Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017

United States National Center for Complementary and Integrative Medicine United States Department of Health & Human Services United States National Institute on Drug Abuse Evans The Food and Drug Administration The National Academies of Sciences, Engineering, and Medicine Official Publication of Joint Commission Requirements, 2017, New and revised standards related to pain assessment and management, Jt Comm Perspect, 37, 3 McDonald, 2017 Vickers, 2012, Acupuncture for chronic pain: individual patient data meta-analysis, Arch Intern Med, 22, 1444, 10.1001/archinternmed.2012.3654 Weidenhammer, 2007, Acupuncture for chronic pain within the research program of 10 German health insurance funds–basic results from an observational study, Complement Ther Med, 15, 238, 10.1016/j.ctim.2006.09.005 Corbett, 2013, Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis, Osteoarthritis Cartilage, 21, 1290, 10.1016/j.joca.2013.05.007 Qaseem, 2017, Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians, Ann Intern Med, 166, 514, 10.7326/M16-2367 Ji, 2015, The efficacy of acupuncture for the treatment of sciatica: a systematic review and meta-analysis, Evid Based Complement Alternat Med, 2015, 192808, 10.1155/2015/192808 Lewis, 2015, Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses, Spine J, 15, 1461, 10.1016/j.spinee.2013.08.049 Gadau, 2014, Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials, BMC Complement Altern Med, 14, 136, 10.1186/1472-6882-14-136 Clark, 2012, The effectiveness of acupuncture for plantar heel pain: a systematic review, Acupunct Med, 30, 298, 10.1136/acupmed-2012-010183 An, 2014, Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing supratentorial craniotomy, Am J Chin Med, 42, 1099, 10.1142/S0192415X14500682 Chen, 2015, Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial, Reg Anesth Pain Med, 40, 31, 10.1097/AAP.0000000000000138 Cho, 2016, Can perioperative acupuncture reduce the pain and vomiting experienced after tonsillectomy? A meta-analysis, Laryngoscope, 126, 608, 10.1002/lary.25721 Cho, 2015, Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials, Pain Pract, 15, 279, 10.1111/papr.12208 Crespin, 2015, Acupuncture provides short-term pain relief for patients in a total joint replacement program, Pain Med, 16, 1195, 10.1111/pme.12685 Gilbey, 2015, Acupuncture for post tonsillectomy pain in children: a randomized, controlled study, Paediatr Anaesth, 25, 603, 10.1111/pan.12621 Liu, 2015, Acupuncture-point stimulation for postoperative pain control: a systematic review and meta-analysis of randomized controlled trials, Based Complement Alternat Med, 2015, 657809 Lu, 2015, Perioperative acupuncture modulation: more than anaesthesia, Br J Anaesth, 115, 183, 10.1093/bja/aev227 Tsao, 2015, Intraoperative acupuncture for post tonsillectomy pain: a randomized, double-blind, placebo-controlled trial, Laryngoscope, 125, 1972, 10.1002/lary.25252 Golianu, 2007, Non-pharmacological techniques for pain management in neonates, Semin Perinatol, 31, 318, 10.1053/j.semperi.2007.07.007 Fry, 2014, Acupuncture for analgesia in veterinary medicine, Top Companion Anim Med, 29, 35, 10.1053/j.tcam.2014.03.001 Levy, 2015, Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012, Am J Prev Med, 49, 409, 10.1016/j.amepre.2015.02.020 Thiels, 2017, Wide variation and overprescription of opioids after elective surgery, Ann Surg, 266, 564, 10.1097/SLA.0000000000002365 Wunsch, 2016, Opioids prescribed after low-risk surgical procedures in the United States, 2004–2012, JAMA, 315, 1654, 10.1001/jama.2016.0130 Hill, 2017, Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures, Ann Surg, 265, 709, 10.1097/SLA.0000000000001993 Brummett, 2017, New persistent opioid use after minor and major surgical procedures in US adults, JAMA Surg, 152, e170504, 10.1001/jamasurg.2017.0504 Pang, 2017, Chronic opioid use following surgery for oral cavity cancer, JAMA Otolaryngol Head Neck Surg, 10.1001/jamaoto.2017.0582 Meissner, 2003, Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia, Crit Care Med, 31, 776, 10.1097/01.CCM.0000053652.80849.9F Dublin, 2011, Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population-based case-control study, J Am Geriatr Soc, 59, 1899, 10.1111/j.1532-5415.2011.03586.x Burry, 2017, Delirium and exposure to psychoactive medications in critically ill adults: a multi-centre observational study, J Crit Care, 42, 268, 10.1016/j.jcrc.2017.08.003 Tedesco, 2017, Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis, JAMA Surg, e172872, 10.1001/jamasurg.2017.2872 Asmussen, 2017, Meta-analysis of electroacupuncture in cardiac anesthesia and intensive care, J Intensive Care Med, 10.1177/0885066617708558 Huang, 2017, J Anesth, 31, 58, 10.1007/s00540-015-2057-1 Asmussen, 2017, Effects of acupuncture in anesthesia for craniotomy: a meta-analysis, J Neurosurg Anesthesiol, 29, 219, 10.1097/ANA.0000000000000290 Yang, 2017, Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial, Sci Rep, 7, 37826, 10.1038/srep37826 Smith, 2011, Acupuncture for primary dysmenorrhoea, Cochrane Database Syst Rev, 10.1002/14651858.CD007854.pub2 Abaraogu, 2015, As acupressure decreases pain, acupuncture may improve some aspects of quality of life for women with primary dysmenorrhea: a systematic review with meta-analysis, J Acupunct Meridian Stud, 8, 220, 10.1016/j.jams.2015.06.010 Cho, 2010, Acupuncture for primary dysmenorrhoea: a systematic review, BJOG, 117, 509, 10.1111/j.1471-0528.2010.02489.x Xu, 2014, Effects of moxibustion or acupoint therapy for the treatment of primary dysmenorrhea: a meta-analysis, Altern Ther Health Med, 20, 33 Chung, 2012, Acupoint stimulation intervention for people with primary dysmenorrhea: systematic review and meta-analysis of randomized trials, Complement Ther Med, 20, 353, 10.1016/j.ctim.2012.02.008 Chen, 2013, Acupuncture or acupressure at the Sanyinjiao (SP6) acupoint for the treatment of primary dysmenorrhea: a meta-analysis, Evid Based Complement Alternat Med, 2013, 493038 Levett, 2014, Acupuncture and acupressure for pain management in labour and birth: a critical narrative review of current systematic review evidence, Complement Ther Med, 22, 323, 10.1016/j.ctim.2014.03.011 Vixner, 2014, Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial, BMC Complement Altern Med, 14, 187, 10.1186/1472-6882-14-187 Dong, 2015, Effects of electro-acupuncture on labor pain management, Arch Gynecol Obstet, 291, 531, 10.1007/s00404-014-3427-x Liu, 2010, A systematic review on acupuncture for trigeminal neuralgia, Altern Ther Health Med, 16, 30 Deare, 2013, Acupuncture for treating fibromyalgia, Cochrane Database Syst Rev, 10.1002/14651858.CD007070.pub2 Grissa, 2016, Acupuncture vs intravenous morphine in the management of acute pain in the ED, Am J Emerg Med, 34, 2112, 10.1016/j.ajem.2016.07.028 MacPherson, 2017, The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain, Pain, 158, 784, 10.1097/j.pain.0000000000000747 Feeney, 2017, Acupuncture for pain and nausea in the intensive care unit: a feasibility study in a public safety net hospital, J Altern Complement Med, 10.1089/acm.2016.0323 Lao, 2006, Acupuncture practice, past and present: is it safe and effective?, J Soc Integr Oncol, 4, 13 Lu, 2008, The value of acupuncture in cancer care, Hematol Oncol Clin North Am, 22, 631, 10.1016/j.hoc.2008.04.005 Ambrosio, 2012, Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials, Complement Ther Med, 20, 364, 10.1016/j.ctim.2012.05.002 MacPherson, 2017 Center for health information and analysis Australian Acupuncture and Chinese Medicine Association Ltd Da Silva, 2015, Acupuncture for migraine prevention, Headache, 55, 470, 10.1111/head.12525 Liodden, 2013, Acupuncture and related techniques in ambulatory anesthesia, Curr Opin Anaesthesiol, 26, 661, 10.1097/ACO.0000000000000017 Spackman, 2014, Cost-effectiveness analysis of acupuncture, counselling and usual care in treating patients with depression: the results of the ACUDep trial, PLoS One, 9, e113726, 10.1371/journal.pone.0113726 Taylor, 2014, Cost-effectiveness of acupuncture for chronic nonspecific low back pain, Pain Pract, 14, 599, 10.1111/papr.12116 Andronis, 2017, Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review, Appl Health Econ Health Policy, 15, 173, 10.1007/s40258-016-0268-8 Lin, 2002, The effect of high and low frequency electroacupuncture in pain after lower abdominal surgery, Pain, 99, 509, 10.1016/S0304-3959(02)00261-0 Wang, 1997, Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement, Anesth Analg, 85, 406 Zheng, 2008, The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial, Eur J Pain, 12, 671, 10.1016/j.ejpain.2007.10.003 Crawford, 2017, Reduction in pain medication prescriptions