Just Published on Journal of Integrative Medicine: “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” (version 2.0)

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。 

2. 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。

3. 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。

4. 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。

5. 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。

6. 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。 

7. 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

Advertisement

Read Full Post »

Is acupuncture expensive? How much is the reasonable price? by Dr. Arthur Yin Fan

The discussion below is only for the patients who have NO acupuncture benefits. If the patients have acupuncture coverage, please read other information in our blogs regarding to the insurance issues.

Different in answers.

When some patients come, they hope we could give them a very low price for acupuncture–if their insurance plan does not cover the acupuncture. They actually have no idea about how much acupuncture price should be.

How much? around $40-50?—acutually, their expectation is, the acupuncture self-pay price is just a little bit higher than or close to the copayment (for example $20-35) in their insurance plan for other medical specialties when they have NO acupuncture coverage in their insurance.

In current market, the average price or cost  for human patients in Washington DC/ Northern Virginia is around $65-110 (do you know how much-if your pets,dog or cat, need to do acupuncture? the Vet-doctors’ fee schedule is–the first session $250, next $125. Much higher than human patients’ payment for acupuncture services). Some acupuncturises may charge $50-60, some may charge more than  $100.  Some also charge initial visit in additional,$40 -100(or more) because the examination/evaluation and paper works.  Some give patients who have no acupuncture coverage in insurance or senior an additional discount.  Some do not. Some offer a free initial visit.

Considering the price, we should think of:

(1) the actual cost in conventional medicine; for example, the treatment for low back pain, how much for the overall price for an operation/surgery? how much for the overall cost of physical therapy? or how much for the overall cost of Chiropractic treatment?

If we consider the cost/effectiveness ratio, acupuncture overall value actually very high.  It means you pay less and get a good result, with less side effect too. That means acupuncture therapy is less expensive one.  But when patient considers their self-payment, they may feel it is high, that is true—if insurance could cover, patients only need to pay the deductible, and copay. i.e. patient think it is high, it is higher than the copayment, but it is much lower than the actual cost in conventional therapies.

(2) the provider’s condition; if we consider the provider’s costs in training, getting experience, the high level / better provider may have better result, or say, patient might see the effectiveness earlier.  So, paying a little bit more to get a better result is not a bad idea.  In a overall view, patient maybe still save money.

(3) see how many therapies, time  or efforts the provider using for patient; if the provider used acupuncture alone 20 mintues for you and charged $80-90, it may be a little bit high;  if use 40-60 minutes, it is valuable;

If the provider uses comprehensive therapies, such acupuncture with electrical therapy, infarared, cupping, tuina, etc., which would be very valuable and patient may see the effectiveness much earlier.

The price should reflect the value– the technology, training and experience level, treatment time, effectiveness, and other costs, such as office running cost, etc.

Read Full Post »