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In response to the need for pain relief therapies that don’t involve opioid medications, acupuncture is one recommended alternative in addition to cognitive behavioral therapy, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs). The Centers for Medicare and Medicaid Services (CMS) announced in January 2020 that it would cover acupuncture for chronic low back pain in Medicare beneficiaries, citing the potential for acupuncture to reduce overuse of and addiction to opioids. Although acupuncture has been proposed to reduce exposure to opioids, few studies have examined its effect on lowering prescribed opioid use because it is very difficult to study due to variations in applied techniques and a strong potential for placebo effects. This study compared outcomes in people who used acupuncture to those who used non-steroidal anti-inflammatory drugs (NSAIDs) and and/or physical therapy (PT).

Findings: Acupuncture does appear to reduce opioid initiation for certain chronic pain conditions including neck and back pain, and headaches and migraine, as compared to NSAIDs or PT.

Fewer people began taking opioids after starting acupuncture therapy relative to a control group of usual care. For those who did take opioids, the number of fills and total days of supply were lower for the acupuncture group. These differences were statistically, but not clinically, significant. Overall, acupuncture showed an advantage in ceasing opioid use entirely rather than reducing use.

People receiving acupuncture also experienced a modest reduction in emergency department visits, while the comparison group experienced an increase in visits. 

“We have been encouraged by the recent decreases in opioid prescribing, but many people are still dealing with chronic pain on a daily basis,” said Andrea DeVries, vice president for Health Services Research at Elevance Health. “They need a range of available options to manage their condition.”

What’s Next:  Following the peer review publication of the study, Elevance Health carried out a formal review and updated medical policy, which included expanding the list of indications. A comprehensive literature review of scientific evidence on the role of acupuncture in pain management by clinical indication was also conducted. 

Methodology: The retrospective observational study looked at the administrative claims of 52,346 commercially insured people treated with either acupuncture or usual care (NSAIDs/PT) from 2014 to 2017. Studied outcomes included opioid use, subsequent invasive surgical procedures, hospitalizations, emergency department visits, and costs. Outcomes were assessed by looking at the differences between the 12 months before and after the first date of service.

Read the Study:

Acupuncture was
associated with

  • 7% less opioid initiation 
  • 7% less continued opioid use