A new randomized clinical trial published in JAMA Network Open provides evidence that could help influence Medicare’s coverage decisions for acupuncture (and more importantly, acupuncturists). The trial was conducted “[in] response to a call by the Centers for Medicare & Medicaid Services to inform a national-coverage determination for Medicare reimbursement of acupuncture for CLBP among older adults.”
While chronic low back pain is one of the most common and disabling conditions among older adults, older patients have generally been underrepresented in large acupuncture trials. The BackInAction study fills this gap by evaluating acupuncture specifically in adults 65 and older, making its findings highly relevant to current policy debates, including the Acupuncture for Our Seniors Act. Another key aspect of the study: More than 50 licensed acupuncturists provided treatment, “mirroring typical community delivery.”
Study Parameters
The trial enrolled 800 adults ages 65 and older across four large U.S. health systems, representing diverse care environments from integrated networks to community clinics. All participants had LBP lasting more than three months that significantly interfered with daily activities.
Participants were randomly assigned to one of three groups: usual medical care only (access to non-acupuncture pain management services via the patient’s health system); standard acupuncture (8-15 treatments over 12 weeks, in addition to usual care); or enhanced acupuncture (standard acupuncture and usual care, plus 4-6 additional “maintenance” acupuncture sessions over the next 12 weeks).
Researchers tracked disability, pain and quality of life over a full year, with the primary outcome improvement in function as measured by the Roland-Morris Disability Questionnaire.
Acupuncture Protocol
The trial followed a semi-standardized acupuncture treatment approach, combining a consistent set of core points with individualized point selection tailored to each patient’s presentation. The goal of the approach: to balance scientific rigor with the flexibility reflective of real-world acupuncture practice. All treatments followed STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) guidelines to maintain quality and consistency across practitioners while allowing some personalization.
Key Study Takeaways
Better function: Both acupuncture groups showed greater reductions in disability (RMDQ scores) compared to usual care at six and 12 months.
Reduced pain: Pain levels also fell more in the acupuncture groups vs. the usual care group, with the enhanced acupuncture protocol showing somewhat stronger results (although not dramatically more than the standard protocol).
Meaningful change: A higher percentage of acupuncture patients achieved at least a 30% improvement in symptoms compared to usual care patients.
Safe for seniors: Adverse events were extremely rare, underscoring acupuncture’s safety in older adults.
Media Outlets Advance Acupuncture’s Case
Various news outlets have discussed the BackInAction trial – including “Good Morning America,” which posited acupuncture in an extremely positive light – and not just with regard to the chronic LBP treatment conversation. GMA Chief Medical Correspondent, Dr. Tara Narula, went far beyond simply promoting the study findings; she also briefly detailed acupuncture’s origins, how it is performed, other health conditions it can help manage, its utilization in cancer centers, and that acupuncture is safe and doesn’t hurt. In other words, an enormous public-service promo for the profession! (You can watch the GMA segment here.)
Momentum for Medicare Recognition?
The timing of this study – and its media promotion – is particularly important. Medicare covers acupuncture for chronic low back pain – but currently, licensed acupuncturists are unable to bill Medicare for their services, as they are not recognized as Medicare providers. Will the BackInAction findings add weight to the argument that Congress should pass the Acupuncture for Our Seniors Act and give acupuncturists the Medicare recognition they – and their patients – deserve?
