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Archive for the ‘Acupuncture White Paper’ Category

We have a new published article: there are 50 days free access online, if you like to read the detail, you may click the link:

https://authors.elsevier.com/a/1XydF3RTyQQ3iH

Abstract

This study was conducted to identify the approximate number and density of actively licensed acupuncturists, as well as the number of schools in acupuncture and oriental medicine (AOM) by January 1, 2018 in the United States (U.S.). We contacted the appropriate department governing acupuncturists, such as the Board of Acupuncture or Board of Medicine, etc. in each state and U.S. territories, to collect the data. We also conducted online license information searches in order to collect the most accurate numbers of licensed acupuncturists, especially for those states in which a board could not be reached. We found that the number of actively licensed acupuncturists as of January 1, 2018 in the U.S. was 37,886. The ten states with the largest number of acupuncturists (28,452 or 75.09% of the U.S. total), in order by total, included California, New York, Florida, Colorado, Washington, Oregon, Texas, New Jersey, Maryland and Massachusetts. The number of practitioners was greater than 1000 for each of these states. Among them, the largest three were California (12,135; 32.03%), New York (4438; 11.71%) and Florida (2705; 7.13%). These three states accounted for more than half of the overall total. The number of total licensed acupuncturists has increased 257% since 1998. The overall acupuncturist density in the U.S. – measured as number of acupuncturists per 100,000 – was 11.63 (total number of licensed acupuncturists: 37,886, divided by the total population: 325,719,178 at the start of 2018). There were 20 states with an acupuncturist density of more than 10 per 100,000 population. Hawaii (52.82) was the highest, followed by Oregon (34.88), Vermont (30.79), California (30.69) and then New Mexico (30.27). There were 62 active, accredited AOM schools which altogether offered 100 programs: 32 master degrees in Acupuncture, 53 master degrees in Oriental medicine, 13 postgraduate doctorate degrees and 2 entry-level doctorate degrees. Among these active accredited schools, institutions in the West and East Coast states comprised 77.42% of the national total. California, Florida, and New York represented 41.94%. There were 48 jurisdictions (47 States and the District of Columbia) with acupuncture practice laws in place. States without acupuncture laws included Alabama, Oklahoma and South Dakota. The data suggests that acupuncture profession has steadily grown in the United States.

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我国首次发布中医药发展白皮书《中国的中医药》

http://www.xinhuanet.com/health/2016-12/06/c_1120063254.htm
2016年12月06日 12:21:51 来源: 新华网
    新华网北京12月6日电(刘映)12月6日,国务院新闻办发布《中国的中医药》白皮书,这也是我国首次发布中医药发展状况的白皮书。据了解,白皮书从中医药的历史发展脉络及其特点、中国发展中医药的国家政策和主要措施、中医药的传承与发展、中医药国际交流与合作等方面对我国中医药的发展情况进行了概述。全文约9000余字,由前言、正文、结束语三部分组成,以中、英、法、俄、德、西、日、阿等语种发表,中文版和英文版已分别由人民出版社和外文出版社出版。

    国家卫生计生委副主任、国家中医药管理局局长王国强表示,在推进“健康中国”建设过程中,中医药在普及健康生活方式,在“治未病”、重大疾病防治、康复以及完善健康保障方面都能发挥重要作用,在建设健康环境方面,中医药也具有优势。

    中医药“整体化、个体化、治未病”等理念意蕴深远

国务院新闻办新闻发言人袭艳春表示,中医药作为中华文明的杰出代表,是中国各族人民在几千年生产生活实践和与疾病做斗争中逐步形成并不断丰富发展的医学科学,不仅为中华民族繁衍昌盛做出了卓越贡献,也对世界文明进步产生了积极影响。

白皮书显示,中医药在历史发展进程中,兼容并蓄、创新开放,形成了独特的生命观、健康观、疾病观、防治观,实现了自然科学与人文科学的融合和统一,蕴含了中华民族深邃的哲学思想。随着健康观念变化和医学模式转变,中医药越来越显示出独特价值,并形成了鲜明的特点,包括重视整体,注重“平”与“和”,强调个体化,突出“治未病”,使用简便等。

从历史上看,中华民族屡经天灾、战乱和瘟疫,却能一次次转危为安,人口不断增加、文明得以传承,中医药做出了重大贡献。近些年来,抗疟药物“青蒿素”的发明,拯救了全球特别是发展中国家数百万人的生命。2015年,中国中医科学院研究员屠呦呦因“青蒿素的发现”而获得诺贝尔生理学或医学奖,更是让世界见证了传统中医药的魅力。

    中医药传承与发展提速,中医医疗服务体系覆盖城乡

中国历来高度重视中医药事业发展,近年来,更是出台了一系列推动中医药发展的政策文件。比如2003年,国务院发布实施《中华人民共和国中医药条例》,2009年,国务院颁布实施了《关于扶持和促进中医药事业发展的若干意见》,逐步形成了相对完善的中医药政策体系。2015年国务院常务会议通过《中医药法(草案)》,并将提请全国人大常委会审议,将为中医药事业发展提供良好的政策环境和制度保障。2016年,国务院印发了《中医药发展战略规划纲要(2016-2030年)》,这是把中医药发展上升为国家战略的具体体现,是新时期推进我国中医药事业发展的纲领性文件。

近期举行的全国卫生与健康大会强调,要“着力推动中医药振兴发展”。

在中医药的传承与发展方面,王国强表示,目前,我国已基本建立起覆盖城乡的中医医疗服务体系。在城市,形成了以中医(民族医、中西医结合)医院、中医类门诊部和诊所以及综合医院中医类临床科室、社区卫生服务机构为主的城市中医医疗服务网络。在农村,形成了由县级中医医院、综合医院(专科医院、妇幼保健院)中医临床科室、乡镇卫生院中医科和村卫生室为主的农村中医医疗服务网络,提供基本中医医疗预防保健服务。截至2015年底,全国有中医类医院3966所,其中民族医医院253所,中西医结合医院446所。中医类别执业(助理)医师45.2万人(含民族医医师、中西医结合医师)。全国有中医类门诊部、诊所42528个,其中民族医门诊部、诊所550个,中西医结合门诊部、诊所7706个。2015年全国中医类医疗卫生机构总诊疗人次达9.1亿,全国中医类医疗卫生机构出院人数2691.5万人。

