A Step Forward for Acupuncture, Four Decades Too Late

Probably few of you remember that at one time there was virtually no acupuncture available in the US. Until the late 1970s the phrase “Why not try acupuncture?” simply didn’t exist. In 1971, when President Nixon made his historic visit to the People’s Republic of China, his press secretary James Reston experienced acupuncture for post-operative pain and for the first time Americans saw what acupuncture looked like.

Schools of acupuncture opened in the US in the 1980s, including one here in Chicago. However, because of the stubbornness of the Illinois State Medical Society (ISMS) to accept acupuncture as anything but nonsense, legislation allowing acupuncturists to be licensed health care professionals was effectively blocked until the late 1990s. Before that, the ISMS declared that because acupuncture penetrated the skin it was surgery and thus could be performed only by a physician. This meant that acupuncturists were “practicing medicine without a license” and therefore subject to arrest on a felony charge. The fact that virtually all MDs were clueless about acupuncture meant it was inaccessible to most people unless you were willing to hang around with what the ISMS had deemed a “criminal element.”

After years and years of hard work, acupuncture associations around the US convinced various state licensing boards to allow acupuncturists their professional standing, and now you needn’t travel far to find a good one. But licensing hasn’t managed to convince the majority of MDs that acupuncture is little more than an interesting placebo therapy, a pleasant hour of quiet relaxation. I can still remember doctors who regarded photos of Chinese patients undergoing open heart surgery while anesthetized with acupuncture as faked.

Later, various studies in conventional medical journals sought to prove the placebo effect by showing that a good response to acupuncture didn’t rely on where you placed the needles…or even the insertion of needles at all. Just pinching skin while the patient’s eyes were covered and saying “the needles are in place” as she said she felt better was given as proof this whole acupuncture thing was really, as one doctor had dubbed it, “quackupuncture.”

Naturally the health insurance companies loved this physician reluctance because it justified classifying acupuncture as a “non-covered benefit,” an insurance term translated as “you can have all the acupuncture you want, and it may work for you, but don’t expect a dime from us.”

For chronic pain, acupuncture validated

So imagine my delight seeing the October 22, 2012, issue of the Archives of Internal Medicine declaring 40 years after America’s first glimpse of Chinese medicine that when it comes to the treatment of chronic pain, acupuncture works. The article itself, “Acupuncture for Chronic Pain,” is accompanied by an editorial slyly entitled “Needling the Status Quo.”

The project is the result of a worldwide research group, The Acupuncture Trialists’ Collaboration, which conducted a meta-analysis on acupuncture clinical trials. This meant reviewing studies that had already been performed, selecting those of the highest quality, and then seeing what kind of data emerged when these trials were pooled.

Given that more than three million Americans undergo acupuncture treatment every year, mainly for chronic pain problems, it really is vital to know for certain that acupuncture works. At first you might think “Why bother? People feel better with acupuncture. End of discussion.” But consider how we currently treat chronic pain, using expensive and sometimes risky pharmaceuticals, steroid injections (possibly contaminated), and a variety of surgical procedures, all with decidedly iffy results. But if acupuncture actually works, and it’s not simply a placebo effect, then we’re looking at a dramatic shift in our approach to pain management.

The researchers involved reviewed a total of 82 randomized clinical trials in which subjects received either actual or sham acupuncture or actual versus no acupuncture. From these, they selected 29 studies that met their stringent criteria for a strong clinical trial. These 29 represented 17,922 patients who had pain from the most common causes–non-specific neck and back pain; headache, shoulder, and elbow pain; and osteoarthritis.

To someone like me, involved with acupuncture for decades, the results were highly gratifying though not at all surprising. Across these studies, acupuncture was deemed an effective method of treating chronic pain, superior to both sham acupuncture and no acupuncture. To the tens of thousands of conventional physicians who for the past four decades have viewed acupuncture as little more than an inconsequential novelty, the final sentence of the article says it all:

“Our results of individual patient data analysis from nearly 18,000 patients in high quality randomized control trials provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain.”

So to you 50,000 licensed acupuncturists currently practicing across the US, it’s taken more than 40 years. Although you knew all along that acupuncture helped your patients coping with pain, now you’ve officially arrived. Primary care physicians and health insurance companies are almost morally obligated to help patients explore the virtually risk-free benefits of acupuncture before wheeling out the big guns like opioid drugs, epidural steroid injections (with and without fungal infestation), arthroscopies, and surgical spinal fusions.

Expect this sentence to be heard during a medical malpractice trial sometime in the next few years, “Wait a minute, doctor. You mean you scheduled a patient for back surgery without trying acupuncture first?”

Congratulations. You’ve shifted the status quo!

Be well,

David Edelberg, MD