and self-reported outcomes associated with acupuncture in a military patient population, Med Acupunct, 29, 229, 10.1089/acu.2017.1234 Kligler, 2017, Integrative health in the veterans health administration, Med Acupunct, 29, 187, 10.1089/acu.2017.29055.bkl Helms, 2017, Medical acupuncture meets the military, Med Acupunct, 29, 189, 10.1089/acu.2017.29054.jmh Hanlon, 2017, Central nervous system medication burden and serious falls in older nursing home residents, J Am Geriatr Soc, 65, 1183, 10.1111/jgs.14759 Robb, 2017, Medication-related patient harm in New Zealand hospitals, N Z Med J, 130, 21 Goldman, 2010, Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture, Nat Neurosci, 13, 883, 10.1038/nn.2562 Takano, 2012, Traditional acupuncture triggers a local increase in adenosine in human subjects, J Pain, 13, 1215, 10.1016/j.jpain.2012.09.012 Zhao, 2008, Neural mechanism underlying acupuncture analgesia, Prog Neurobiol, 85, 355, 10.1016/j.pneurobio.2008.05.004 Han, 2011, Acupuncture analgesia: areas of consensus and controversy, Pain, 152, S41, 10.1016/j.pain.2010.10.012 Han, 2004, Acupuncture and endorphins, Neurosci Lett, 361, 258, 10.1016/j.neulet.2003.12.019 McDonald, 2015, Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture, Evid Based Complement Alternat Med, 2015, 975632, 10.1155/2015/975632 Zhang, 2014, Mechanisms of acupuncture-electroacupuncture on persistent pain, Anesthesiology, 120, 482, 10.1097/ALN.0000000000000101 Harris, 2009, Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on µ-opioid receptors (MORs), Neuroimage, 47, 1077, 10.1016/j.neuroimage.2009.05.083 Dowell, 2016, CDC Guideline for prescribing opioids for chronic pain–United States, 2016, MMWR Recomm Rep, 65, 1, 10.15585/mmwr.rr6501e1 Shaheed, 2016, Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis, JAMA Intern Med, 176, 958, 10.1001/jamainternmed.2016.1251 Krebs EE. Effectiveness of opioid therapy vs. non-opioid medication therapy for chronic back and osteoarthritis pain over 12 months. Annual Meeting, Society for General Internal Medicine, Washington DC. 2017. Xing, 2007, Long-term synaptic plasticity in the spinal dorsal horn and its modulation by electroacupuncture in rats with neuropathic pain, Exp Neurol, 208, 323, 10.1016/j.expneurol.2007.09.004 Napadow, 2006, Somatosensory cortical plasticity in carpal tunnel syndrome–a cross-sectional fMRI evaluation, Neuroimage, 31, 520, 10.1016/j.neuroimage.2005.12.017 Napadow, 2007, Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture, Hum Brain Mapp, 28, 159, 10.1002/hbm.20261 Liu, 2017, Acupuncture therapies and neuroplasticity, Neural Plast, 2017, 6178505, 10.1155/2017/6178505 Wen, 1973, Treatment of drug addiction by acupuncture and electrical stimulation, Asian J Med, 9, 138 National Acupuncture Detoxification Association Hu, 2009, Electroacupuncture treatment reverses morphine-induced physiological changes in dopaminergic neurons within the ventral tegmental area, Addict Biol, 14, 431, 10.1111/j.1369-1600.2009.00163.x Lee, 2012, Acupuncture at SI5 attenuates morphine seeking behavior after extinction, Neurosci Lett, 529, 23, 10.1016/j.neulet.2012.09.020 Wen, 1978, Reduction of adrenocorticotropic hormone (ACTH) and cortisol in drug addicts treated by acupuncture and electrical stimulation (AES), Comp Med East West, 6, 61 Chan, 2014, Clinical efficacy of acupuncture as an adjunct to methadone treatment services for heroin addicts: a randomized controlled trial, Am J Chin Med, 42, 569, 10.1142/S0192415X14500372 Lin, 2012, Acupuncture for the treatment of opiate addiction, Evid Based Complement Alternat Med, 2012, 739045, 10.1155/2012/739045 Raith, 2015, Laser acupuncture for neonatal abstinence syndrome: a randomized controlled trial, Pediatrics, 136, 876, 10.1542/peds.2015-0676 Wu, 1999, Suppression of morphine withdrawal by electroacupuncture in rats: dynorphin and kappa-opioid receptor implicated, Brain Res, 851, 290, 10.1016/S0006-8993(99)02069-7 Birch, 2012, Challenges for clinical practice guidelines in traditional medicines: the example of acupuncture, Chin J Integr Med, 18, 643 2017 Fan, 2017, Distribution of licensed acupuncturists and educational institutions in the United States in early 2015, J Integr Med CCAOM NCCAOM AAMA HMI Lin, 2017, The regulation of the practice of acupuncture by physicians in the United States, Med Acupunct, 29, 121, 10.1089/acu.2017.1235