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 non-pharmacologic 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 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.
The National Center for Complementary and Integrative Health, part of NIH, says “research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.”
For low-back pain, the institute cites a study that found it “more helpful than either no acupuncture or simulated acupuncture.” But another found “strong evidence that there is no difference between the effects of actual and simulated acupuncture,” according to its website.
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. They contend that acupuncture shows all the signs of the placebo effect, with providers and recipients who believe it works and the elaborate ritual of placing the needles in specially selected spots.
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