Acupuncture for Chronic Pain

Despite inconsistent health insurance coverage, acupuncture shows promise as a cost-effective chronic pain management therapy.

Acupuncture for Chronic Pain — Evidence Rating: Low to Moderate Quality

The overall quality of evidence supporting acupuncture for chronic pain is low to moderate, depending on the condition. Systematic reviews and meta-analyses demonstrate that acupuncture provides modest but clinically meaningful improvements in pain and function compared with usual care or no treatment, with smaller but statistically significant benefits compared with sham acupuncture. Sham acupuncture refers to a comparison control used in clinical trials that can include shallow or non-penetrating needles or regular needling on non-acupuncture point areas. Studies involving sham acupuncture typically demonstrate mild therapeutic effects in the sham group, which can contribute to the apparent lesser improvements observed with real acupuncture. However, variability in trial quality, particularly heterogeneity in comparator groups and condition definitions, limits the quality of the evidence base. The American College of Physicians recommends acupuncture as a nonpharmacologic option for the management of chronic lower back pain. Evidence suggests that, in addition to lower back pain, acupuncture can achieve modest pain improvements for neck pain, osteoarthritis, and headache disorders. Acupuncture is also safe and generally well accepted by patients, making it a viable adjunct in multimodal pain care. For insurance-based acupuncture care, the most frequent conditions submitted between 2010 and 2015 were joint-related conditions (e.g., rheumatoid arthritis, osteoarthritis), back pain, connective tissue disorders, anxiety disorders, and headaches or migraines. Future research on implementing acupuncture care for chronic pain may help scale its utilization further.

Evidence-based Scale

Acupuncture may be a cost-effective strategy for chronic lower back pain management. A study using national healthcare utilization and expenditure data found that individuals who used complementary and integrative health (CIH), including acupuncture, to manage chronic lower back pain had significantly lower healthcare expenditures than those who did not use CIH. These findings were driven by lowered outpatient expenses and lower prescription medication costs. Additional studies further demonstrate the cost-effectiveness of acupuncture for the management of chronic pain across different chronic pain sites or types.

Despite its potential cost-effectiveness, acupuncture coverage by health insurance plans varies widely and can limit access to care for many. Insurance policy trends indicate low but increasing coverage for acupuncture services. Further, coverage can be limited by provider type, covered pain conditions, the number of sessions, or may involve higher cost-sharing relative to other CIH treatments. Most acupuncture services in 2018-2019 were covered through out-of-pocket expenses. The mean out-of-pocket expenditure for acupuncture services in 2018-2019 was $554.26.