Acupuncture Moving Mainstream in Workers’ Comp
The acceptance of Eastern medicine as an alternative treatment for injuries continues to move west, with Washington State piloting the use of acupuncture to treat a specific occupational injury.
The state’s Department of Labor & Industries (L&I), which oversees its state-run workers’ compensation program, first began exploring the idea of covering acupuncture services back in 1996, and revisited the idea nearly a dozen times since then.
In 2016, L&I formally requested a pilot program based on a systematic review of the use of acupuncture to treat lower back pain, conducted by the Washington East Asian Medical Association (WEAMA). The program, which launches Oct. 1, will run for two years and will enroll up to 150 qualified acupuncturists.
Leah Hole-Marshall, a medical administrator at L&I, said that before the WEAMA review, the agency didn’t have enough literature to review to support acupuncture’s use as a viable treatment.
The WEAMA review found that acupuncture outperformed usual care in nine out of 10 clinical trials, and performed statistically significantly better than usual care for pain in 10 out of 11 trials.
The Washington state trial will cover five acupuncture visits for lower back pain and allow for an additional five sessions if there is documented clinical improvement in the patient’s pain.
Injured workers must be referred for acupuncture treatment by their attending physician and be treated by one of the agency’s accepted providers.
The agency has already received more than 200 applications from acupuncturists interested in participating in the pilot.
Hole-Marshall says the agency will not be reviewing the effectiveness of the acupuncture treatments, but will examine the effectiveness of communication between attending providers and acupuncturists, and identify any possible red flags.
“We’re looking at whether there are any unanticipated consequences … and mostly how acupuncture fits in a workers’ comp system focused on functional recovery,” she said.
Acceptable for Pain Relief
In the past two years, both the American College of Physicians and the National Institutes of Health have supported the use of non-drug therapies, such as acupuncture, for the treatment of low back pain.
The Joint Commission, which accredits nearly 21,000 health care organizations, recently revised its pain management standards to require accredited hospitals to provide non-pharmacological pain options, such as acupuncture provided by licensed independent practioners, by Jan. 1, 2018.
As a workers’ compensation benefit, acupuncture is covered in 29 states and Washington, D.C. In Ohio, the state’s Bureau of Workers’ Compensation (BWC), began covering the use of acupuncture for treating workers’ comp covered injuries in the late 2000s. The Ohio workers’ comp system, a state-run program similar to Washington State’s comp program, currently covers up to two hours of acupuncture for workplace injuries, with treatments billed in 15-minute increments.
Although the number of acupuncture treatments billed has declined in the past five years, the bureau billed 16,057 15-minutes treatments in 2016.
“Patients have to be partners in treatment and it’s pretty hard to get compliance with forms of treatment that patients won’t accept,” — Dr. Robert Goldberg, chief medical officer, Healthesystems
California approved the use of acupuncture as a legitimate form of treatment for workplace injuries in the 1990s, in part because its large population of East Asian immigrants, as well as a significant percentage of people in the state interested in non-Western treatment, noted Dr. Robert Goldberg, chief medical officer at Healthesystems, a national workers’ comp pharmacy and ancillary benefits provider.
While he said it’s hard to argue against offering acupuncture as a treatment because of the low risk and cost, he noted that there are medical and sociocultural barriers to widespread use among workers’ comp patients.
“Patients have to be partners in treatment and it’s pretty hard to get compliance with forms of treatment that patients won’t accept,” Goldberg said. He also noted that there is still limited evidence of acupuncture’s efficacy, particularly for uses outside of treating lower back pain.
However, he sees the use of acupuncture increasing with more physicians and individuals looking at active forms of treatment, such as acupuncture, yoga and biotherapy, as an alternative to opioids.
Though very few studies have been published showing a link between the use of acupuncture to reduce opioid dependence, Goldberg expects more of these to be forthcoming.
In 2016, a clinical trial published in Mayo Clinic Proceedings found that acupuncture effectively managed pain for individuals suffering from lower back pain and osteoarthritis of the knee.
In August, the Patient-Centered Outcomes Research Institute Board of Governors approved $5.7 million in funding to explore the use of nondrug strategies, including acupuncture, to treat Oregon Medicaid recipients who suffer from lower back pain.