Chronic debate over back therapy
Medicare debates whether to pay for acupuncture
Seeking ways to address chronic pain without narcotics, Medicare is exploring whether to pay for acupuncture, a move that would thrust the government health insurance program into the long-standing controversy over whether the therapy is any better than placebo.
Coverage would be for chronic low-back pain only, a malady that afflicts millions of people. Low-back pain, acute and chronic, ranks as the third-greatest cause of poor health or mortality in the United States, behind only heart disease and chronic obstructive pulmonary disease, according to the National Institutes of Health.
In its request for comments on acupuncture, the Department of Health and Human Services said that “in response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based nonpharmacologic treatment options for chronic pain.”
The agency said it hopes “to determine if acupuncture for (chronic low-back pain) is reasonable and necessary under the Medicare program.” A proposal is due by July 15, with a final decision by Oct. 13.
Chronic pain — generally defined as pain that lasts 12 weeks or more — is a complex disorder with numerous causes and many possible treatments. But there is widespread agreement that health care providers have overused powerful opioid painkillers to address it, with little research to support that approach.
Currently, Medicare covers injections, braces, implanted neurostimulators and chiropractic care as well as drugs for chronic low-back pain, under certain conditions set by the program.
Acupuncture continues to gain legitimacy as a treatment for pain relief in the United States. A 2014 review reported that more than 10 million acupuncture treatments are administered each year.
Some insurance companies cover the practice, respected medical institutions offer it, and schools of acupuncture produce new practitioners. The Department of Veterans Affairs has trained 2,400 providers to offer “battlefield acupuncture,” five tiny needles inserted at points in each ear, for pain relief.
Medicare coverage “is long overdue,” said Tony Chon, director of integrative medicine and health at the Mayo Clinic in Minnesota. “The opioid epidemic is going to be the momentum that’s really needed to push not just acupuncture but other kinds of nonpharmacological interventions to the forefront.”
Some proponents also note that acupuncture is one of the safest interventions available for pain — though some accidents have been reported. Even if it works only for some people, they argue, there is little harm in trying it when other options are not effective.
Taken overall, however, research shows that acupuncture is little more effective than placebo in many cases. When the government’s Agency for Healthcare Research and Quality reviewed research on a wide range of therapies for chronic pain in 2018, it found the “strength of evidence” that acupuncture works for chronic low-back pain is “low.”
Critics go further, noting that hundreds of years of anatomical studies have not found evidence of the points in the body linked to the “energy channels” that acupuncture claims to be stimulating to provide pain relief.