Clasina (Sina) Leslie Smith, MS, MA, LAc, MD, Dipl. Ac., FAAMA;
Bill Reddy, LAc, Dipl. Ac.
Authors’ Note: In part 1 of this series, we explained the background of the project that produced “The State of 21st Century Acupuncture in the United States” paper and proposed a new naming convention of Acupuncture and Herbal Medicine (AHM) in place of the terms that have heretofore been used to describe the profession. In this segment, we describe clinical utilization of acupuncture within the larger healthcare system.
In 1997, the World Health Organization (WHO) and the National Institutes of Health (NIH) convened a multiday conference on acupuncture to evaluate its clinical utilization and mechanisms of action. The resultant document recommended acupuncture for a wide variety of clinical issues, including postoperative and chemotherapy-induced nausea and vomiting, morning sickness in pregnancy, postoperative dental pain, headache, stroke rehabilitation, low back pain, and menstrual cramps, among others. The document also recommended that acupuncture be taught in medical schools and brought into mainstream medicine.
Twenty-eight years later, while some medical and osteopathic schools and conventional residency programs have incorporated components of integrative medicine (including AHM), acupuncture is far from integrated into conventional medical training in the way that the document portends.
Promising Signs
However, governmental and private sector healthcare organizations have begun to advocate for the use of acupuncture in clinical settings; outpatient care clinics are slowly bringing in acupuncture services; and hospitals are beginning to see the value of inpatient acupuncture as an adjunct to services they provide.
Patient utilization of acupuncture doubled over 20 years, according to the National Health Interview Surveys performed in 2002 and 2022. This increase from 1% to 2.2% translates to 7.3 million people. Unsurprisingly, pain management is one of the top uses of acupuncture and has increased from 55% to 72% in the same time frame.
Sharing Our Strengths
Because acupuncturists find themselves increasingly interfacing with conventional practitioners, mutual respect and referrals are becoming more needed, and an ability to communicate with conventional providers is more important than ever to the future of our profession. The more licensed acupuncturists can articulate the value of our care – supported by current biomedical research and clinical outcomes – the greater our impact will be within integrative health teams. Conventional practitioners, many of whom are unfamiliar with modern acupuncture education and training standards, are particularly interested in safety as well as efficacy (where we shine).
|
Series Outline
This six-part series presents key conversations we had in the process of creating the paper. While much of that conversation was not ultimately appropriate for scientific journal publication, we feel it is important to be transparent about the process and open the conversation to a wider audience.
We will therefore bring these conversations to you each month. This month, we discuss clinical utilization of acupuncture. In subsequent months, we will discuss questions of insurance and payment structure, the latest scientific mechanisms explicating how acupuncture works physiologically and anatomically, current and future acupuncture education, and marketing the profession.
We welcome your feedback, insights, and discussion. We also hope you find our five-year project worthy of a place in your waiting room and a support to you in your professional goals.
|
This is where data matters: As highlighted in our paper, robust safety profiles and up-to-date utilization statistics can provide the concrete assurances medical colleagues seek. Having these facts at your fingertips not only boosts your confidence during interdisciplinary conversations, but also reinforces the profession’s credibility as a whole.
As our healthcare landscape evolves, equipping ourselves with well-referenced, peer-reviewed evidence enables us to engage more productively, foster collaborative patient care and advance the profession for future generations.
Pain is the door through which many of us first entered collaborative care with conventional providers. We know firsthand that our medicine reliably delivers meaningful, lasting relief where so many pharmaceutical and interventional options fall short. Our profession has a unique opportunity – not just to offer patients respite from chronic pain in ways that restore quality of life, but also to directly address the devastating ripple effects of opioid dependence in our communities.
We also must recognize that conventional pain management has well-defined limits: medication tolerance, adverse effects (including death), and, too often, a sense of hopelessness once the pharmacologic arsenal wears thin.
By confidently communicating the strengths of acupuncture – our ability to ease suffering without side effects or dependency – we position ourselves not only as healers, but also as essential allies in redefining pain management for the 21st century. Now, more than ever, our voice belongs at every table where chronic and acute pain – and hope – are discussed.
TCM Diagnostic Codes Will Help Overcome Barriers to Integration
One barrier to incorporating AHM broadly into conventional medicine is the lack of AHM diagnostic codes and the issue of translating AHM diagnostics into conventional ICD-10 vernacular. However, TCM diagnostic codes have been included in the ICD-11 code set, which was officially released in 2022 in other countries and is projected to be adopted in the U.S. between 2025 and 2027.
Opening Doors and Gathering Momentum
Our profession is witnessing a remarkable and encouraging evolution, reflected by a growing list of legislative bills and clinical guidelines championing the integration and coverage of acupuncture within mainstream healthcare. (See Appendix 1 in “The State of 21st Century Acupuncture in the United States” for specifics.) These endorsements – from Medicaid / Medicare benefit expansions to acupuncture as an essential health benefit in at least six states – reflect an increasing recognition of acupuncture’s safety, efficacy and cost-effectiveness.
Each bill passed and guideline issued does more than just open doors for reimbursement. It signals a shift in how policymakers and healthcare leaders view acupuncture: not as an adjunct or alternative limited to niche settings, but as a vital component of integrative, patient-centered care.
This momentum empowers us as practitioners, providing concrete advocacy tools to engage collaborators and administrators in conversation grounded in respect and evidence. It is a testament to our profession’s perseverance in advancing beyond historical misconceptions of “ancient Chinese secrets” toward a future where acupuncture stands shoulder to shoulder with other trusted healthcare disciplines.
Next Segment
In the next segment of this series [November issue], we will discuss insurance coverage and reimbursement for AHM in the U.S.
Reference
- Smith CL, Reddy B, Wolf CM, et al. The state of 21st century acupuncture in the United States. J Pain Res, 2024;17:3329-3354. https://doi.org/10.2147/JPR.S469491
