Further research questions regarding acupuncture may include:

1. Expanding data on the workforce and capacity of acupuncturists in the United States. With utilization data suggesting treatment use that does not align with patterns of chronic pain burden across the country, it would be of particular interest to fill this gap with geographical availability data that may ultimately support bolstering workforces in high-need areas of the country. This is further compounded by a mixture of health care professionals delivering the acupuncture. Acceptance of different payer types across acupuncture providers would be an additional area of supply-side research of particular interest.
2. Investigating the integration of acupuncture with the rest of one’s care team. This information would help identify and address implementation barriers. As coordination across providers and difficulty with referral pathways and reimbursements for some provider types and settings are frequently cited as implementation barriers, further insight into this process would help identify potential scalable solutions from the health system to the policy level.
3. Advancing the implementation literature. This is essential to the broader adoption of acupuncture in different care settings for pain. While the current implementation research identifies several barriers and facilitators to acupuncture adoption, no trials exist that compare different sets of implementation strategies. Such research would help identify which aspects of addressing barriers yield the most beneficial results. For example, should educational materials focus on providers, care recipients, or both? Further, there are unique questions regarding the implementation of acupuncture in medically underserved populations who often receive their health care at federally qualified health centers or community clinics. Evaluation of implementation of documentation standardization and adoption of uniform EHR documentation practices (e.g., templates) may optimize communication among health care professionals and enable acupuncture referrals and care coordination. The first steps are to assess and characterize the current state of EHR documentation practices
4. Increasing data on cost-effectiveness. This may also help encourage increased payor coverage of acupuncture services, both within an episode of pain care and across time. While health plans are trending towards increased coverage of acupuncture for chronic pain, many plans, including most state Medicaid programs, do not cover these services and introduce cost barriers to many who stand to benefit (e.g., medically underserved). Increased focus on cost-effectiveness research may help spur coverage policy reform. Additionally, adequate reimbursement rates would be needed to ensure optimal service provision of acupuncture care.
5. Evaluation of the downstream care cascade. This evaluation may indicate parallels with other nonpharmacological approaches, such as chiropractic care, which has demonstrable evidence that early care engagement results in reductions in costs associated with imaging, opioids, and surgical utilization. Such research would help determine the downstream cost savings benefit of acupuncture for the management of pain conditions.