Medicare to Cover Acupuncture in Pilot Program

By Pat Anson, PNN Editor

A week after a federal report documented a significant decline in opioid prescriptions among Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) has taken a tentative step to cover acupuncture as an alternative treatment for chronic low back pain.

Under a CMS proposal, patients enrolled in clinical trials of acupuncture sponsored by the National Institutes of Health (NIH) or in studies approved by CMS would be covered under Medicare’s Part D program. CMS has been collaborating with the NIH in studying acupuncture as a treatment of chronic low back pain in adults 65 years of age and older.

In a statement, CMS acknowledged that while “questions remain” about acupuncture’s effectiveness, interest in the therapy had grown in recent years as a non-drug alternative to opioids.  

Acupuncture is an ancient Chinese form of treatment that involves the insertion of fine needles into various points on the body to alleviate pain and other symptoms.


“Chronic low back pain impacts many Medicare patients and is a leading reason for opioid prescribing,” said CMS Principal Deputy Administrator of Operations and Policy Kimberly Brandt. “Today’s proposed decision would provide Medicare patients who suffer from chronic low back pain with access to a nonpharmacologic treatment option and could help reduce reliance on prescription opioids.”

Currently, acupuncture is not covered by Medicare. CMS is inviting public comment on the proposal to gather evidence and help determine if acupuncture is appropriate for low back pain. Comments will be accepted through August 14.

“Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain, and this proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain.” said Health and Human Services Secretary Alex Azar.

Spending on Opioids Peaked in 2015

Medicare Part D spending on opioid prescriptions has been falling for years. It peaked in 2015 at $4.2 billion and now stands at its lowest level since 2012, according to a report released last week by the HHS Office of Inspector General.

The decline in opioid prescriptions appears to be accelerating. Last year, 13.4 million Medicare beneficiaries received an opioid prescription, down from 14.1 million in 2017.



The Inspector General identified over 350,000 Medicare patients as receiving high amounts of opioids, with an average daily dose great than 120 MME (morphine milligram equivalent) for at least three months. The CDC opioid guideline recommends that daily doses not exceed 90 MME.  

The report highlighted the case of an unnamed Pennsylvania woman who received 10,728 oxycodone tablets and 570 fentanyl patches in 2018. Her average daily dose was 2,900 MME. She received all of her opioid prescriptions from a single physician.

The report said there were 198 prescribers who “warrant further scrutiny” because they ordered high doses of opioids for multiple patients.

“Although these opioids may be necessary for some patients, prescribing to an unusually high number of beneficiaries at serious risk raises concerns. It may indicate that beneficiaries are receiving poorly coordinated care and could be in danger of overdose or dependence,” the report found.  “Prescribing to an unusually high number of beneficiaries at serious risk could also indicate that the prescriber is ordering medically unnecessary drugs, which could be diverted for resale or recreational use.”

Under a new federal law, CMS is required to identify and warn “outlier prescribers of opioids” on an annual basis about their prescribing patterns. Medicare insurers could also require high-risk patients to use selected pharmacies or prescribers for their opioid prescriptions.

Many Alternative Therapies for Back Pain Not Covered

By Pat Anson, PNN Editor

A new study by the Johns Hopkins Bloomberg School of Public Health has confirmed what many back pain sufferers already know: Public and private health insurance plans often do not cover non-drug alternative pain therapies.

Bloomberg researchers looked at dozens of Medicaid, Medicare and commercial insurance coverage policies for chronic lower back pain and found that while most plans covered physical therapy and chiropractic care, there was little or no coverage for acupuncture, massage or counseling.

"This study reveals an important opportunity for insurers to broaden and standardize their coverage of non-drug pain treatments to encourage their use as safer alternatives to opioids," says senior author Caleb Alexander, MD, a professor of epidemiology at the Bloomberg School.  

Alexander and his colleagues examined 15 Medicaid, 15 Medicare Advantage and 15 major commercial insurer plans that were available in 16 states in 2017.

Most payers covered physical therapy (98%), occupational therapy (96%), and chiropractic care (89%), but coverage was inconsistent for many of the other therapies.

Acupuncture was covered by only five of the 45 insurance plans and only one plan covered therapeutic massage.


Nine of the Medicaid plans covered steroid injections, but only three covered psychological counseling.

"We were perplexed by the absence of coverage language on psychological interventions," Alexander says. "It's hard to imagine that insurers wouldn't cover that."  

Even for physical therapy, a well-established method for relieving lower back pain, insurance coverage was inconsistent.

