Skepticism is part and parcel of the practice of medicine. First Do No Harm looms large in every encounter. So when new practice modalities gain popularity, it’s not surprising that they take some time to gain widespread usage, particularly when their mechanism of action is unclear. Acupuncture definitely falls into that category, but its use is gaining momentum and its acceptance is growing.
The American Academy of Neurology has added the Section on Neurohealth & Integrative Neurology because of the growing acceptance of complementary and alternative medicines into mainstream medicine, including acupuncture.
At the 2019 AAN Annual Meeting, Jennifer Bickel, MD, provided an acupuncture demonstration for those who wanted to experience the treatment. She walked the attendees through a mini-acupuncture session, with needling at the LV3 point on both feet. Full disclosure: this author found it mildly unpleasant, but she also wasn’t in need of pain relief at the time. Other attendees found it relaxing and hoped to pursue a more extensive treatment.
Bickel discussed how acupuncture has been a popular addition to her practice. She emphasized that this is not a profit center—yet—but it is a popular added service that attracts patients to her practice over her competitors. In the current environment of reimbursements, that added attraction might be the key to remaining profitable.
But what of the evidence? Does acupuncture work?
Potentially. Recent research suggests group acupuncture reduces pain in patients with peripheral diabetic neuropathy (PDN). The study enrolled 40 patients with PDN who were then randomized to acupuncture once weekly or twice weekly or to usual care. There was no significant difference between those who received acupuncture once or twice weekly, and those results were combined in the main analysis of the study.
The conclusion? Clinically-relevant pain reduction from PDN, as well as quality-of-life improvements were found in those who received acupuncture. So in this instance, the answer is yes, acupuncture works. Acupuncture research is ongoing and we will certainly have more definitive evidence about the use of acupuncture for various types of pain in the coming years.
In an article published in Medical Acupuncture, authors Michael Freedman, MD, and Patricia Bierwirth, LPN, argue for the pragmatic use of acupuncture in the neurology practice. Freedman added acupuncture to his own neurology practice caring for VA patients in 2015. He had grown frustrated with the options for pain management in his patients and wary of the growing issues with opioid dependence.
The article briefly outlines his experience adding acupuncture to his practice, which has been positive with many accounts of immediate relief for migraine patients who “leave a visit smiling and free of the headache.” He has also found acupuncture to be particularly useful in cervicogenic and temporomandibular joint-related headaches as well as in patients with phantom limb pain.
Freedman and Bierwirth argue that acupuncture is “easily and quickly learned and delivered, simple, safe, inexpensive and effective.” As an alternative to opiate pain treatment, it can be an excellent choice for several pain conditions seen in the general neurology practice. They further argue that neurology training programs should include medical acupuncture training and the skills should be a “core competency required of all neurologists in a general practice.”
The question then is if—in light of the evidence and arguments for acupuncture—it makes sense for you to add acupuncture to your neurology practice. Only you can answer that question, but it deserves consideration. It seems that for the neurologist who struggles with finding effective non-opiate pain relief for her patients, acupuncture may be worth trying. You have the option to pursue training and offer acupuncture yourself or to have a trained acupuncturist offer the service to your patients. Either option offers a fairly low-risk way to test the effect it has on your practice and your patients’ lives. And if the results are positive, you’ll be glad you did.