Good choices abundant for reliving patients’ pain

Acupuncture practitioners have long touted the ancient approach as the answer to dozens of maladies like headaches, allergies, arthritis and anxiety. Today, some health care providers see it as a possible tool to stem the growing U.S. opioid problem. The American College of Physicians has gone so far as to recommend acupuncture as a first treatment for low back pain, and the Joint Commission’s “Pain Management Standards” now includes acupuncture as a non-pharmacological strategy for managing pain.

Eastern medicine defines ailments in terms of an excess of or deficiency in yin or yang, forces that are connected and interdependent. Energy, or qi (pronounced “chee”), flows through the meridians or pathways of the body. These pathways connect via acupuncture points that relate to internal organs; acupuncture’s specialized needle placements restore the balance of yin and yang by reducing disruptions along the meridians, improving the flow of qi and promoting healing.

Western medicine has developed several theories on acupuncture. One premise: It stimulates the release of endorphins, the body’s own painkillers. This theory is supported

by research that indicates needle insertion prompts the flow of adenosine, a chemical that reduces inflammation. Another hypothesis, the Gate Control Theory of Pain, argues that the body shuts down pain receptors in response to the needles.

There is evidence that acupuncture often alleviates pain and successfully treats a range of symptoms and diseases, but clinical studies aimed at measuring its effectiveness are limited. Many skeptics argue that any benefits of getting stuck probably flow from a placebo effect.

The lack of evidence may not mean acupuncture is not effective. It’s simply difficult to test the efficacy of acupuncture. In double-blind studies, the gold standard for testing effectiveness of drugs or treatments, neither participants nor experimenters know which group is getting which treatment. Typically, one group receives the conventional drug or treatment while another group receives a placebo. The problem is, there are no good placebo substitutes for acupuncture — even when testers use sham needles, patients typically know they aren’t really being poked.

Another problem in assessing acupuncture (and many other medical treatments) is that ailments often simply resolve themselves. Back pain, Bell’s palsy or insomnia may go away during a course of acupuncture treatment, but these problems might also have disappeared without acupuncture — or medication or surgery.

So, what to think? Maybe acupuncture’s usually positive results are from a placebo effect. Or maybe all those needles stimulate the body to heal itself or suppress pain. Or maybe getting yourself stuck works due to an as-yetundiscovered process. If you’re the patient, since it works and, when properly performed, involves

very few risks and virtually no negative side effects, maybe you shouldn’t over-think it.

After all, thousands of drugs and medical procedures are approved and prescribed to treat conditions at enormous cost every day, often without a precise understanding of why they work, or even whether they are effective at all. Unlike acupuncture, often these approved and accepted treatments pose serious risks to patients who undergo treatment.

One thing is absolutely clear: Patients who try acupuncture love it. A recent study by American Specialty Health surveyed 89,000 patients who received treatment for chronic pain. It found a vast majority (87 percent) of patients rated their acupuncturists favorably (9 or 10 on a 0-to-10 scale), somewhat more favorably than patients rated conventional health care providers (76 to 80 percent). Nearly all (99 percent) of the surveyed acupuncture patients rated their providers good or excellent, and almost none reported minor or serious adverse effects.

If you decide to try acupuncture, here are some tips:

If the acupuncturist is a physician, look for certification by the American Board of Medical Acupuncture (www.dabma. org), which means he or she is a medical school graduate, has completed at least 300 hours of acupuncture education in a board-approved education program, passed an exam, and completed at least two years of medical acupuncture clinical experience with a case history of not less than 500 medical acupuncture treatments.

Alternatively, consider a physician who is a member of the American Academy of Medical Acupuncture (www.medical acupuncture.org), which means he or she completed at least 220 hours of Editor’s note: The Chronicle is partnering with Bay Area Consumers’ Checkbook magazine and Checkbook.org, a nonprofit consumer group with a mission to help consumers get the best service and lowest prices. Checkbook is supported by consumers and takes no money from the service providers it evaluates. To see ratings of local acupuncturists, and advice on finding and working with them, until March 5: www.checkbook.org/ chronicle/acupuncture formal acupuncture training (there’s no exam).

If the acupuncturist is not a physician, check for certification by the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org), which means he or she earned a three-year master’s degree or a combination of an apprenticeship with at least two academic years of formal education.

Although some competent acupuncturists don’t bother seeking certification, there are plenty of certified ones, so take advantage of this quality check.

Because there are so many acupuncturists whose customers are highly satisfied, it’s worth paying attention to price. Checkbook’s undercover shoppers called a sample of area acupuncturists for their fees for treatment of arthritic knee pain and were quoted prices ranging from $35 to $275 for an initial private session. There was a lot of variation in how long the acupuncturists said this initial visit would last, though most estimated between 45 and 90 minutes.

Also, consider community acupuncture, where the practitioner treats multiple patients in the same room. Our undercover shoppers were quoted prices far lower than those for private sessions, ranging from $15 to $55 per session.