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Gordon Liu, a 28-year-old office worker in Hong Kong, goes to a Chinese medicine clinic after work to get acupuncture for his shoulder and neck pains. Liu enters a large closed cabin for more privacy. He takes off his shirt, lies down on a bed and an acupuncturist places needles near his shoulders, neck and hands, leaving them for about 20 minutes.
"Now, it feels like my neck and shoulders are more mobile, as they have loosened," he says.
Liu says it worked. Before the session, his neck was very stiff but now he feels better and is less in pain.
Acupuncture is the ancient Chinese practice of stimulating specific points of the body with needles. In Hong Kong, there are more than 9,000 licensed Chinese medicine practitioners, most of whom practice acupuncture. In most of Asia, it is considered an alternative to the treatment of pain.
The clinic where Liu is treated is part of Pok Oi Hospital, one of the city's public hospitals. His insurance covers the sessions.
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Chi-wai Cheung, anesthetist at Queen Mary Hospital, one of Hong Kong's largest public hospitals, says he recommends acupuncture to about 10% of his pain patients, but he would like to recommend more .
"Some of the patients … we really can not help them, with even … pain medications or interventional pain procedures," says Cheung.
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In Hong Kong, Western medicine is still the norm, but according to him, these drugs are powerful drugs that cause major side effects. Acupuncture is therefore an effective alternative, especially for elderly patients.
"They can not tolerate pain medications, including opioids," he says. "The drug will cause them to feel dizzy, drowsy during the day."
Inconclusive data
In the United States, some health insurers cover acupuncture. But the old practice is not considered a medical option for the control of pain in health circles. Critics say that despite numerous clinical trials, the results are still inconclusive. A recent study of clinical trials showed that acupuncture was effective for chronic neck and lower back pain.
Despite inconclusive evidence, practice is increasingly accepted in the United States as a means of coping with pain. This is partly explained by the rise in deaths due to the opioid epidemic.
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Last year, in the United States, more than 49,000 people died from a fatal overdose due to opioids – a record. Deaths are often attributed to overuse of prescription pain medications.
The Veterans Health Administration, as the largest integrated health care system in the country, is an important prescriber of opiate narcotics for pain. A survey conducted in 2013 by the Center for Investigative Reporting showed that opioid prescriptions to VA patients have increased by 270% since the early 2000s and contributed to an overdose rate almost twice as high as that of the general population.
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The VA in Philadelphia offers acupuncture to treat pain since the 1990s. But with the recent increase in the number of overdose deaths from opioids, the agency has been striving to improve the quality of life. offer more complementary and integrative health services, such as acupuncture. Nowadays, acupuncturists no longer have to have a medical degree to practice.
Integrative health services at the VA
Reno Reali, 38, visits the VA Medical Center in Philadelphia every two weeks for acupuncture for neck and back pain. In 2005, while serving in Iraq, he was seriously injured in a mortar attack.
"There is almost no disc in my neck, as if I had an 80 year old spine when I came back from Iraq," he says. "I had a herniated disc, I had a degenerative disc disease, I had a lot of problems with my spine."
Reali, tall with tattoos and shaved head, underwent several surgeries. He found himself in a wheelchair and was suffering.
"I had so much pain that getting out of bed required a lot of effort."
For years, doctors have prescribed strong Reali opiates, such as fentanyl patches, to manage his pain. But he says the drugs made him hazy and he was not as efficient.
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A few months ago, he decided to try acupuncture.
"I was open to the idea because I did not want to feel the pain anymore."
"Side effects are minimal to none"
Iliana Robinson is the acupuncturist of Reali. For most of the week, Robinson is a gynecologist at the University of Pennsylvania, but she also comes to the VA to provide acupuncture services to veterans.
"These are the patients who really want to reduce their opioids," she says. "Acupuncture is one of the things that should be tried first. Side effects are minimal to none. "
Practice skeptics say that there is no science to support acupuncture and that public resources should not be wasted.
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"It's the end of the corner where they are [supporters of acupuncture] using placebo effects to continually expand their claims and diverting people from other strategies that might be effective, "says Steven Novella, editor of the Science-Based Medicine blog and assistant professor of neurology at the faculty of medicine from Yale University. .
But as states face a high number of deaths from opioid overdoses, public health officials are looking for new ways to reduce prescriptions for opioid narcotics. Many states have done this by limiting the prescription of painkillers. But more recently, a handful of states have begun to cover acupuncture pain treatments through their Medicaid programs.
Medicaid to include acupuncture
"This is a conversation without a trace," says Barbara Sears, director of Ohio Medicaid.
Ohio has some of the highest overdose mortality rates in the country. Earlier this year, the state expanded coverage of Medicaid to include acupuncture.
"We need to consider everything we can do beyond opiates, so what other forms of treatment are available," says Sears.
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California, Massachusetts, Oregon, New Jersey and Rhode Island currently cover acupuncture through their Medicaid programs. Delaware and the state of Washington plan to do the same.
Vermont, which has been facing a large number of opioid deaths, has also debated the extension of Medicaid coverage to include acupuncture. But the state finally decided that more scientific research needed to be done before funding the old practice.
But for patients like Reali who has been living with the pain since he was injured in Iraq, no scientific proof is needed to prove that acupuncture works. He left the army for eight years and finally graduated. He attributes much of his progress to an acupuncture treatment controlling his pain.
"Being able to sit in a classroom without pain is great, being able to walk without pain," says Reali. "I could not do that with drugs."
This report was supported by the International Center for Journalists as part of their Bringing Home the World Scholarship.
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