Acupuncture
Introduction and Overview
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Definition
U.S. History
Evidence of Efficacy
Mechanism of Action
Types of Acupuncture
Practical Tips
Coding
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3.1 million have used in U.S
Literally means 'needle piercing’
Traditional acupuncture regulates the flow of Qi (vital energy)
There are many types of Qi
Qi is considered one of the human body's fundamental substances
and helps to maintain normal activities
• Qi permeates all parts of the body, and flows along organized
pathways known as acupuncture channels, or meridians.
• Traditional Chinese Medicine practitioners believe that a balanced
flow of Qi throughout the system is required for good health, and
imbalances can be corrected by acupuncture stimulation
• Thus, a state of good health is determined by the dynamic balance
between opposing yin-yang forces
Acupuncture in the U.S.
• Documented evidence of use in 1826-Franklin
Bache, a Philadelphia physician and grandson to
Benjamin Franklin, published an article of its use
• Sir William Osler also endorsed acupuncture as an
effective treatment for lumbago and sciatica in The
Principles and Practice of Medicine
• Referenced in an Civil War surgeon's manual
Modern U.S. History
• 1971 James Reston wrote a front-page article for the
New York Times describing how his postoperative pain
from an emergency appendectomy was relieved by
acupuncture while traveling in Beijing
• Prompted a group of US physicians to observe practice
in China and publish an article in Journal of the
American Medical Association
• During Historic visit to China in 1972, President
Nixon and his personal physician witnessed several
surgeries using acupuncture-assisted anesthesia
• Most well designed studies show mixed results
• Placebo response high- If positive expectation
then greater pain relief
Fair Evidence for:
• Back pain
• Joint pain
• Neck pain
• Headache
• Cancer Pain
• N/V from Pregnancy and Cancer
Acupuncture Point
• Nerve fibers woven
among blood and
lymph vessels
leading to superficial
levels on the dermis
• Epidermis thins at
the acupuncture
point and has a
corresponding
modification of
collagen fibers
*71% correlation between trigger points and acupuncture points*
Mechanism of Action
• Mechanism of action is through conduction of
bioelectromagnetic signals
• Activates opioid systems, and autonomic and
central nervous systems, causing the release of
various neurotransmitters and neurohormones
Note: Acupuncture analgesia can be completely
blocked by Naloxone
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Mechanism of Action
Needling an acupuncture point stimulates a bioelectric response
Changes the electrical charge
2 Hz releases diencephalons act on anxiolytic μ receptors
2 to 15 Hz releases β-endorphin and met-enkephalin in the
brain and dynorphin in the spinal cord -more effective in
relieving deep and chronic pain
• 100 Hz causes release of dynorphin alone
• Something else is actually going
on as analgesic effect is much
longer than the half-life
of endorphins
Evidence of Efficacy
• fMRI Evidence
• Technetium-99m injected at acupuncture point
shows diffusion along different pathways and
rates than vascular and lymphatic channelscredence to meridian theory
PRINCIPAL MERIDIANS
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• Needle
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Type
Combination
Depth
Direction
• Location
• What is done to the needle
– Left alone- dispersion
– Manipulated and/or Stimulated
• Manually- rate and duration
• Electrically
– Frequency
– Duration
• Heated – (Moxa Cigar/Heat lamp/etc)
• Functional Point Acupuncture
• Energy Moving Acupuncture
– Principal Meridian
– Curious Meridian
– Tendon Muscular Meridian
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Distinct Meridian
Scalp Acupuncture
Auricular Acupuncture
Cupping
Qua Sha (Scraping)
Two Needle Technique
• Great for trigger points or musculotendinous pain
• Point of Maximal Tenderness- place 2 needles about 5-10
mm apart
• Connect to Electrical Stimulator for 10-15 min at >10 Hz
• Repeat as needed
Scalp Acupuncture
-Good for general
pain states
-Used alone or as
adjunct
Semi-Permanent
Needle
Ear Acupuncture – same as scalp BFA-all purpose pain tx
Coding(CPT) and Reimbursement
• 97810: one or more needles, without electrical
stimulation, initial 15 minutes -0.60 RVU
• 97811: Each additional 15 minutes, with reinsertion of needles -0.50 RVU
• 97813: one or more needles, with electrical
stimulation, initial 15 minutes -0.65 RVU
• 97814: Each additional 15 minutes with reinsertion of needles – 0.55 RVU
Complications
• Few complications have been reported
• Serious adverse are infections and punctured
organs
• There are fewer adverse effects associated with
acupuncture than with many standard drug
treatments
• At least 2 reports of Pneumothorax
QUESTIONS????
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