain resolution time was quicker with acupuncture: 8-14 minutes in the acupuncture group and 14-42 minutes in the morphine group. Overall, 29.6% of patients experienced minor adverse effects. 2.6% of patients were in the acupuncture group and 56.6% in the morphine group. Overall, acupuncture was associated with faster and more effective analgesia with better tolerance and less adverse effects. Currently, there is no sufficient evidence to support using acupuncture in acute medical settings, but with more trials and studies, it can possibly find a central place or have a larger role in acute pain management in emergency settings.

According to the December 2017 publication, 'Evidence-based Non-pharmacologic Strategies for Comprehensive Pain White Paper, "In multiple systematic reviews with meta-analyses, acupuncture was effective in reducing post-surgical pain compared to sham acupuncture, controls and usual care with reduction in opioid need (21% opioid reduction at 8 hours, 23% at 24 hours and 29 % at 72 hours post-surgery) with lowered incidence of opioid-related side effects such as nausea, dizziness, sedation, pruritus and urinary retention."[1]

That same report cited research on the use of Virtual Reality (VR) technology that enables people to become immersed in a computer-simulated, three-dimensional environment as a distraction to pain. Coupled with standard analgesia, VR has been found beneficial in reduction of burn-induced pain and burn wound care in adults and children.[2] VR assisted burn and nonburn wound care reduced opioid need by 39% compared to no VR, while levels of pain and anxiety were similar.[3]

Research on Acupuncture for Chronic Pain

Based on a recent 2017 study , acupuncture is now recommended by many professionals in the medical field to treat several chronic pain conditions. There have been many successful cases in which acupuncture has been used to treat chronic low back, neck, shoulder and knee pain, and also in perioperative settings. Acupuncture has also been used as an adjunct or alternative to opioids, as it is finding its way more and more into pain medicine practices and procedures as well as in training programs. Although further study is needed in regards to its use as an adjunct or alternative to opioids, acupuncture has been proven to be safe, effective, and economical method to treat several chronic pain conditions.

Payment Options and Issues for Acupuncture

Paying for acupuncture treatments is often a problem for patients. Medical insurance only rarely covers acupuncture, and most people who would benefit from it cannot afford it. Treatments cost between $70 and $100 per visit, and most people need several over the course of weeks. Neither Medicare nor the Veterans Administration typically cover acupuncture.[4] (Medicare seems to cover it is Michigain... Investigate.)

Medicare and Medicaid Coverage for Acupuncture

As of early 2018, Medicaid covers acupuncture in Ohio, California, Oregon, New Jersey, Massachusetts and Minnesota. In addition, Maine and Vermont are considering whether to cover the treatment for their Medicaid patients after completing pilot studies testing its effectiveness.The Social Security Act also affords Medicaid agencies significant flexibility
in covering additional services allowable under state law and Medicaid agencies can use this flexibility to cover alternative chronic pain management services, including acupuncture.[5]

Ohio

Ohio’s Medicaid program recently expanded its coverage for acupuncture for pain after an opioid task force urged state officials to explore alternative pain therapies.[6]
Starting January 1, 2018 more than 108,000 Ohioans on Medicaid who have diagnosed low back pain or migraines will be able to see an acupuncturist for pain management. The change in policy is to help reduce opioid prescriptions and overdose deaths resulting from treating chronic pain with addictive drugs. Ohio has been one of six states in the country to cover acupuncture treatments for Medicaid patients, but only when offered by a doctor. Starting in 2018, Medicaid reimbursement will be open to licensed non-physician acupuncturists who register as Medicaid providers.[7]

Michigan

In Michigan, Medicare Supplemental benefits with the State Health Plan PPO covers 80% of acupuncture treatments (after deductible) up to a maximum of 20 visits in a calendar year when performed by a licensed physician (MD or DO), or supervised and billed by a licensed physician (MD or DO). Acupuncture is covered only for the treatment of the following conditions:[8]
  • Sciatica
  • Neuritis
  • Postherpetic neuralgia
  • Tic douloureux
  • Chronic headaches such as migraines
  • Osteoarthritis
  • Rheumatoid arthritis
  • Myofascial complaints such as neck and lower back pain

Barriers for Acupuncture Treatment

While there have been promising studies and programs demonstrating the effectiveness of acupuncture in treating certain types of chronic pain, without clearer quality outcomes and cost-effectiveness, many policymakers are hesitant to support non-pharmaceutical alternatives in treating pain, and while there are insurances that will cover alternative pain management methods, they also acknowledge that there is a need for more evidence.[9] Companies and policymakers are still weighing the evidence against the possible outcomes for opioids and hoping that more pilots and studies will help illuminate some of these questions.

