On point: Broadening pain management options with acupuncture

By Maria T. Chao, DrPH, MPA

As I think about the year ahead, one change that I’m really excited about is the prospect of acupuncture for patients at San Francisco General Hospital (SFGH). In the US, pain management is the leading reason that patients seek care from acupuncturists. Acupuncture utilization has increased by 50% over the past decade, but is not commonly used by non-Asian minority populations and those with limited income. Barriers to use include high out-of-pocket costs and limited access to services.

                          

But some exciting developments are afoot that could address these barriers.

• Acupuncture is considered an Essential Health Benefit in the State of California (SB 951 and AB 1453, signed into law on September 30, 2012 by Governor Brown, effective January 1, 2014). 

• The San Francisco General Hospital’s bylaws have been changed to include credentialing of licensed acupuncturists as hospital providers for the first time.

• A new Integrative Health Service was recently established as part of the SFGH Community Wellness Program. Part of its mission is to develop models of integrative health care that are clinically effective, cost effective, and accessible to all people.

• The first project of the SFGH Integrative Health Service will be to implement a pilot program of acupuncture for chronic pain this spring.

Why offer acupuncture for chronic pain at SFGH? Chronic pain is a pressing public health concern affecting 116 million adults in the US and rising in prevalence. Moreover, disparities in the prevalence, severity, and treatment of chronic pain place an ‘unequal burden of pain’ on vulnerable populations with limited access to quality healthcare. Pain management is certainly an unmet need for many SFGH patients. About 1/3 of SFGH patients have chronic pain and the SFGH Pain Consultation Clinic consistently has a six-month waiting list. Considerable risks are associated with regularly prescribing controlled substances. In fact, the increasing trend of opioid-related substance abuse and overdose deaths has reached epidemic proportions (See Soraya’s post for more on this). Few non-pharmaceutical options for pain management are currently available for SFGH patients.

But does acupuncture actually work? Is it safe?

• A meta-analysis of 29 RCTs supports the efficacy of acupuncture for symptom relief and functional improvement for patients with pain conditions, including back and neck pain, osteoarthritis, headache, and cancer-related pain.
• Acupuncture is safe when performed by an experienced, well-trained practitioner. Serious side effects from acupuncture are extremely rare. 
• Some studies indicate that acupuncture is associated not just with clinical effectiveness, but also high patient satisfaction and potential cost savings.

When I describe my research focus on integrative medicine among underserved populations, I sometimes get perplexed looks from people. Integrative medicine – incorporating therapies like massage, acupuncture, chiropractic, mindfulness, or nutritional approaches – conjures serene, spa-like images and is thought of as boutique services catering to the wealthy. What does this have to do with the healthcare safety net and medically underserved patients? What relevance do these treatments have for patients who are in need of basic housing, food security, and gainful employment?

Acupuncture actually has humble roots as a people’s medicine. It was part of the repertoire used by barefoot doctors providing health for the masses in China during the Cultural Revolution. Here in the US, since the 1970s, a number of public health clinics integrated a simple acupuncture detoxification protocol as part of substance abuse treatment programs. Acupuncture certainly cannot address the fundamental upstream factors that cause health inequities. But to achieve health equity, defined by Healthy People 2020 as "attainment of the highest level of health for all people”, broadening access to treatment options to improve quality of life is part of this effort. Integrative medicine has the potential to improve patient care by addressing common clinical issues – like pain, stress, anxiety, and fatigue – that are often not addressed by conventional medicine. Given the recent policy changes, acupuncture for chronic pain is a great place to start making inroads towards broadening access to evidence-based complementary and integrative medicine for diverse populations and creating a constellation of efforts to support health equity.