- CMS is proposing Medicare cover acupuncture for chronic lower back pain in patients enrolled in National Institutes of Health trials or studies approved by CMS.
- Medicare doesn't usually pay for alternative medical procedures, but HHS Secretary Alex Azar on Monday said it aligned with the agency's push to find alternate treatments for pain to decrease the country's dependence on opioids.
- The government made its decision based on growing evidence suggesting acupuncture is successful in easing lower back pain, but questions still remain about the treatment's efficacy.
The U.S. medical community is rushing to find non-pharmacological interventions for pain to halt the progress of a deadly public health crisis spurred by decades of overprescribing of opioids, highly addictive painkillers. Opioids are now responsible for more deaths than heroin and cocaine combined.
One alternative is acupuncture, a component of traditional Chinese medicine where hair-thin needles are inserted in specific sites throughout the body. The practice is meant to rebalance the body's energy, release stress and stimulate healing.
"Defeating our country’s epidemic of opioid addiction requires identifying all possible ways to treat the very real problem of chronic pain," Azar said in a statement. "This proposal would provide patients with new options while expanding our scientific understanding of alternative approaches to pain."
CMS released a roadmap last June to address the public health crisis. Along with expanding access to non-opioid treatments for pain, all of the programs offer some form of medication-assisted therapy, and it's expanded a physician education program on safe prescribing.
Congress and the White House also have gotten involved. President Donald Trump rolled out plans to tackle the public emergency in March last year and he signed a bipartisan law in October expanding access to treatment for opioid misuse, cracking down on people mailing supplies of illicit drugs and providing federal funding for research on alternative pain treatments.
Research from a number of studies suggests acupuncture may help ease types of chronic pain like low-back, neck, osteoarthritis in the knees and migraines or tension headaches. The targeted, pervasive pain is widespread — an estimated 70% of adults in industrialized countries suffer from lower back pain during their lifetime.
A 2015 review of lower back pain studies over the past decade found acupuncture in isolation or combined with another conventional treatment relieved chronic pain and improved function in the short-term compared to no treatment.
Some detractors still dub acupuncture a pseudoscience. Studying it can be difficult given pain is a subjective, self-reported experience, and there's also some evidence acupuncture's success in trials could be chalked up to the placebo effect.
There are currently roughly 260 studies on acupuncture being conducted worldwide, ranging from the treatment's effect on motor dysfunction in stroke patients to deadening the gag reflex.
A number of private payers already cover the therapy, categorizing it as a medically necessary treatment, in line with chiropractic treatment, physical therapy and steroid injections. However, half of public plans and three-fourths of private plans didn't cover the intervention in 2018, according to a study published in JAMA Network Open.
NIH recently announced funding for a large-scale trial to evaluate acupuncture for adults aged 65 and older with chronic low back pain, and CMS plans to conduct a review of the evidence to see if the therapy should be covered across all of Medicare. The agency is also asking for public comment on the topic, due August 14.