Intervention
Barriers and facilitators (sometimes called "contextual determinants") are factors that make it harder or easier to implement acupuncture for chronic pain. These factors span multiple levels. Click the buttons on the left to read more about common barriers and facilitators for acupuncture for chronic pain. In addition, view the RASC guides on Contextual Determinants Affecting Implementation and the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) to learn practical ways to assess these constructs.
Acupuncture for chronic pain is a low-risk nonpharmacological option for pain management that shows promise for several types of pain. However, treatment logistics and a lack of awareness hinder broader patient use.
Barriers
Acupuncture treatment requires continued engagement for both the care recipient and the provider. Treatment duration typically spans several weeks, and sessions can last over an hour for evaluation, treatment, and discussion, though follow-up visits can be shorter than the initial visit. Individuals with limited financial coverage (e.g., insurance coverage, disposable income) or other barriers (e.g., transportation, geographic availability) may have difficulty maintaining the required level of engagement to complete treatment or achieve the intended benefit. Transportation and appointment availability during evening hours have also been cited as barriers to acupuncture treatment. Data suggest that higher-income and more highly educated individuals are more likely to complete acupuncture treatment than their lower-income or less educated counterparts.
According to data from the National Health Interview Survey, one of the main reasons for individuals not utilizing acupuncture was unawareness or unfamiliarity with acupuncture as a pain treatment option.
Facilitators
Acupuncture is seen as a safer option than other pain treatments, specifically opioids, particularly for specific populations like pregnant individuals. Various qualitative studies demonstrate that both providers and care recipients view acupuncture as a safe and effective treatment. Safety research suggests that serious adverse events are very rare.
Acupuncture can be delivered in a variety of care settings, including independent practitioner offices, hospital settings (i.e., inpatient, ambulatory care), and integrated primary care settings. Subtypes of acupuncture, such as auricular acupuncture, can be standardized (e.g., battlefield acupuncture [BFA]) and quickly taught to a variety of health care disciplines. Telehealth can also expand treatment access by allowing acupuncturists to assess an individual’s condition and develop a needleless “acupressure” treatment plan that involves the individual applying pressure to stimulate acupuncture points to achieve a treatment response without needles. Acupuncture can also be delivered in community health centers and group settings to improve efficiency.
Acupuncture is a low-risk option that allows individuals and providers to try the procedure with a modest time burden (similar to other nonpharmacological therapies) and with no to minimal medical risk. Within a limited treatment trial (e.g., 6-8 visits), individuals and providers can determine initial effectiveness and gauge interest in, and the appropriateness of, continuing or discontinuing treatment. Because results are easily observable to the individual receiving care (pain reduction, reduced reliance on pain medications, improved functioning, etc.), individuals can assess their interest in continuing treatment in real time.