It's a fact that the world of medicine is ever-changing and evolving as new discoveries are made, laws passed and treatments tested. However, one form of therapy has stood the test of time throughout the centuries.
An ancient system of medicine originating in China, acupuncture has found its way to the Western world of medicine and has become a useful tool to integrate with traditional medicine. According to the Michigan Public Health Code, acupuncture is defined as the insertion and manipulation of needles through the surface of the human body at specific locations for the prevention or correction of disease, injury, pain or other conditions.
"Acupuncture is a deeply relaxing experience that is often able to significantly reduce chronic pain and inflammation, improve immune response and decrease stress," says Henry Buchtel, president of the Michigan Association of Acupuncture and Oriental Medicine.
Once considered controversial, the benefits of integrating acupuncture therapy with traditional medicine are becoming more accepted, especially in the treatment of pain.
A study conducted by the Department of Epidemiology and Biostatistics at the Memorial Sloan-Kettering Cancer Center, aimed to determine the effect of acupuncture for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. The study concluded that acupuncture is effective for the treatment of chronic pain and is a reasonable referral option.
As a non-pharmacologic alternative to managing patients' chronic pain, acupuncture's role in helping to address our nation's opioid addiction and overdose crisis should be part of the discussion. It is important to consider the value of alternatives such as acupuncture and other complimentary treatments that help manage pain especially for patients with a history of addiction, chronic comorbidities, and prescriptions for multiple pharmacologic agents.
"One of the biggest issues facing physicians these days is how to reduce patients' reliance on opioids while still managing their pain," says Buchtel. "All chronic pain sufferers can benefit from acupuncture, and some may be symptom free after a series of 10 to 12 treatments."
But what do doctors look for in order to prescribe acupuncture as a form of treatment?
"If I'm prescribing something, I need to know that it's accessible, affordable and, most importantly, that it works," says Robert Bouvier, MD. "Traditional medicine has about 80 percent of the diagnostic tools. By adding the alternative treatments, you're addressing the entire body versus just the one place that hurts."
A good start is to understand the current legal landscape in Michigan. According to Michigan law, in order to practice as an acupuncturist, an individual must meet the following requirements*:
- Complete an accredited acupuncture educational program that is minimally three academic years or 27 months in duration with at least 1,900 hours (or its equivalent) of didactic and clinical instruction.
- Pass the national board exam administered by the National Certification Commission for Acupuncture and Oriental Medicine.
- Submit an application for registration with the state.
- Have a collaborative relationship with a licensed physician in Michigan.
The Michigan Department of Licensing and Regulatory Authority and the Michigan Board of Acupuncture maintain regulatory oversight of acupuncturists in Michigan. The Board is charged with ascertaining minimal entry level competency of acupuncturists, as well as taking disciplinary action against registrants who have adversely affected the public's health, safety, and welfare.
The Michigan Board of Acupuncture consists of 13 voting members including seven acupuncturists, three physicians and three public members.
While Michigan's requirement for acupuncturists to practice under the delegation and supervision of a physician is unique in the United States, it offers the potential to be advantageous to clinicians and patients alike by fostering care coordination and communication opportunities. Both acupuncturists and physicians benefit from a common understanding of the times acupuncture can work as its own form of treatment and when and how it can be used in conjunction with other traditional treatments.
Many physicians, including Doctor Bouvier, have created collaborative partnerships with their local acupuncturists to refer patients for a more integrated treatment plan. There are a variety of focus areas in which acupuncturists practice -- including fertility, pain and mental health -- that can benefit physicians when diagnosing and treating a patient.
According to Doctor Bouvier, creating a collaborative partnership with an acupuncturist is as easy as 1-2-3 -- credentials, experience and anecdotal evidence.
"First you look at the credentials, similar to how you would look at any doctor's background and experience," says Doctor Bouvier. "It isn't so much about the institution they attended, but the amount of time they studied and years of experience that followed."
Make sure that any non-physician acupuncturist with whom you are considering a collaborative relationship is currently registered in Michigan and certified by NCCAOM. You can use LARA's licensure and registration verification system at https://w2.lara.state.mi.us/VAL/License/Search to confirm registration status, issue date, and expiration date, as well as any open complaints and disciplinary action.
Once the background and experience is satisfactory, then it's time to test the alternative treatments -- are the patients the physician is referring seeing results in their health? The anecdotal evidence from the patient's perspective can be the deciding factor on whether or not the physician should collaborate with that acupuncturist.
If you are taking on the role of collaborating/supervising physician versus simply referring physician, you will need to discuss expectations and responsibilities with your partnering acupuncturist. For example, under Michigan's laws pertaining to delegation and supervision, there is an expectation that the supervising physician be continuously available for direct communication in person or by radio, telephone or telecommunication and that there is an agreed upon process for periodic medical record review, consultation and communication.
While the use of acupuncture and oriental medicine for medical treatment has been around for centuries, Western medicine is still testing the integration of alternative treatments with traditional medicine. Advocates of this integrated approach will continue to work together to ensure that quality, complementary care is accessible to patients and part of the ongoing integration of patient-centered, whole-person treatment plans.
*Provisions in the Michigan Administrative Code's Acupuncture - General Rules address the criteria for obtaining registration by endorsement (R 338.13010) and documentation and evaluation of nonaccredited training that is substantially equivalent to required standards (R 338.13015).