"Some plans covered two visits, some six, some 12; some allowed you to refer yourself for treatment, while others required referral by a doctor," Alexander says. "That variation indicates a lack of consensus among insurers regarding what model coverage should be, or a lack of willingness to pay for it.”  

The Bloomberg study is being published online in the journal JAMA Network Open.  It was funded by the U.S. Department of Health and Human Services, National Institutes of Health and the Centers for Disease Control and Prevention.  

Lower back pain is the world’s leading cause of disability, but there is surprisingly little consensus on the best way to treat it. A recent series of reviews by an international team of experts in The Lancet medical journal found that low back pain is usually treated with bad advice, inappropriate tests, risky surgeries and painkillers.

“The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work,” said lead author Rachelle Buchbinder, PhD, a professor at Monash University in Australia. “Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”

The authors recommend counseling, exercise and cognitive behavioral therapy as first-line treatments for short-term low back pain, followed by spinal manipulation, massage, acupuncture, meditation and yoga as second line treatments. They found limited evidence to support the use of opioids for low back pain, and epidural steroid injections and acetaminophen (paracetamol) are not recommended at all.

The Pros and Cons of Acupuncture

By Pat Anson, Editor

Acupuncture has been an integral part of Chinese medicine for thousands of years, but Western medicine still has trouble deciding whether needle therapy is an effective treatment for chronic pain.

The latest example appears in the British Medical Journal (BMJ), with two opinion pieces written by doctors who sharply disagree about acupuncture’s effectiveness. One doctor with the British Medical Acupuncture Society feels it’s a safe and effective alternative to drugs, while two Danish researchers maintain there is no solid clinical evidence that acupuncture works.

“Doctors should not recommend acupuncture for pain because there is insufficient evidence that it is clinically worth while,” wrote Professors Asbjørn Hróbjartsson, University of Southern Denmark, and Edzard Ernst, University of Exeter. “Overviews of clinical pain trials comparing acupuncture with placebo find a small, clinically irrelevant effect that cannot be distinguished from bias.”

Hróbjartsson and Ernst point out that acupuncture has fallen in and out of favor -- even in China. In the 1700’s acupuncture was considered "irrational and superstitious" and it was latter banned from the Imperial Medical Institute. Not until Mao Tse Tung took over China in 1949 was acupuncture revived as a form of treatment – in part because there were so few doctors in rural areas.

Acupuncture started gaining popularity in the West in the 1970’s, and medical guidelines in many developed countries now recommend it as a treatment for back pain and migraine.


The UK’s National Health Service spends about $34 million a year paying for acupuncture treatments -- money that Hróbjartsson and Ernst believe would be better spent elsewhere.

“Health services funded by taxpayers should use their limited resources for interventions that have been proved effective,” they wrote. “After decades of research and hundreds of acupuncture pain trials, including thousands of patients, we still have no clear mechanism of action, insufficient evidence for clinically worthwhile benefit, and possible harms. Therefore, doctors should not recommend acupuncture for pain.”

Mike Cummings says there is plenty of evidence that acupuncture works. The medical director of the British Medical Acupuncture Society, Cummings started using acupuncture in his own clinical practice in 1989.

“For those patients who choose it and who respond well, it considerably improves health related quality of life, and it has much lower long term risk for them than non-steroidal anti-inflammatory drugs,” Cummings wrote. “It may be especially useful for chronic musculoskeletal pain and osteoarthritis in elderly patients, who are at particularly high risk from adverse drug reactions.”

According to Cummings, the main reason there have been few clinical studies of acupuncture is lack of funding.

“Is it all about money? In hospitals, acupuncture seems to incur more staffing and infrastructure costs than drug based interventions, and in an era of budget restriction, cutting services is a popular short term fix,” he wrote. “Another challenge is the lack of commercial sector interest in acupuncture, meaning that it does not benefit from the lobbying seen for patented drugs and devices.”

As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there is little consensus in the medical community about acupuncture’s value, a large study in the Archives of Internal Medicine found that acupuncture is an effective treatment of chronic pain and "a reasonable referral option.”

Another large study found acupuncture significantly reduced pain severity, when combined with other treatments such as anti-inflammatory drugs.

9 Holistic Approaches to Relieve Joint Pain

By Nicole Noel, Guest Columnist

Whatever your ailment may be, holistic medicine has an answer.

A therapeutic method that dates back to early civilizations, holistic medicine takes into account the mind, body, emotions and spirit -- with the aim of helping patients achieve or restore proper balance in life and prevent or heal a range of conditions, including musculoskeletal pain. Holistic treatments offer a ray of hope for many patients suffering from arthritis, osteoporosis, fibromyalgia and other conditions that cause joint pain.