In recent surveys, multiple states have indicated that state budgets have hindered their ability to expand new alternative pain management techniques; therefore, even if some states indicate that non-pharmaceutical pain management techniques are desired, states like Washington and and Alabama have not been able to expand to such programs due to budgets not being expanded to accommodate new alternatives like acupuncture.[10]

Improving Access to Acupuncture Providers

Even if acupuncture is covered by Medicaid, Medicare or insurance, it is still important to expand access to licensed providers who offer acupuncture services. Ohio is striving to improve access to acupuncture for pain management by allowing Medicaid patients to see licensed, non-physician acupuncturists who register as Medicaid providers starting in January of 2018[11] . About half of Ohio's 250 licensed acupuncturists are expected to register as Medicaid providers, and about 60 chiropractors are expected to add acupuncture to their services. Oregon Health Authority is also working on programs to educate health providers about the use of acupuncture in treating certain types of chronic pain and newly covered services; similarly, Vermont is now mandating that all licensed health professionals take a continuing education two hour program that details prescribing opioids and alternatives in treating pain.[12]


Improving Awareness on the Effectiveness of Acupuncture

It is not enough for acupuncture to be covered by insurance companies. Even in states where it is covered, it is often not used, in spite of the evidence that it could be effective.
In Ohio, Medicaid began to cover acupuncture for low back pain and and migraines in January of 2017, but in the first year, less than one-half of 1 percent of eligible patients, about 485 so far, took advantage of the treatment option.[13]
  1. ^ https://www.researchgate.net/publication/321842653_Evidence-Based_Nonpharmacologic_Strategies_for_Comprehensive_Pain_Care_White_Paper_1215_2017?enrichId=rgreq-a9f5e3620eeb14823a7da166d6e4a84f-XXX&enrichSource=Y292ZXJQYWdlOzMyMTg0MjY1MztBUzo1NzI2MjYxMDQ3OTkyMzJAMTUxMzUzNjExMDgyNg%3D%3D&el=1_x_3&_esc=publicationCoverPdf
  2. ^ Li L, Yu F, Shi D, et al. Application of virtual reality technology in clinical medicine. Am J Transl Res. 2017;9(9):3867-3880.

    Hoffman HG, Chambers GT, Meyer WJ, 3rd, et al. Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med. 2011;41(2):183-191
  3. ^ McSherry T, Atterbury M, Gartner S, Helmold E, Searles DM, Schulman C. Randomized, crossover study of immersive Virtual Reality to decrease opioid use during painful wound care procedures in adults. J Burn Care Res. 2017
  4. ^ https://www.cleveland.com/healthfit/index.ssf/2017/12/new_medicaid_rule_will_further.html
  5. ^ https://nashp.org/wp-content/uploads/2016/09/Pain-Brief.pdf
  6. ^ https://www.washingtonpost.com/national/health-science/stuck-in-an-opioids-crisis-officials-turn-to-acupuncture/2018/02/20/c451e952-1603-11e8-930c-45838ad0d77a_story.html
  7. ^ https://www.cleveland.com/healthfit/index.ssf/2017/12/new_medicaid_rule_will_further.html
  8. ^ https://www.michigan.gov/documents/mdcs/R032050_SHP-PPO_YBG_Medicare_04proof_471204_7.pdf
  9. ^ https://nashp.org/wp-content/uploads/2016/09/Pain-Brief.pdf
  10. ^ https://nashp.org/wp-content/uploads/2016/09/Pain-Brief.pdf
  11. ^ https://www.cleveland.com/healthfit/index.ssf/2017/12/new_medicaid_rule_will_further.html
  12. ^ https://nashp.org/wp-content/uploads/2016/09/Pain-Brief.pdf
  13. ^ https://www.cleveland.com/healthfit/index.ssf/2017/12/new_medicaid_rule_will_further.html