Approximately 76 million people nationwide suffer from pain, whether chronic, acute or postsurgical. Since 2017, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recognized alternative therapies to treat and "reduce pain and the risk of opioid addiction,"2 including acupuncture. This was a significant step toward validating and integrating acupuncture as a viable treatment solution for acute and/or chronic pain. The JCAHO offers this unbiased acknowledgment as an independent, nonprofit organization that accredits and certifies health care organizations and programs throughout the U.S.
The statement by JCAHO has significant influence on policy, as it is an important authority upholding standards for health care organizations. This statement has had a positive impact on the profession of traditional Chinese medicine (TCM) and acupuncture in two ways. First is the recognition and exposure of TCM integrated into established health care systems including hospitals, which will subsequently increase access for patients, as well as normalize TCM as a viable medical treatment option. Second, having broad support among mainstream providers can result in evidence for fair and equitable compensation and reimbursements for TCM practitioners.
Conflating TCM & Acupuncture: The Consequences
Conversely, there may be negative consequences construed from the inclusion of acupuncture as part of the fight against opioid addiction. One negative impact is the conflation of TCM and acupuncture being akin to other "physical medicine" professions such as chiropractic, physical therapy and massage. This may increase or reinforce the misconception of the narrow application of acupuncture.
In truth, the comprehensive system of TCM can treat not only physical conditions such as pain, but also myriad internal diseases such as anxiety, stress, fertility, colds, infections – and more recently, even some symptoms of COVID-19.
One of the major barriers for the TCM field is this lack of understanding of the application and efficacy of TCM beyond pain management. A second negative impact is the potential increase in attempts by Western medical doctors, or other ancillary professions, such as nursing or physical therapy, to expand their scope to include "dry needling." This technique is essentially acupuncture, but with limited skills gained through a short weekend training program that forgoes the foundational basis of TCM as a whole medical system.
More recently, the problematic conflation of TCM and acupuncture has manifested in the classification of acupuncture as a non-essential service during the COVID-19 pandemic. This is damaging to both the perception of the profession and the economic well-being of practitioners. Although each practitioner should be able to conclude individually whether to temporarily close or remain open, the categorization as "non-essential" further perpetuates the misconception that TCM and acupuncture are limited in efficacy and scope of ailments treated.
This includes the inaccurate belief that TCM and acupuncture cannot treat infectious diseases. Classified as non-essential, this means in-person acupuncture services are mandated to close, and also overlooks the opportunity for practitioners to provide other valuable services such as herbal prescriptions, lifestyle, dietary and exercise recommendations, which can be safely conducted through virtual appointments.
Solving the Problem: Critical Steps We Need to Take
An important component to combat misconceptions and avoid the conflation of TCM as solely acupuncture is education, which must be clearly communicated to legislative bodies and other key stakeholders. This includes decision-makers that have influence in public policy: state acupuncture boards, TCM associations, legislators and other government officials.
There must be continual advocacy at all levels from within the acupuncture boards and TCM association lobbyist groups to educate government officials to understand the comprehensive nature of TCM, as well as to neutralize established mainstream medical professions from expanding their scope to include pseudo acupuncture through the practice of "dry-needling."
In politics, the bottom line has historically been economically-driven instead of morally-driven; therefore licensed acupuncturists must leverage success in business to financially support a robust lobbyist group for the TCM profession.
Education Is the Key
Acupuncture has made great progress integrating into the mainstream health systems, aided by the statement put forth by the JCAHO. As a result of any public advocacy that may produce economic opportunity, there must be considerations of possible unfavorable outcomes, including the conflation of TCM and acupuncture as synonymous; as well as non-acupuncturists taking advantage of economic prospects by expanding their scope through co-opting a historically rich and complex practice.
To address these issues, key players such as acupuncture boards and TCM associations, as well as all licensed acupuncturists, must continue to advocate and educate decision-makers to fully understand TCM as a comprehensive medical system, not just the singular tool of acupuncture.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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