Not all alternative medicine is created equal, and some natural healing methods will produce better and quicker results. If you want to treat arthritis and other joint aches with holistic treatments, here are a few natural pain relievers you can try.

1. Tai Chi

A low-impact activity that can increase range of motion and strengthen joints and surrounding muscle tissue, tai chi is an ancient physical and spiritual practice that can help arthritis patients soldier through their pain.

According to a 2013 study, tai chi can relieve pain, stiffness, and other side-effects of osteoarthritis. In addition to pain relief, tai chi can help improve range of motion and alleviate joint pain for people living with fibromyalgia and rheumatoid arthritis.


2. Yoga

Another ancient technique which promotes natural healing, yoga is perfect for individuals suffering from lower back and joint pain. Gentle stretches and poses opening the joints can help prevent and alleviate chronic soreness in the shoulders, hips, and knees.

A form of yoga called mudras utilizes a series of hand gestures to increase energy, and improve mood and concentration.

3. Massage

An invigorating massage with warm essential oil can help many conditions, and joint pain is one of them.

By enhancing blood flow, relaxing the muscle tissue and soothing inflammation, a well-timed massage can ease joint stiffness and increase range of motion in individuals suffering from arthritis, fibromyalgia, and osteoporosis.


4. Acupuncture

A 2013 review of medical studies has shown that acupuncture can help relieve musculoskeletal pain caused by fibromyalgia. By activating the body’s natural pain relief system and stimulating the nerves, muscles and connective tissue, acupuncture can relieve joint aches for people who are resistant to other holistic pain relief techniques.

A 2010 study found that acupuncture can also be a beneficial for peripheral joint osteoarthritis.

5. Diet Changes

An apple a day may or may not keep the doctor away, but a custom-tailored diet can help you with joint pain. Nutritional tweaks can begin with increased intake of chondroitin sulfate, glucosamine, and Omega 3 fatty acids, which can reduce joint pain in arthritis and osteoporosis patients.

To ease joint problems, your pantry should be stocked with foods that promote healing and reduce inflammation, such as onions, carrots, and flaxseed. Herbs and spices such as turmeric (curcumin) and cayenne pepper can also help with pain relief.


6. Aromatherapy

If you think pain relief can’t smell good, you’re mistaken. Studies have shown that peppermint and eucalyptus oil can reduce swelling, pain and discomfort in patients with inflamed joints. For joint soreness and stiffness caused by arthritis, aromatherapy experts recommend regular application of myrrh, turmeric, orange, or frankincense oil to ease inflammation and pain, and to increase range of motion.

You can also combine aromatherapy with heat and cold treatments.  Be sure to keep the tender joints elevated during treatment to reduce swelling.

7. Spa Treatments

Few things can beat the appeal of a full-scale spa experience. If you’re suffering from knee, hip, shoulder or elbow pain and other holistic methods haven’t helped, try balneotherapy, which combines aqua massage with deep soaks in heated mineral water and medicinal mud baths.

One study found that balneotherapy significantly reduced knee and back pain in older adults.

8. Aquatic Sports

If you don’t want to immerse yourself in mud, you can supplement your holistic pain therapy with water aerobics, swimming, aqua jogging or aqua spinning. According to a 2014 study, water exercises can ease pain and improve joint function for osteoarthritis patients.

Additionally, a 2015 study found that aquatic circuit training can help relieve knee pain in cases of progressed osteoarthritis.


9. Capsaicin cream

Another natural treatment for joint pain and stiffness is homemade capsaicin cream, which can help reduce swelling and increase range of motion. To stay on the safe side, you should be careful when handling hot peppers when preparing the cream, and avoid using it on sensitive and damaged skin.

As our bodies age, joint pain can become a chronic. If you don’t want to take your chances with conventional pharmaceuticals, you can always turn to holistic medicine for answers and help. When musculoskeletal pain hits home, one or more of these holistic treatments can help.

Nicole Noel is a lifestyle blogger who is passionate about yoga and healthy living. She enjoys sharing her experiences and ideas on how to lead a happy and healthy life. If you want to read more from Nicole, you can find her on Twitter and Facebook.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.


The 4 A’s That Can Help Relieve Chronic Pain

By Barby Ingle, Columnist  

I often hear from pain patients who say that they have tried everything to help lower or relieve their pain levels. Many times what they mean is that their healthcare provider did all they could, and they got minimal or no relief and gave up.

We must realize that providers don’t have all the answers, insurance doesn’t cover all the options that may help, and there are new treatments and therapies that may lower your pain. Many of these treatment modalities are not covered by insurance – so providers may not even offer them. Access to them is limited unless you know your options and create a plan to get them.

Many of these treatment modalities are not covered by insurance – so providers may not even offer them. Access to them is limited unless you know your options and create a plan to get them.

In my next few columns I’m going to focus on some of these treatments, starting with the 4 A’s: acupressure, acupuncture, aromatherapy and art therapy.  


When it comes to acupressure, you can go to a practitioner or you can learn to do the techniques on yourself at home for free. The practitioner works with your pressure points, which are known as meridians. Putting pressure on these meridian points can reduce muscle tension, improve circulation and stimulate the release of endorphins, which are natural pain relievers. All can help lower pain levels.

They are also said to work on your body’s energy field, mind, emotions and spirit. A session with a practitioner lasts about an hour, but you can learn the techniques and do them on your own or with a caregiver.

During the session, you’ll usually lay on a flat comfortable massage table or bed. Some of the pressure points in your hands can be treated while sitting and watching a movie or TV show.

The pressure point that works best for me to calm my mind, improve memory, relieve stress, lower fatigue, and reduce my migraines and insomnia is known as the Third Eye Acupressure point.


Acupuncture is a little more invasive than acupressure. Due to having a small nerve fiber disease, it is not the best option for me, but I know others who love it.

Acupuncture practitioners insert very small needles through your skin at acupuncture/meridian points. Some potential side effects can be temporary soreness, minor bleeding or bruising at the needle sites. If the needle is pushed in too deeply, it can damage muscles and organs. These are rare complication, but make sure you use an experienced practitioner.

Lower back pain is the number one reason people seek this form of treatment, and there are hundreds of clinical studies that show acupuncture can be beneficial for musculoskeletal issues like back and neck pain.

It can also help with nausea, migraines, depression, anxiety and insomnia, all challenges we can face as pain patients. There is promising evidence acupuncture helps with arthritis, spinal stenosis and inflammation.

Although relief is typically short-term for acupuncture and many other treatments, it can still give the patient back some quality of life.


Have you ever smelled something that took you back to a time and place when good things happened in your life? Like apple pie reminding you of July 4th celebrations as a child? Or pumpkin pie bringing back memories of Thanksgiving dinner? Or good times raking up the leaves in the yard?

Aromatherapy can help you get in a good mood for meditation. I use it for migraines and taking the edge off my pain levels. You can use essential oils that help with specific challenges you are facing. You just massage them into your skin or put a dab on your temples. I also use a scented light in my house to keep positive vibes flowing.

This type of therapy has been around for many years, but started to become popular in the 1980’s. Lotions, candles, oils and teas can fill your house with good smells and memories to take the edge off your pain levels. Some promote physical healing, emotional healing, relaxation, and calming properties.

When using a practitioner who combines massage with aromatherapy, the session lasts about an hour and usually involves essential oils. This way your skin absorbs the oils and you also breathe their aroma at the same time. Plus, you experience the physical therapy of the massage itself.

Evidence as to how aromatherapy works is not entirely clear. But it provides relief for many different conditions, including psoriasis, rheumatoid arthritis, cancer pain, headaches, itching, insomnia, constipation, anxiety, and agitation. Studies have shown that chronic pain patients require fewer pain medications when they use aromatherapy.

Aromatherapy products can be inexpensive and are more attainable for low income and underinsured patients.

Art Therapy

There are many forms of art therapy, from music, dancing and writing to painting, sculpting and even just watching someone else perform. One of my favorites for dystonia is working on impossible puzzles.

Art therapy can enhance one’s mood, improve emotions, and reduce stress and depression. If we can get these challenges under control, then the stress hormones and chemicals they produce in our body that aggravate pain can be lessened.

Art therapy can also help heal emotional injuries. Think of it as a form of mindfulness where we develop our capacity for self-reflection, which can alter behavior and negative thinking patterns. These forms of expression can be done at home, while on a car ride, in a quiet place during a trip or even at a rock concert as you dance and sway to the beat of the music.

Like aromatherapy, music can help bring back positive memories and get our minds off pain. I believe music is the most accessible and productive art therapy for lowering pain levels.

These techniques may be strange to you, but remember to keep an open mind and realize that there is more you can do in between doctors’ appointments to make your days better and more purposeful.

Whether you choose any of these four treatment modalities or find another that is right for you, keep looking for those things in your life that you have control over and have access to. Find ways to make the most out of life despite the physical and mental pain you may be experiencing.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain FoundationShe is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Acupuncture Effective in Treating Pain and Depression

By Pat Anson, Editor

Acupuncture can boost the effectiveness of medical care and lessen the severity of chronic pain and depression, according to a new study led by British researchers.

In a meta-analysis (a study of studies) of 29 clinical trials involving nearly 18,000 patients with chronic neck, lower back, knee or headache pain, researchers found that acupuncture significantly reduced the severity of pain when combined with standard medical care such as anti-inflammatory drugs.

Acupuncture is an ancient Chinese form of treatment that involves the insertion of fine needles into acupuncture points on the body. About four million acupuncture sessions are provided each year in the UK, about half of them for pain relief. The evidence to support such treatment has been limited.

"There has been a question mark for many years over whether policy and decision makers should or should not provide wider access to acupuncture,” said Hugh MacPherson, PhD, a professor of acupuncture research at the University of York.

“Our aim was to bring together data from high quality clinical trials and provide a robust evidence base that will help reduce this uncertainty and support commissioners and health professionals in making informed decisions backed up with research."

The study, published in the National Institute for Health Research (NIHR) Journals Library, found that the addition of acupuncture -- compared to standard medical care alone -- significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain.  Acupuncture also reduced the pain and disability of osteoarthritis, which led to patients using less anti-inflammatory medication to control pain.

The research team also conducted a new clinical trial for depression, in which 755 patients were provided with acupuncture, counseling or antidepressants. They found that both acupuncture and counseling significantly reduced the severity of depression, and that the benefits were sustained up to 12 months after treatment.

"In the largest study of its kind, we have now provided a solid evidence base to show that not only can acupuncture and counseling bring patients out of an episode of depression, but it can keep the condition at bay for up to a year on average," said MacPherson, who added that antidepressants don’t work well for more than half of patients.

Researchers admit the benefits of acupuncture are partially associated with a placebo effect, which has contributed to uncertainty about it's clinical effectiveness. However, when compared with sham acupuncture – in which fake needles are used or inserted in the wrong locations – they say “real” acupuncture provides substantially more pain relief.

“Our new data provides a significant step forward in treating chronic pain and managing depression, because patients and health professionals can now make decisions on acupuncture with more confidence. Not only is it more cost effective, but it reduces pain levels and improves mood levels, which could reduce over reliance on drugs that can sometimes result in unwanted side effects," MacPherson said.

Acupuncture is one of the most widely practiced forms of alternative medicine. As many as 3 million Americans receive acupuncture treatments, most often for relief of chronic pain. While there is little consensus in the medical community about acupuncture’s value, a large study in the Archives of Internal Medicine found that  “acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.”

What Alternative Treatments Work for Chronic Pain?

By Pat Anson, Editor

A review of over a hundred clinical trials has found that some alternative pain therapies such as acupuncture, yoga, tai chi, and massage are effective in treating chronic back and neck pain, osteoarthritis of the knee, migraine and headaches.

But only weak evidence was found that they might help people with fibromyalgia.

The review was conducted by scientists at the National Center for Complementary and Integrative Health at the National Institutes of Health (NIH). The study,  published online in the Mayo Clinic Proceedingswas conducted to give patients and primary care providers better evidence on the effectiveness of non-drug treatments for chronic pain.

“One major goal for this study was to be as relevant as possible to primary care providers in the United States, who frequently see and care for patients with painful conditions. Providers need more high quality information on the evidence base for pain management tools, especially nondrug approaches,” said lead author Richard Nahin, PhD, an epidemiologist with NIH.

“Overall, the data suggest that some complementary approaches may help some patients manage, though not cure, painful health conditions.”

The scientists “found promise” in the safety and effectiveness of these treatments:

  • Acupuncture and yoga for back pain
  • Acupuncture and tai chi for osteoarthritis of the knee
  • Massage therapy for neck pain  
  • Relaxation techniques for severe headaches and migraine.

Though the evidence was weaker, the researchers found that massage, spinal manipulation, and osteopathic manipulation may provide some help for back pain. Relaxation approaches and tai chi might also help some people with fibromyalgia.

Mixed or no evidence was found that glucosamine, chondroitin, omega-3 fatty acids, and S-Adenosyl methionine (SAMe) are effective in treating chronic pain.

Each year Americans spend about $30 billion on alternative and so-called complimentary health treatments, even though few studies have been conducted on their effectiveness. The NIH researchers had to go back 50 years to find enough clinical studies to review. Many of the studies involved fewer than 100 people, which weakens the conclusions drawn from them. Some of the same studies were used by the Centers for Disease Control and Prevention as evidence for its opioid prescribing guidelines, which encourage "non-pharmacological" treatments for chronic pain.

“It's important that continued research explore how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations," said David Shurtleff, PhD, deputy director of National Center for Complementary and Integrative Health.