Pain

Take Action Now to Require Insurance to Cover Acupuncture!

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Recent attention on the Opioid Crisis has highlighted the incredible numbers of people suffering from chronic pain.  Changes in national and state laws are being made.  Here in Rhode Island, we are nearing votes on bills in our general assembly:

http://webserver.rilin.state.ri.us/BillText19/SenateText19/S0068.pdf

http://webserver.rilin.state.ri.us/BillText/BillText19/HouseText19/H5120.pdf

These would require insurance companies pay for non-opioid pain treatments including acupuncture, massage therapy, physical therapy and occupational therapy.  If you value acupuncture, and wish to assure its coverage by your health insurance, please consider contacting one or more of our state senators or representatives.  Here are some easy ways, including a sample letter from our Rhode Island Society of Acupuncture:

It’s time to take action.

The bills requiring insurance coverage for acupuncture and other non-opioid treatment modalities are at a crossroads.  We need your help.  Please copy and past this form letter below, modify it to personalize, and send to the Representatives and Senators on this list ASAP.

Urge your friends, and family to do the same!

House Bill H5120

The Honorable Nicholas A. Mattiello, Speaker of the House of Representatives     Rep-mattiello@rilegislature.gov
The Honorable Joseph M. McNamara, Chairman of House HEW                                rep-mcnamara@rilegislature.gov
The Honorable Michael A. Morin, Primary Sponsor of 2019 H5120                           rep-morin@rilegislature.gov

Senate Bill S0068

The Honorable Dominick J. Ruggerio, President of the Senate          sen-ruggerio@rilegislature.gov
The Honorable Joshua Miller, Chairman of Senate HHS                     sen-miller@rilegislature.gov
The Honorable Roger A. Picard, Primary Sponsor of 2019 S0068     sen-picard@rilegislature.gov

The fate of this legislation will be decided in the next week or two, so time is of the essence!  The suggested email to these House and Senate leaders is below:

Please title the email: “Please Support the Non-Opioid Pain Treatment Bill (bill # – insert H5120 or S0068)”

Dear (insert name of legislator)

My name is (insert name). I am writing to request your support for bill # – (insert H5120 or S0068).  This legislation is important because it will help address the opioid crisis by requiring that the safe, conservative, non-opioid pain treatments of massage therapy, acupuncture, occupational therapy, and physical therapy are fully covered by insurance.  Patients must have affordable access to all these therapies to prevent further individuals from becoming addicted to prescription opioids.

This bill is an issue of fairness.  Rhode Islanders of all financial means deserve fuller access to non-opioid pain treatments.  Opioid deaths in the United States continue to increase.  According to the Centers for Disease Control (CDC), opioid prescriptions were involved in more than 35% of all opioid related deaths in 2017.1
A research study from Washington State found that patients using non-opioid pain treatments had lower insurance costs than those patients not using such treatments. (If you can reference an insurance claim with costs of prescription or treatment related to opioid use, put your example here).

In 2016, the CDC issued guidelines on chronic pain that recommended that “nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain”3 and that non-opioid therapies are less expensive than opioids due in part to the high costs of opioid addiction and overdose.  Importantly, the Governor’s Overdose Prevention and Intervention Task Force states “It’s time to change how we treat pain—opioids don’t need to be the first line of defense”.4

(Insert personal story here if applicable)

By voting to pass this bill, you will increase access to better healthcare overall and will help reduce the number of addictions and deaths resulting from opioid prescription use.

Thank you for your support!
(Your name and address)

https://www.cdc.gov/drugoverdose/data/prescribing.htmld
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110809/
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.
4
 https://preventoverdoseri.org/our-action-plan/.

 

How Acupuncture Helps Rheumatoid Arthritis

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https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1892-acupuncture-alleviates-rheumatoid-arthritis-swelling-and-pain

 

HealthCMi CEUs

Acupuncture Alleviates Rheumatoid Arthritis Swelling And Pain

rheumatoid arthritis

Acupuncture is an effective treatment modality for the the alleviation of rheumatoid arthritis. Researchers conclude that acupuncture alone or in combination with additional treatment modalities alleviates rheumatoid arthritis, restores bodily functions, and improves quality of life. [1] In a meta-analysis, the researchers note that acupuncture exerts its effective actions through several biological mechanisms. The acupuncture research indicates that acupuncture produces anti-inflammatory, antioxidative, and immune system regulatory actions.

Three acupuncture points were common across the research reviewed in the China Medical University and Tri-Service General Hospital meta-analysis. The researchers note that ST36 (Zusanli) was the most commonly tested acupoint in patients with rheumatoid arthritis. GB34 (Yanglingquan) and LI4 (Hegu) were also commonly applied.

The results indicate that acupuncture applied to the aforementioned acupoints and others produces changes in specific inflammatory biomarkers. Acupuncture regulates the following: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), interleukins, nuclear factor kappa B (NF-𝜅 B), and tumor necrosis factor alpha (TNF-𝛼). Another meta-analysis (Wang et al.), confirms that acupuncture regulates both ESR and CRP in rheumatoid arthritis (RA) patients. [2] In an important finding, researchers (Han et al.) conclude that acupuncture successfully downregulates “TNF-𝛼 and VEGF [vascular endothelial growth factor] in peripheral blood and joint synovia to improve the internal environment which is beneficial for RA.” [3]

In another study under review in the meta-analysis (Dong et al.), investigators used laboratory conditions to test the efficacy of electroacupuncture at acupoints ST36 (Zusanli) and BL60 (Kunlun). The researchers indicate that the “toll-like receptor (TLR) signaling pathway contributed to the development and progression of RA and acupuncture could reduce the expression of TLR4, thus leading to anti-inflammation.” [4] In addition, many other studies indicate that acupuncture improves quality of life.

The research team drew conclusions after a full review of each individual study in the meta-analysis. Based on the data, the researchers note, “acupuncture alone or combined with other treatment modalities is beneficial to the clinical conditions of RA without adverse effects reported and can improve function and quality of life and is worth trying.” [5] They add that additional well-designed randomized controlled trials are recommended to confirm these findings.

The conclusions were based on several parameters. The primary outcomes were determined by quantifying pain levels, morning stiffness, pain related disability, joint swelling characteristics and diameter, number of swollen joints, skin temperature, and arthritis index. Serum levels of inflammatory and anti-inflammatory biomarkers plus antioxidant levels were recorded for objective measurements. In addition, positron emission tomography (PET) scans were used to monitor changes in inflammation along with X-rays of the hands. Quality of life was assessed using the rheumatoid arthritis quality of life questionnaire (RAQoL), Pittsburgh sleep quality index, health assessment questionnaire (HAQ), and the short form-36 health survey. Overall, the meta-analysis reveals extensive use of subjective and objective instruments to verify the data and conclusions.

The majority of studies included in the meta-analysis were randomized controlled trials and several were double-blinded. The trials were human clinical trials and controlled laboratory experiments. Many acupuncture points were used in the clinical trials. As stated earlier, ST36, GB34, and LI4 were most commonly administered.

The researchers note that there is a difficulty in using only one acupuncture point prescription for all patients diagnosed with rheumatoid arthritis. According to Traditional Chinese Medicine (TCM) principles, rheumatoid arthritis may be divided into many diagnostic subcategories such as wind, cold, dampness, and heat. In addition, these categories are further differentiated according to syndrome presentation location and overall constitution of the patient. As a result, there is a need for heterogenous acupuncture point prescriptions. In TCM, no one set of acupoints for this biomedically defined condition is applicable to all patients. As a result, this makes study design a difficult proposition.

Despite these difficulties, the researchers conclude that acupuncture is effective for the alleviation of rheumatoid arthritis. Many of the findings mapped pathways of effective action. One interesting finding was that acupuncture enhances antioxidative effects by increasing serum superoxide dismutase (SOD) and catalase activities in rheumatoid arthritis patients. This indicates that acupuncture reduces oxidative stress and subsequent inflammation. Moreover, acupuncture “triggered release of endorphins” and regulated the immune system; levels of IgG, IgA, and IgM were successfully downregulated. [6]

 

Summary
Rheumatoid arthritis is an autoimmune disorder. Inflammation may occur in any location (including internal organs); however, the hands and knees are among the most common regions affected by the disorder. In joints, inflammation affects synovial membranes causing a fluid build-up and degradation. No singular blood test defines the diagnosis, although ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies are tests are helpful in making a determination. Ultrasound , MRI, and X-ray imaging are also important tools for confirming a diagnosis.

The meta-analysis results indicate that acupuncture benefits patients with rheumatoid arthritis. Acupuncture prevents or slows joint destruction, reduces pain levels, and increases mobility. However, acupuncture is not presented as a cure. Nonetheless, acupuncture is an important treatment option that may significantly improve quality of life. To learn more, contact a local licensed acupuncturists about treatment options.

 

References:
[1] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[2] C. Wang, P. de Pablo, X. Chen, C. Schmid, and T. McAlindon, “Acupuncture for pain relief in patients with rheumatoid arthri- tis: a systematic review.,” Arthritis & Rheumatology, vol. 59, no. 9, pp. 1249–1256, 2008.
[3] R. X. Han, J. Yang, T. S. Zhang, and W. D. Zhang, “Effect of fire-needle intervention on serum IL-1 and TNF-alpha levels of rheumatoid arthritis rats,” Zhen Ci Yan Jiu, vol. 37,no. 2, pp. 114–118, 2012.
[4] Z.-Q. Dong, J. Zhu, D.-Z. Lu, Q. Chen, and Y.-L. Xu, “Effect of Electroacupuncture in “Zusanli” and “Kunlun” Acupoints on TLR4 Signaling Pathway of Adjuvant Arthritis Rats,” American Journal ofTherapeutics, 2016.
[5] Chou, Pei-Chi, and Heng-Yi Chu. “Clinical Efficacy of Acupuncture on Rheumatoid Arthritis and Associated Mechanisms: A Systemic Review.” Evidence-Based Complementary and Alternative Medicine 2018 (2018).
[6] Ibid.

 

 

A wonderful article on how disease often begins: in the Gut

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7 Reasons to Seek Out Acupuncture

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Do you ever feel your life’s a ride that won’t ever stop? How many nights do you wait for Mr. Sandman to magically appear? How often do you truly take time for yourself? Do you have aches and pains almost daily? Are over-the-counter or prescription medications controlling your life? When was the last time you actually felt at peace? If any of these questions resonate with you, then it might be time to look at Traditional Chinese Medicine and acupuncture for an answer. People in Asian countries have known the magnificence of acupuncture for thousands of years. Traditional Chinese Medicine is growing in popularity in the United States and here are some reasons why you might want to consider utilizing it also. continue reading »