中医药除在常见病、多发病、疑难杂症的防治中贡献力量外,在重大疫情防治和突发事件医疗救治中也发挥重要作用。中医、中西医结合治疗传染性非典型肺炎,疗效得到世界卫生组织肯定;中医治疗甲型H1N1流感,取得良好效果,成果引起国际社会关注。同时,中医药在防治艾滋病、手足口病、人感染H7N9禽流感等传染病,以及四川汶川特大地震、甘肃舟曲特大泥石流、江苏昆山爆炸等突发事件医疗救治中,都发挥了独特作用。

此外,中医药在预防保健、文化建设等多个方面取得快速发展。白皮书显示,中国政府重视和保护中医药的文化价值,积极推进中医药传统文化传承体系建设,已有130个中医药类项目列入国家级非物质文化遗产代表性项目名录,“中医针灸”被列入联合国教科文组织人类非物质文化遗产代表作名录,《黄帝内经》和《本草纲目》入选世界记忆名录。

此外,中医药标准化工作也取得积极进展。制定实施了《中医药标准化中长期发展规划纲要(2011—2020年)》,中医药标准体系初步形成,标准数量达到649项,年平均增率29%。中医、针灸、中药、中西医结合、中药材种子种苗5个全国标准化技术委员会及广东、上海、甘肃等地方中医药标委会相继成立。

    中医药已成最具代表性的中国元素

从里约奥运会、G20杭州峰会,以及最近在上海举行的全球健康促进大会等国际重大活动和会议中,都“不约而同”地出现了中医药热现象。

对此,王国强表示,今年,中国外文局对外传播研究中心开展了第四次中国国家形象全球调查。此次调查引用LightSpeed Research全球样本库中覆盖G20中除欧盟外的19个成员国9500个样本,并严格执行Online在线调查的国际标准。调查结果显示,与2012年第一次调查相比,中医药首次被认为是最具代表性的中国元素,选择比例达50%,中国整体形象稳步提升,并呈现新特点。与中医密不可分的武术列居第二,远超书法、戏曲、饮食等元素。

白皮书显示,目前,中医药已传播到183个国家和地区。据世界卫生组织统计,目前103个会员国认可使用针灸,其中29个国家和地区设立了法律法规,18个国家和地区将针灸纳入医疗保险体系。中药逐步进入国际医药体系,已在新加坡、古巴、越南、阿联酋和俄罗斯等国以药品形式注册。有30多个国家和地区开办了数百所中医药院校,培养本土化中医药人才。总部设在中国的世界针灸学会联合会有53个国家和地区194个会员团体,世界中医药学会联合会有67个国家和地区251个会员团体。

王国强表示,中国政府一直致力于推动国际传统医药发展,与世界卫生组织保持密切合作关系,为全球传统医学发展做出贡献。目前,中国政府与相关国家和国际组织签订专门的中医药合作协议86个,中国政府已经支持在海外建立了10个中医药中心。

此外,为促进中医药在全球范围内的规范发展,保障安全、有效、合理应用,中国推动在国际标准化组织(ISO)成立中医药技术委员会(ISO/TC249),秘书处设在中国上海,目前已发布一批中医药国际标准。在中国推动下,世界卫生组织将以中医药为主体的传统医学纳入新版国际疾病分类(ICD-11)中。推动传统药监督管理国际合作,保障传统药安全有效。

    我国将建全国中药资源动态监测网,提升中药安全性

    一图读懂中国的中医药

【纠错】

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冬雪春雨4296952 [中国浙江省杭州市 ]2016年12月06日 19:04 发表

中国的传统中医医务工作者,中国的中药材质量,中国的中药产品的质量,中国新闻有关中国中医的报道质量,中国的医务工作者,中药材,中药产品检验质量到底怎么样?有多少真实性?有多少被污染了?

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悲欢离合4294282 [中国贵州省黔西南布依族苗族自治州 ]2016年12月06日 07:55 发表

中国药助中华民族人数众多,人材济济,繁荣昌盛、就是最明显的疗效。

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Today, 10:45am, Dr. Arthur Fan was on a TV show, and interviewed by known TV host Ms. Marylee Joyce. The topic is acupuncture’s role in opioids epidemic.

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Arthur Yin Fan1,2 , Jun Xu1,3, and Yong-ming Li1,3

1. American Alliance for Professional Acupuncture Safety. Greenwich, Connecticut (06878), U.S.A.;
2. American Traditional Chinese Medicine Association. Vienna, Virginia (22182), U.S.A.;
3. American Acupuncture Association of Greater New York, New York, (10016), U.S.A

The original white paper was published in Chinese Journal of Integrative Medicine:   [AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM]

1. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (I) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med. 2017 Jan;23(1):3-9. doi: 10.1007/s11655-016-2630-y.
2. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (II) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med. 2017 Feb;23(2):83-90. doi: 10.1007/s11655-017-2800-6
3. Fan AY, Xu J, Li YM. Evidence and expert opinions: Dry needling versus acupuncture (III) : -The American Alliance for Professional Acupuncture Safety (AAPAS) White Paper 2016. Chin J Integr Med 2017 Mar; (3):163-165. doi: 10.1007/s11655-017-2542-x.

The white paper includes in 7 topics:
1. What Is Dry Needling? [page3]
2. Who First Used Dry Needling in the West? [page5]
3. Has Dry Needling Been Used in China? [page7]
4. Does Dry Needling Use Acupuncture Points? [page9]
5. What Is New About Dry Needling Points (Trigger Points)? [page13]
6. Is Dry Needling a Manual Therapy? [page16]
7. Summary of Dry Needling [page17]
(1) Academic perspective [page17]
(2) The Problems Dry Needling caused [page18]
(3) Our Position [page20]

Summary[AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM]
In the last twenty years, in the United States and other Western countries, dry needling (DN) became a hot and debatable topic, not only in academic but also in legal fields. This White Paper is to provide the authoritative information of DN versus acupuncture to academic scholars, healthcare professionals, administrators, lawmakers, and the general public through providing the authoritative evidence and experts’ opinions regarding critical issues of DN versus acupuncture, and then reach consensus.

