https://doi.org/10.1089/acu.2020.1482

Abstract

Nascent research is beginning to link reduced opioid prescribing and increased well-being with acupuncture. While pain is the most common reason patients see physicians, acupuncture is often recommended to treat it. Due to lack of a common nomenclature around acupuncture treatment protocols, it can be difficult for clinicians to replicate research findings. This article discusses communication of ideas about how the National Institutes of Health (NIH) could help propagate meaningful research findings to practicing acupuncturists. While communication strategies can increase uptake of acupuncture in primary care and pain practices, the NIH could: (1) describe priorities in developing algorithmic acupuncture protocols; (2) require some grant applications to include both clinical and basic science outcomes; (3) develop a “dating service” to match clinical acupuncture researchers and those with the capability and interest to test mechanisms; and (4) initiating fellowships for young investigators that prioritize bringing together the art and science of acupuncture.

Introduction

Medical care for the 50 million patients in the United States with chronic pain and resulting secondary disability costs exceed $100 billion annually, and pain is the most-common complaint/symptom for which individuals seek outpatient care. Chronic pain, that is pain lasting more than 3 months, is part of what is known as the “polytrauma triad,” which also includes traumatic brain injury and post-traumatic stress disorder (PTSD).1 Chronic pain is present in 44% of returning military service members, and 48.3% of these report that their pain has lasted at least 1 year. Despite the significant demand for chronic-pain management, pain care in the United States is often uncoordinated, highly variable, and tends to be pharmaco- and/or procedure-centric, as opposed to the more-comprehensive and multimodal approach recommended by evidence-based clinical practice guidelines. Fortunately, there are now few barriers to practicing acupuncture in the Military Health System.

In addition to acupuncture's effectiveness for treating pain,2 patients treated with acupuncture use fewer opioids.3,4 This is critically important in military populations, who cannot be taking opioids while serving. Additionally, physicians who learn acupuncture report prescribing less-strong opioids and experiencing less burnout themselves.5,6 While these results are encouraging, the mechanisms and origins of the reduction in opioid use following acupuncture are unknown. Understanding why acupuncture reduces opioid use could lead to other breakthroughs in both pharmacologic and nonpharmacologic treatments for pain. However, the vast majority of acupuncture clinicians are either not affiliated or are loosely affiliated with university laboratories. This leads to clinicians researching their successful protocols without making expanded inquiries into biomarkers, brain function, the effect of touch and relationships, and other potential mechanisms, including those of the placebo effect.

Discussion

Acupuncture research is often critiqued because it cannot be replicated. Many acupuncture studies allow acupuncturists to treat patients based on clinical judgments. While pragmatic and matching real-life applications of acupuncture, these studies weaken the science of acupuncture. Protocol- or algorithm-based treatments that are clearly described in methods are replicable and are sorely needed. Examples of such protocols include Battlefield Acupuncture and the Auricular Trauma Protocol—both are well-described in the literature and can be repeated by any acupuncturist.7,8

Providing access to acupuncture through primary-care practice is the key to alleviating pain using this modality; however, without adequate training slots provided in an affordable manner early in a physician's career, acupuncture is unlikely to grow much in popularity. Many physicians hold biases against acupuncture, and they can be suspicions about the validity of acupuncture prior to having direct experience with it. In research, participants have described acupuncture as “voodoo, hippie stuff, or quackery.” However, their opinions and perspectives changed when instructors provided them with evidence that acupuncture is an effective medical treatment with valid scientific evidence and studies behind it. Furthermore, acupuncture training has been linked to less opioid prescribing and less depersonalizing of patients when acupuncture is incorporated into family medicine residency training.9,10

There are several barriers to acupuncture training (see Box 1). However, the allure of a treatment alternative with a low risk of adverse effects—or when debilitating pain has not responded to other treatments—can motivate patients to pursue alternatives to medicaiton.11 Shared decision-making, patient-centered communication (not pushing the patient, carefully choosing language, explaining treatment outcomes, and being responsive to the patient) and continuity of care (1 physician interacting with the patient across treatment) can all increase adoption of acupuncture in primary care.

Conclusions

The National Institutes of Health (NIH) can do much to strengthen the science of acupuncture, which could assist clinician–researchers in bringing their successful treatments to the public through several initiatives. Recommended strategies include: