Acupuncture: A Clinical Review

Victor S. Sierpina, MD; Moshe A. Frenkel, MD

Disclosures

South Med J. 2005;98(3):330-337. 

In This Article

What the Patient Can Expect

An initial consultation with the medical acupuncture practitioner might not include needle treatment. Depending on the complexity of the problem, this initial consultation may be devoted to history and physical examination and review of the medical records. Additional diagnostic studies such as laboratory or radiologic examinations may be requested. This evaluation is necessary in the Western model to determine the full spectrum of the patient's treatment options, to confirm preceding diagnostic impressions, and to decide if acupuncture is likely to be helpful in this case. In the case of the Oriental Medical Doctor or Licensed Acupuncturist, the history will include a detailed inquiry into diet and lifestyle and familial and personal factors such as taste, color, and seasonal preferences, not usually included in the routine medical history. The tongue, pulses, and ear will be closely examined in addition to standard physical examination. Chinese herbal mixtures may be offered as part of the treatment plan, and although these are a significant part of classic TCM practice, patients must be aware that contaminants, pharmaceuticals, heavy metals, and other impurities have been reported in Chinese herbs and that standardization and dosage is imprecise and unregulated.[27]

Patients should inquire into the practitioner's training, certification by the NCCAOM, state licensure, whether sterile, single-use needles are to be used, and the expected number and cost of treatments. Although some patients are intolerant of needles, most feel little if any discomfort besides a slight aching sensation at the site of insertion. Despite usual apprehension about pain, needle treatments are comfortable and relaxing for most patients. The patient typically lies on an examination or massage-type table while as few as one needle but occasionally up to 30 needles are commonly inserted on the extremities, trunk, ear, or other selected points. These needles are then either manually manipulated, heated with an herb called moxa ( Artemisia vulgaris ), or stimulated with an electrical device powered by a 9 V battery, similar to a typical transcutaneous electrical nerve stimulation unit. A typical treatment session is 20 to 40 minutes. Some styles of treatment use fewer needles for shorter periods and do not use the electrical stimulation. Imbedded tacks are sometimes left in place for a few days, particularly in the ear. Visits typically start at weekly intervals or more often and as improvement occurs are spaced further apart.

Patients may experience a mild euphoria or drowsiness, especially after the first treatment, and should be advised not to drive or operate machinery immediately after the treatment. Bleeding or bruising, pain on needling, and aggravation of symptoms occur in 1 to 3% of patients. Patients are also advised to avoid strenuous physical activity, heavy meals, alcohol intake, or sexual activity for up to 8 hours after a treatment. This is thought to improve the take or effectiveness of the treatment.

Acupuncture costs $50 to 100 per treatment, plus the additional cost of the initial evaluation. For physician acupuncturists, the initial evaluation, not including the acupuncture treatment, can generally be billed as a consultation visit or standard E & M code. Inpatient acupuncture can also be provided as a consultation service.[28] A series of 4 to 10 sessions is generally considered an adequate initial trial of therapy. Nonresponders can be referred for other treatment modalities. In the United States, some health maintenance organizations and major insurance plans including Worker's Compensation do cover acupuncture, but this remains a minority. Medicare and Medicaid do not currently cover acupuncture.

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