We conclude that DN is the use of dry needles alone, either solid filiform acupuncture needles or hollowcore hypodermic needles, to insert into the body for the treatment of muscle pain and related myofascial pain syndrome. DN is sometimes also known as intramuscular stimulation, TrP acupuncture, TrP DN, myofascial TrP DN, or biomedical acupuncture. In Western countries, DN is an over-simplified acupuncture using biomedical language in treating myofascial pain, a contemporary development of a
portion of Ashi point (Ah-yes point, or tender point) acupuncture from traditional Chinese acupuncture. As developed by Travell & Simons, C. Chan Gunn and Peter Baldry, et al, it seeks to redefine Acupuncture by re-translating reframing its theoretical principles in a Western manner. It reflects the effort of de-acupoint, and de-theory of Chinese medicine by some healthcare professionals and researchers. DN with filiform needles have been widely used in Chinese acupuncture practice over the past 2,000 years, and with hypodermic needles as Dr. Travell described has been used in China in acupuncture practice for at least 72 years. In Eastern countries, such as China, since 1800s or earlier, DN is a common name of acupuncture among acupuncturists and the general public, which has been used 2000 years, and its indications, is not limited to treating and preventing musculoskeletal disorders or illness including so called the myofascial pain.
Medical doctors Travell, Gunn, Baldry and others who have promoted dry needling by simply rebranding:
(1) acupuncture as dry needling and (2) acupuncture points as trigger points (dry needling points). Dry needling simply using English biomedical terms (especially using “fascia” hypothesis) in replace of their equivalent Chinese medical terms. Trigger points belong to the category of Ashi acupuncture points in traditional Chinese acupuncture, and they are not a new discovery. By applying acupuncture points, dry needling is actually trigger point acupuncture, an invasive therapy (a surgical procedure) instead of
manual therapy. Travell admitted to the general public that dry needling is acupuncture, and acupuncture professionals practice dry needling as acupuncture therapy and there are several criteria in acupuncture profession to locate trigger points as acupuncture points. Among acupuncture schools, dry needling practitioners emphasize acupuncture’s local responses while other acupuncturists pay attention to the responses of both local, distal, and whole body responses. For patients’ safety, dry needling practitioners
should meet standards required for licensed acupuncturists and physicians.
DN is not merely a technique but a medical therapy and a form of acupuncture practice. As a form of acupuncture, an invasive practice, it is not in the practice scope of physical therapists (PTs). DN has been “developed” simply by replacing terms and promoted by acupuncturists, medical doctors, and researchers, and it was not initiated by PTs. In order to promote DN theory and business, some commercial DN educators have recruited a large amount of non-acupuncturists, including in PTs, as students and
customers in recent years. The national organizations of PT profession, such as APTA and FSBPT, started to support the practice of DN by PTs around 2010. Currently, there are probably more PTs involving DN practice and teaching than any other specialties. In most states, licensed acupuncturists are required to attain an average of 3,000 educational hours via an accredited school or program before they apply for a license. The physician or medical acupuncturists are required to get a minimum of an
additional 300 educational hours in a board -approved acupuncture training institution and have 500 cases of clinical acupuncture treatments in order to get certified in medical acupuncture. However, a typical DN course run only 20-30 hours, and the participants may receive “DN certificate” without any examination. For patients’ safety and professional integrity, we strongly suggest that all DN practitioners and educators
should have met the basic standards required for licensed acupuncturists or physicians.
KEYWORDS dry needling, acupuncture, biomedical acupuncture, authoritative evidence, experts’ opinions, consensus

Click to access AAPAS%20White%20Paper%20on%20Dry%20Needling.pdf

AAPAS White Paper on Dry Needling(I-III) Fan AY, Xu J, Li YM

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Acupuncture: Safety [120]

The World Health Organization (WHO) reports that acupuncture can be considered inherently safe in the hands of well-trained practitioners; however without proper training, acupuncture can lead to serious, sometimes life-threatening complications (as in the case of organ puncture and hepatitis transmission). Large-scale clinical trials of over 2 million acupuncture treatments found only 8.6% adverse events in which less than 1% reported as serious.[3,10] All of the reported infections and 68% of the serious adverse events occurred in village clinics or rural hospitals in China where clinical skill disparities exist between rural and urban hospital acupuncturists because rural acupuncturists rarely receive formal education in acupuncture medical colleges.[10] In the United States, ACCAOM accredited curriculum includes indications and contraindications for acupuncture point selection (single and combination), anatomy and needle insertion depth, as well as evidence-based clean needle technique practice, as necessary to protect the public.

Increased cost of care from Opioid Epidemic.

In contrast to acupuncture’s safety record, deaths related to opioid misuse have reached epidemic levels, the financial impact of the epidemic is at crisis levels, and incurred expenses rise from general pharmacological-care side effects, medical errors, and failed surgical procedures. In fact, two Oklahoma citizens die daily from opioid overdose according to the Center for Disease Control: 725 deaths in 2015, 777 in 2014, and 790 in 2013 which 12 is an increase from 662 deaths in 2010, and 127 deaths in 1999.113 Oklahoma, has the highest prevalence of prescription painkiller abuse in the country and more overdose deaths involve hydrocodone than methamphetamines, heroin, and cocaine combined.113 The national epidemic is costing public and private insurers more than $72 billion annually.13 Additionally 30% of patients with chronic pain conditions also suffer from clinical depression, and nearly 50% of patients who suffer from both anxiety and depression disorders have a co-morbid pain diagnosis, which shows the compounding concerns of opioid use for pain.13 The impact of the epidemic is far reaching, including but not limited to families, incarcerated persons, children, and disabled. See Appendix C, D, F.

 

Emergency room misuse.

The percentage of emergency department (ED) visits associated with pharmaceutical misuse or abuse increased 114% between 2004 and 2011. Opioid overuse not only increases ED visits but leads to increased avoidable services and costs that may actually harm beneficiaries. In fact, Medicaid recipients have a higher rate of ED visits and hospitalization for poisoning by opioids and related narcotics than individuals with other forms of insurance or the uninsured.13

 

Acupuncture Regulation Impact

Accepted method of care. Acupuncture is a standardized, licensed and regulated health care profession1 that conducts technical, master’s, and doctoral level training in U.S. Department of Education recognized accredited institutions.2 A Licensed Acupuncturist (or comparable state designated title) provides safe, low cost, and comparatively effective health care services.3,4 Forty seven states and the District of Columbia have developed licensure laws and regulation for acupuncturists. Alabama, Oklahoma, and South Dakota are without acupuncturist regulations. See Appendix B.

 

Recognized as a distinct occupation.

In 2016, a recommendation to establish a new code for this distinct occupation in 2018, “29-1291 Acupuncturists,” was made by the Bureau of Labor and Statistics (BLS) Standard Occupational Classification Policy Committee (SOCPC).1 Projected growth of the profession through 2024 is greater than average (13%), with 17,700 new job positions predicted.8 Since 2009, “Acupuncturists” have been recognized by the Bureau of Labor and Statistics’ O-Net Online as an emerging profession and assigned a Standard Occupational Code (SOC) of 29-1199.01 under “Health Diagnosing and Treating Practitioners, All Others.”7,8

 

Congressional Support.

The National Institutes of Health (NIH) affirms the validity and promise of acupuncture by the 1997 NIH Consensus Conference, concluding that there is sufficient evidence to expand its use into conventional medicine, encouraging further studies of its physiology, and urging broader public access through insurance companies, federal and state health insurance programs, including Medicare and Medicaid, and other third party payers.67 For twenty years thereafter, rigorous scientific investigation of acupuncture continues through the NIH National Center for Complementary and Integrative Medicine.68

 

Acupuncture efficacy.

An expanding body of evidence confirms that acupuncture stimulates the body’s natural healing abilities, promoting physical and emotional well-being.15,18 Through evidence review in 2003, the World Health Organization determined that acupuncture is an effective treatment for 28 named conditions and 79 potential conditions.78 See Appendix A.

 

Utilization.[120]

Acupuncture utilization is rapidly increasing in the United States. Nearly 100 primary and specialty physician practice guidelines recommend acupuncture as a non-pharmacological approach to patient care. An integral component of the “collaborative
model of care”, thousands of licensed acupuncturists are independently practicing acupuncture in hundreds of clinics, hospitals, universities, military and veterans’ care facilities. An increasing number of insurance companies are reimbursing for acupuncture, Medicaid in some states covers acupuncture for specific conditions, and the military has long utilized acupuncture for conditions from PTSD to brain injury. 61 See Appendix C, D, E, F.

 

Acupuncture for pain and mental health.[120]

Effective as a non-pharmacological approach to pain management and compounded by a holistic approach to comorbidity care, tens of thousands of licensed acupuncturists effectively treat patients with acute and chronic pain across the nation while now thousands of hospitals and clinics employ acupuncturists to improve outcomes and reduce costs. Acupuncture has recently been found to be as effective as counseling, and both more effective than usual care, for reducing symptoms of depression, a common co-morbid condition found in patients managing chronic pain.50 See Appendix D, E, F.

 

The opioid epidemic & auricular (ear) acupuncture.

To improve behavioral health program retention, reduce withdrawal symptoms, enhance recovery outcomes, and decrease costs, a standardized auricular (ear) acupuncture protocol has gained favor throughout the nation for use as an adjunctive treatment by a variety of health care and criminal justice workers within a variety of comprehensive programs.28,32,33,36,39,92,94 The National Acupuncture Detoxification Association (NADA) has trained over 25,00029 professionals to use the NADA 5-point auricular acupuncture protocol to treat individuals of all ages recovering from substance use disorder, trauma, and other behavioral health issues.28 Over 628 licensed addiction treatment facilities utilize NADA30 and inclusion within comprehensive criminal justice programs has reduced inmate expense and re-incarceration rates for two decades.33,36,37,39,40,42,103 See Appendix D.

 

Emergency department savings.

Expanding acupuncture utilization in the ED provides a non-pharmacological option to citizens, reduces drug-seeking behavior, and can reduce costs. A clinically relevant “real-world” 2016 study published in the Journal of Emergency Medicine, finds acupuncture to be more effective than intravenous morphine in the ED, when individualized patient-centered plans are administered by licensed acupuncturists.55 Newly available preliminary statistical outcomes are available from Rhode Island’s state Medicaid Section 1115 Demonstration, a pilot designed to cut costs by reducing member emergency room visits; members with chronic pain receive acupuncture and other complementary services within a comprehensive pain management plan. Outcomes are demonstrating that on average per year, these members have: decreased ER visits by 61%, reduced opioid prescriptions by 86%, lowered prescription totals by 63%, and reduced annual costs per member by 27%. 90,92-94

 

Other cost benefits.

Overall savings resulting from acupuncture inclusion include decreased requirements for surgical procedures, shorter in-patient hospital stays, reduction in pharmacologic prescriptions, reduction of days lost at work, and reduction of necessary medical review appointments. See Appendix C, D, E, F.

 

Call for Inclusive Collaborative Action

Abusers of opioids have been found to have total health care costs eight times that of non-abusers, placing a significant economic and resource burden on providers and health systems. Dr. Shellie Keast, from the University of Oklahoma’s College of Pharmacy, which supports SoonerCare pharmacy operations, believes that the Medicaid agency is ideally positioned to leverage collaborative efforts with other state agencies in the development of documents and best practice guidelines for intrastate work.13 Appendix F. Oklahoma’s plan in 2012, Reducing Prescription Drug Abuse in Oklahoma, calls for lowering the states’ unintentional overdose deaths by 15% will aim for “action to ensure the proper and appropriate use of opioids to treat pain and improve patient’s quality of life while reducing the risk of abuse and diversion… through various partnerships…is imperative.”113 Governor Fallin emphasizes: “Immediate action must be taken in order to reverse this rapidly growing epidemic, which has become one of the most serious public health and safety threats to our state… a broad-based coordination between law enforcement, prevention and treatment providers, the Oklahoma Legislature, community organizations, tribes, and health care is required… It is unacceptable for any Oklahoman to lose their life to this preventable problem.”113

Appendix A: Physiological Effects of Acupuncture Attention through research has been focused upon the following modern theories to explore acupuncture’s effects upon the body:
· Stimulation of the hypothalamus and pituitary gland
· Change in secretion of neurotransmitters and neurohormones
· Conduction of electromagnetic signals
· Activation of the body’s natural opioid secretion system
Most recently, twenty first century state-of-the-art technological advances allow observation of physiological effects of acupuncture. For example-
· fMRI scans detect reduction in pain sensation within the brain after acupuncture.19
· Ultrasound Color Doppler Imaging detects increased blood flow of peripheral, mesenteric, and retrobulbar arteries.20
· PET-CT study concludes acupuncture induces different levels of cerebral glucose metabolism in pain-related brain regions.21
· Demonstrated autonomic nerve function control and modulation of neurotransmitters in related brain regions are observed.22
· Blood panels measure immune system regulatory function, increased humoral/cellular immunity, and NK cell activity.23
· Synchrontron radiation based Dark Field Image method finds accumulation of miro-vessels in acupoints.24
· fMRI scans detect bilateral activation of insula and adjacent operculum; correlation to increased saliva production.25
· Synchrontron x-ray fluorescence analysis detects concentrations of Ca, Fe, Cu and Zn in and around acupuncture points.26
· Acupuncture’s role in triggering the release of adenosine, a neuromodulator with anti-nociceptive properties, is confirmed.14
· Tonometery, electrocardiogram, phtoplethysmogram, ultrasonography, and cardiographyconfirm acupuncture effects upon peripheral pulse amplitudes, wave, blood flow velocity, and sympathetic nerve activity.27
A 2013 study of acupuncture effect upon central autonomic regulation concludes: “Acupuncture has clinical efficacy on various autonomic nerve-related disorders, such as cardiovascular diseases, epilepsy, anxiety and nervousness, circadian rhythm disorders, polycystic ovary syndrome (PCOS) and subfertility. An increasing number of studies have demonstrated that acupuncture can control autonomic nerve system (ANS) functions including blood pressure, pupil size, skin conductance, skin temperature, muscle sympathetic nerve activities, heart rate and/or pulse rate, and heart rate variability. Emerging evidence indicates that acupuncture treatment not only activates distinct brain regions in different kinds of diseases caused by imbalance between the sympathetic and parasympathetic activities, but also modulates adaptive neurotransmitter in related brain regions to alleviate autonomic response.”22

 

Appendix B: State Licensure and Regulation The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has provided more than 21,000 certificates for acupuncturists applying for licensure in 46 states and the District of Columbia since 1982.6 NCCAOM Diplomates have passed a set of certification examinations which assure that the knowledge, skills, and abilities necessary for safe and effective entry-level practice of acupuncture have been demonstrated. The NCCAOM is the only national organization in the United States whose certification programs are accredited for the purpose of qualifying candidates for state licensure status. The Institute for Credentialing Excellence (ICE)’s National Commission on Certifying Agencies (NCCA) recognizes the NCCAOM national certification programs in Acupuncture, Chinese Herbology, and Oriental Medicine as having achieved national accreditation by meeting the NCCA’s 21 standards.6 When providing services in health system and hospital facilities within the 45 regulated states, licensed acupuncturists are credentialed as “Licensed Independent Practitioners” (L.I.P.) to be in compliance with The Joint Commission quality assurance standard for healthcare system accreditation.5 The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) is recognized by the U.S. Department of Education as the accreditor for Acupuncture and Oriental Medicine (AOM) educational programs in the United States. ACAOM accredited institutions and programs are shaped by a rigorous peer review process. Over sixty institutions throughout the country have achieved the standards of educational excellence by meeting ACAOM’s accreditation requirements.2 The Oklahoma Board of Private Vocational Schools (OBPV) provides licensure and oversight of two acupuncture training schools.9 The existing grass-roots acupuncture education network may contribute to bridge-building collaborations necessary for acupuncturist workforce expansion within the fabric of Oklahoma’s existing infrastructures. Collaboration in the development of innovative tiered apprenticeship programs for life-long career advancement are in alignment with current workforce expansion plans. In addition, to accommodate evolving health care industry workforce requirements, stakeholders are exploring practice scope expansion solutions, such as competency based certifications. Oklahoma appears to be postured for incubating hybrid models that bridge life-long learners from beginner to entry-level and master clinician to doctoral research.

 

Appendix C: Acupuncture Utilization Examples Forty-seven states regulate the practice of acupuncture and over sixty colleges host accredited acupuncture programs. Hundreds of hospitals and health systems throughout the nation utilize licensed acupuncturist services. Some leading hospitals currently employing licensed acupuncturists include but are not limited to: Massachusetts General, Ohio’s UH MacDonald Women’s Hospital, Stanford Hospitals, Seattle Children’s Hospital, Los Angeles’ Cedar Sinai, Athen’s Regional Medical Center, Lutheran’s Medical Center, NYU Rusk, Beth Israel Medical Center, Columbia Presbyterian Medical Center, Long Island Jewish Medical Center, Mount Sinai Medical Center, Memorial Sloan-Kettering Cancer Center, Gouverneur Healthcare, University of Wisconsin Hospital and Clinics, Mercy Hospital Chicago, Children’s Memorial Hospital Chicago, Chanadaigua VA Medical Center, University Medical Center of AZ, Arizona Center for Integrative Medicine, Midwestern Regional Medical Center, Cancer Treatment Centers of America, University of Colorado Medical Center, University of New Mexico Hospitals, Cleveland Clinic for Integrative Medicine, Beth Israel Medical Center (Continuum Center for Health and Healing), and Duke University Medical Center, George Washington University Hospital, Greenwich Hospital Integrative Medicine Program. Research Hospitals that offer licensed acupuncturists services include but are not limited to: John Hopkins, Ronald Regan Hospital – UCLA, Cleveland Clinic, San Francisco Medical Center, University of California, Hospital of the University of Pennsylvania, Barnes Jewish St. Louis, and Henry Ford Hospital Detroit. An ever growing number of insurance plans throughout the nation include acupuncture as a member benefit102 and acupuncture meets, at minimum, five of the Essential Health Benefit (EHB) criteria and service categories of care: ambulatory patient services, maternity/infertility, mental health and substance use disorders services, rehabilitative services, preventative wellness, and chronic disease management. As a result of acupuncture being designated as an EHB, nearly 54 million Americans in six states (California,69 Alaska,70 Maryland,71 Massachusetts,97 New Mexico,72 Washington73) and four territories (American Samoa,74 Guam,75 North Mariana Island,76 Virgin Islands77) gained access to acupuncturists’ services in 2014. As of 2017, eight states provide acupuncture coverage through Medicaid (California,79 Maryland,86-88,99 Massachusetts,97 Minnesota,80 New Mexico,81 Ohio,82,83 Oregon84,85 and Rhode Island89,91); New Jersey’s Medicaid plan covers acupuncture anesthesia during surgery;108 and several states, such as Vermont,96 implement temporary innovative Medicaid pilot programs to examine outcomes and savings.90-93 Various programs within the United States Department of Defense medical community have long utilized acupuncturists’ services and provide introductory training for physicians.56 Acupuncturist services are recognized as important and “extremely effective” treatments for non-opioid pain management;57 post-traumatic stress disorder and resilience care;58 mild traumatic brain injury and related insomnia and headaches;59 traumatic brain injuries and psychological disorders,60 and for Gulf War Illness,62 in facilities across the country (e.g., Camp Pendleton, Ft. Hood, Ft. Bliss, Ft. Carson, Walter Reed Army Medical Center). Additionally, the military has provided these services to military families for stress management and post-traumatic stress disorder.61 The United States Department of Veterans Affairs has integrated acupuncture into a number of facilities while expanding outreach into the community; of 125 Veterans Affairs facilities, 58 offered acupuncture services to patients in 2011.34 The 2014 Veteran Choice Program provides acupuncture as a standalone procedure, or within a comprehensive plan, for treating veterans experiencing service-connected low back pain, PTSD, and more. The U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration identifies acupuncture as a complementary treatment for detoxification in comprehensive addiction treatment programs.31 A 2014 report for the National Association for Medicaid Directors recommends acupuncture as one part of a holistic approach to treating patients suffering from pain and co-morbidities such as substance use disorder (SUD) and behavioral health issues.13 The National Congress of American Indians issued resolution #SD-15-027 in 2015 requesting inclusion of licensed acupuncturist services within Indian Health Services and tribal health facilities. 16 To remove barriers to licensed acupuncturist services, equitable inclusion and expansion of coverage within all payer programs, including state and federally funded programs, is import to industry stakeholders for public health improvement.13,16,17,65,66

 

Appendix D: NADA and Substance Use Disorder – Utilization, Research & Cost-Saving Information Throughout the United States, comprehensive treatment settings utilizing the NADA protocol are multiple including but not limited to inpatient, outpatient, addiction treatment programs, mental health facilities, jails, prisons, criminal justice and parole, drug-court, prison psychiatric units, street outreach, homeless shelters, half-way houses, harm reduction, natural disaster emergency relief, HMOs, active-duty military programs, and veterans healthcare programs.28,29,33-37,39,64 Although studies now confirm high risk groups have poorer completion rates than non-risk groups, the high risk groups are proving more likely to complete treatment when participating in NADA treatment.32 NADA is used in the acute and chronic phases of substance use treatment and is increasingly integrated into dual diagnosis settings to help patients with substance use disorders with concurrent behavioral health conditions, psychiatric symptoms,32 and other comorbidities, including personality disorders.35 Report benefits from NADA include improvement in depression, anxiety, anger, sleep disturbances, impaired concentration, fatigue, and body aches/headaches as well as reduction in withdrawal symptoms and cravings.28,32,35-39 Referrals for comprehensive programs utilizing NADA typically include a variety of agencies, such as probation and parole, Drug-Court, Department of Social Services, Department of Motor Vehicles, Recovering Professionals Program, employee assistance program, and physician offices, to name a few.32,28,39 U.S. Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) identifies acupuncture as a complementary treatment for detoxification recognizing that it can be included as part of a comprehensive treatment program for addictions;31and, multiple studies support the adjunctive use of NADA for the treatment of nicotine, heroin, alcohol, and cocaine addiction.28,32,35-39 628 licensed addiction treatment programs30 included acupuncture as a therapeutic tool in 2012. Twenty-two states encourage utilization of the NADA protocol through regulation.28 A 2016 study of NADA within a substance abuse treatment program demonstrates long term savings to the state in NADA control group upon discharge: increased employment by 71% of those previously unemployed vs 35% in the control group, and long term abstinence from alcohol, drugs, and tobacco use.32 A study outcome produced expenditures in a non-NADA control group totaling $17,890.00 while NADA control group costs were $15,580.00, equating to a savings of $2,310.00 per patient,37 a savings of 1 million dollars to the state for every 433 participants. Prison and jail inmates are seven times more likely than individuals in the general population to have a SUD.13 Inmates medicated for violent behavior experienced improved behavior ratings and required fewer psycholeptic drugs than controls when receiving NADA three times weekly.36 A model comprehensive homeless and criminal justice incarceration diversion program in Oregon reports 11% recidivism, saving the state $25,000/year for every rehabilitated person.42 A Sacramento Drug Court Cost Study of a model program demonstrates cost-benefit through comprehensive programming with a 17% recidivism rate after two years for graduates compared to 67% in the non-participation control group, and a saving of $6,605 per graduate; ten year program lifetime savings is calculated as more than $20 million.64
Incorporating NADA treatment into Oklahoma’s existing drug-court diversion and rehabilitation programs may further reduce prison populations and drive down crime rates; for example, reducing Oklahoma drug court graduates’ re-incarceration rates by 50% could save the state 2 million dollars for every 100 additional rehabilitated persons. “The average annual cost of incarceration in the Oklahoma Department of Corrections is $19,000 per person, compared with the average annual per person cost for drug court participation of $5,000. Drug court graduate re-incarceration rates of 23.5% when compared with rates of those whom successfully complete standard probation, 38.2%, and released inmates, 54.3%, are further proof that Oklahoma Drug Courts work.”100 Oklahoma’s existing drug-court program has expanded to 73 of the 77 counties,100 increasing rural and underserved population
access throughout the state. However, Oklahoma incarcerates “a greater portion of its population than any state but one, and a greater portion of its women than anyone”118 and the building of three new prisons is being considered. Pregnant women and neonates are one of “three populations with unique risk in the context of the opioid epidemic.”65 NADA has proven to be safe during pregnancy.41 Although specific acupuncture points on the body are contraindicated during pregnancy, NADA has consistently proven safe and effective throughout term and post-partum. For more than 25 years, NADA was incorporated into the Maternal Substance Abuse Services Program, inspiring programming world-wide while continuing the legacy of the innovative award winning Lincoln Recovery Center39 pregnancy program, an award granted to the center in 1991 by the American Hospital Association.28 Between 2000 and 2009, the rate of newborns diagnosed with neonatal abstinence syndrome (NAS) and dependent on narcotics nearly tripled and the number of mothers using or dependent upon drugs more than quadrupled, while costs associated with treating these infants increased by 35%. Medicaid was the primary payer for over 75% of these births.13 New studies on NADA efficacy suggest savings in neonatal intensive care units from shorter hospital stays and decreased withdrawal symptoms resulting in reduced costly interventions.44,45 The CDC reports that over $170 billion dollars annually is spent on treating diseases caused by smoking; 16 million Americans are currently living with a disease caused by smoking. When used in combination with educational programming, auricular acupuncture protocols (including NADA) have demonstrated marked effect upon reducing nicotine withdrawal symptoms and long-term measurable outcomes are comparable to that of pharmacological approaches at greatly reduced cost.109

 

Appendix E: Acupuncture, Chronic Pain Efficacy, and Cost-Saving Information 30% of patients with chronic pain conditions also suffer from clinical depression, and nearly 50% of patients who suffer from both anxiety and depression disorders have a comorbid pain diagnosis.13 A study published by the NIH in 2017 documents that “evidence on acupuncture compared with usual care and counseling compared with usual care shows that both treatments are associated with a statistically significant reduction in symptoms of depression in the short to medium term, with no reported serious adverse events related to treatment. Acupuncture is cost-effective compared with counseling or usual care alone, although the ranking of counseling and acupuncture depends on the relative costs of delivering these interventions.” 107 A 2017 study finds that acupuncture rewires the primary somatosensory cortex in patients experiencing carpel tunnel syndrome.18 The research supports previous findings recommending the use of acupuncture as a viable first-line long-term cost-effective approach, prior to consideration of costly surgical procedures. Over one-third of patients avoided surgery (arthroplasty of the knee) when acupuncture was added to the standard treatment protocol – generating a savings of $9,000 per patient.49 When incorporated into pre-surgical care, acupuncture has been found to reduce the amount of post-operative morphine consumption; post-operative pain is a strong predictor of subsequent chronic pain.46 Acupuncture is routinely used to reduce pain in cancer patients, as well as alleviate chemotherapy induced nausea and vomiting.46,51-54 Cancer Treatment Centers of American (CTCA) employs acupuncturists in its five nationwide hospitals, providing acupuncture in an integrative setting.51 Dana Farber Cancer Institute at Harvard University has developed evidence-based acupuncture protocols to provide clinically relevant solutions for clinicians and cancer patients with pain, including: postoperative cancer pain, postoperative nausea and vomiting, postsurgical gastroparesis syndrome, opioid-induced constipation, opioid-induced pruritus, chemotherapy-induced neuropathy, aromatase inhibitor-associated joint pain, and neck dissection-related pain and dysfunction.52-54 The National Cancer Institutes comprehensive cancer database (PDQ) statement on acupuncture indicates usage in a wide range of conditions: hot fashes, xerostomia (dry mouth), neuropathy, and cancer related-fatigue & pain management. A 2008 military study documents how replacing pharmacotherapy with acupuncture care for symptoms of pain can generate a $4,000 savings per patient to the Department of Defense – additional savings of $10,000-$18,000 per patient occur when procedures such as spinal fusion and laminectomy are successfully avoided.47

 

Appendix F: Medicaid and Acupuncture The 2014 Medicaid report articulates: “In addition to the financial implications of prescription drug abuse and overdose, chronic and severe social implications reverberate through Medicaid and social service programs as well in the areas of homelessness, domestic violence, unemployment, foster care, and others that can burden states for years in service and care needs.”13 “Medicaid is the largest health care safety net program and is responsible for the health care of 73 million Americans, including those with the most complex health care needs. The program covers 50 percent of all U.S. births, promotes children’s achievement of developmental milestones and school readiness and, enables adults to maintain good health in support of work readiness and job retention, and furthers the values, dignity, safety and integration of individuals who require long-term services and supports. States and the federal government jointly finance and operate Medicaid, making an effective federal-state partnership critical to success of the program.”114 “Because rates of prescription drug misuse and overdose are elevated in individuals that have co-occurring mental illness and/or have a history of substance abuse, access to and effective coordination of care is essential… Inclusion of other clinical and support specialists on the treatment team could also be considered and may be amenable to payer support, including case management and promotion of non-pharmacologic therapies such as acupuncture, massage, and health/wellness classes. Together these ancillary providers may help in shifting the focus away from prescribing opioids as a primary or exclusive means of pain relief… By incorporating recommendations across the six strategies, states can reasonably expect to bring about a reduction in prescription drug abuse and overdose, resulting in an overall reduction in healthcare expenses and an improvement in the health outcomes of Medicaid beneficiaries.”13 A Medicaid report in March 2017 articulates that “Medicaid must also be given statutory certainty around its ability to support holistic initiatives addressing the social determinants of health, which may cross federal programmatic and funding silos. These types of initiatives represent the next horizon for health care transformation, and with federal support, states may lead the way.”114 The Oklahoma Health Care Authority is a state government agency responsible for administering the Oklahoma’s Medicaid program known as “SoonerCare.”112 In 2015, approximately 17% of Oklahoma enrollees were categorized as disabled, aged, or blind; 61% of enrollees were children and more than half of children in Oklahoma were enrolled; average monthly enrollment was 820,000; and total Medicaid spending was $5.1 billion (including funding of $3.1 billion from federal government).111 The agency’s mission is to “responsibly purchase state and federally-funded health care in the most efficient and comprehensive manner possible; to analyze and recommend strategies for optimizing the accessibility and quality of health care; and, to cultivate relationships to improve the health outcomes of Oklahomans.”112 As of 2017, eight states provide acupuncture coverage through Medicaid (California,79 Maryland,86-88,99 Massachusetts,97 Minnesota,80 New Mexico,81 Ohio,82-83 Oregon84-85 and Rhode Island89,91); New Jersey’s Medicaid plan covers acupuncture anesthesia during surgery;108 and several states, such as Vermont,96 implement temporary innovative Medicaid pilot programs to examine outcomes and savings.90-93 Oklahoma appears to be poised to lead, saving lives by qualifying for supplemental Medicaid funding through 1115 demonstration pilots.90 Expanding upon current successful programming, replicable demonstrations utilizing licensed acupuncturists, with clearly-defined baseline measures, goals, and evaluation criteria in targeted sub-populations groups, have clear potential to propel Oklahoma into the lead for innovative emerging community-based collaborative approaches addressing the unique challenges that must be overcome to successfully combat the nation-wide opioid epidemic.

 

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119. Governor Fallin- 2017 Legislative Session goals http://altustimes.com/category/news This brief has been prepared by Rhonda K Bathurst, L. Ac., Brandy Valentine-Davis, L. Ac., and Tim Williams, Cert. Ac. with evidence base provided by the American Association of Acupuncture and Oriental Medicine (AAAOM) and the National Acupuncture Detoxification Association (NADA). 9 August 2017.

120. Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JA, Meade L, Pang J. Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management—White Paper 2017. J Integr Med. 2017; 15(6): 411–425.

 

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Great news! This month our article”Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017″ 1 (Arthur Yin Fan is the first author, and Dr.David Miller is the correspondence author, our colleague Sarah Faggert also a co-author-there are 14 authors across the United States) has been selected as one of ten articles for the November 2017 Elsevier Atlas Awards Nominations.

As is stated on the Elsevier Atlas Awards homepage: “Each month the Atlas Advisory Board are sent a selection of 10 articles to choose their winning Atlas article. The articles are shortlisted by Elsevier from across journal portfolios based on their potential social impact. We are delighted to present the entire monthly shortlist and congratulate the authors of the nominated articles.” While the voting is still in progress, we are still very excited to even be nominated. This marks the first time that an acupuncture article has been nominated for the Elsevier Atlas Award.You may click on the following link to take you the Elsevier Atlas Nominations page: https://www.elsevier.com/connect/atlas/nominations.

We will let you know should our article win!

Each month the Atlas Advisory Board are sent a selection of 10 articles to choose their winning Atlas article.
ELSEVIER.COM
Reference:
1. Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JA, Meade L, Pang J. Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management—White Paper 2017. J Integr Med. 2017; 15(6): 411–425.

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Today, White Paper version 2.0 was published online first at the Website of Journal of Integrative Medicine

Click to access S2095-4964(17)60378-9.pdf

Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, White Paper 2017

Abstract by Arthur Yin Fan

The title of White Paper is “Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, White Paper 2017”白皮书的题目是“针灸在解决阿片类药物危机中的作用:针灸作为一线非药物疗法治疗和控制疼痛的证据、花费和医疗服务的可行性”。

There were 6 organizations as the co-publishers-参加发表该白皮书的有6个合作单位:The American Society of Acupuncturists, ASA美国针灸师联合会 、The American Alliance for Professional Acupuncture Safety, AAPAS美国执业针灸安全联盟 ,  The Acupuncture Now Foundation, ANF针灸立刻行动基金会,  The American TCM Association, ATCMA全美中医药学会 ,  The American TCM Society, ATCMS)美国中医针灸学会和全美华裔中医药总会 National Federation of TCM Organizations, NFTCMO 。

White paper  was drafted and edited based on a letter, which original authors were(白皮书起草是在一封信的基础上起步的,信的原文作者是): The Joint Acupuncture Opioid Task Force (Chair: Bonnie M. Abel Bolash, MAc, LAc. Member organizations: The Acupuncture Now Foundation (ANF) ,The American Society of Acupuncturists (ASA) ;组员: Matthew Bauer, LAc ;Bonnie Bolash, LAc ; Lindy Camardella, LAc; Mel Hopper Koppelman, MSc ;John McDonald, PhD, FAACMA ;Lindsay Meade, LAc ;David W Miller, MD, LAc .

The first (revising) author 白皮书修改稿第一作者: Arthur Yin Fan, CMD, PhD, LAc (ATCMA) ;Correspondent author通讯作者: David W Miller, MD, LAc 。Other authors参与白皮书的其他作者: Sarah Faggert, DAc, LAc; Hongjian He, CMD, LAc;Mel Hopper Koppelman, MSc; Yong Ming Li, MD, PhD, LAc ; Amy Matecki, MD, LAc*;David W Miller, MD, LAc; John Pang, MD** , etc . *Division Chief, Dept. of Medicine, Highland Hospital, Alameda Health System; **Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego School of Medicine.

Abstract

The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public’s opioid dependence. Acupuncture has emerged as a powerful, evidence based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options, and acupuncture stands as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost -effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of pain seen commonly in hospitals.

Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military.

摘要

美国正处于整个国家的阿片类药物流行危机,医疗系统亟需非药物的疗法、用以治疗疼痛并减少公众对阿片类药物的依赖。针灸作为强有效的、循证的、安全的、具有成本效益的治疗方式,满足这一需求。众多针灸临床试验已经证明针灸对许多类型的疼痛治疗有效,针灸的作用机制已被阐明,并且可以从生物医学和生理学角度解释。同时,从治疗急性疼痛的角度来看,针灸的成本效益可能会大大降低医疗保健支出,并避免发生昂贵的阿片类药物成瘾、破坏生命质量、并导致致命的过量。许多联邦监管机构已经建议或强制医疗保健系统和提供者提供非药物治疗选项,而针灸是最具实证性的、并立即可以采用。针灸可以安全、便利、经济有效地纳入医院设置,如急诊部门、产房以及新生儿重症监护室等,用以治疗医院里普遍见到的各种疼痛。

退伍军人管理局和美国军方的各个部门已经成功地有针对性地采用针灸。

  1. Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain. Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use.

针灸疗法安全有效、经济,治疗多种急慢性疼痛有效:理应作为疼痛的一线治疗,先于阿片类药物使用,针灸疗法可以显著减少阿片类药物用量(我们在以下各分项中归纳了众多证据)。

1.1 Effectiveness/Efficacy of acupuncture for different types of pain.

针灸疗法治疗多种疼痛有效。

1.2 Safety and feasibility of acupuncture for pain management.

针灸疗法治疗疼痛安全、易行。

1.3 Cost-effectiveness of acupuncture for pain management.

针灸疗法治疗疼痛可以减少支出。

1.4 Can adjunctive acupuncture treatment reduce the use of Opioid-like medications?

结合使用针灸疗法可以减少阿片的用量。 

  1. Acupuncture’s analgesic mechanisms have been extensively researched and acupuncture can increase the production and release of endogenous opioids in animals and humans.

针灸的镇痛机制已经有大量的研究,针灸增加动物和人类的内源性阿片肽并促其释放。

  1. Acupuncture is effective for the treatment of chronic pain involving maladaptive neuroplasticity.

针灸治疗慢性疼痛涉及改善其病态的神经塑形。

  1. Acupuncture is a useful adjunctive therapy in opiate dependency and rehabilitation.

针灸是有益的治疗阿片依赖并促其康复的辅助疗法。

  1. Acupuncture has been recommended as a first line non-pharmacologic therapy by the

FDA, as well as the National Academies of Sciences, Engineering, and Medicine in coping with the opioid crisis. The Joint Commission has also mandated that hospitals provide non-pharmacologic pain treatment modalities.

针灸已被FDA、以及美国国家科学院、国家工程院和国家医科院三院应对阿片类药物危机联合委员会推荐为一线非药物疗法。医院考核联合委员会也已经把非药物治痛疗法列为医院必须包括的项目。

  1. Among most non-pharmacologic al managements for pain relief now available, acupuncture therapy is the most effective and specific for opioid abuse and overuse.

迄今为止,可用的非药物治疗疼痛的疗法,针灸疗法最为有效并对于阿片类药物滥用和过用使用针对性最强。 

  1. Acupuncture is widely available from qualified practitioners nationally.

美国有足够的合格的针灸师

Click to access S2095-4964(17)60378-9.pdf

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