Health: Acupuncture in the opioid crisis era

Chris Gaitten

Like any worried, self-critical mother, Brandy Golden felt some guilt when both of her daughters developed unexplainable, unrelenting pain all over their bodies in 2016. Was it dietary? Environmental? Had she done something to cause it? There were lots of hospital visits and skeptical doctors. The constant medical appointments prevented Brandy from holding a job.

“Once the doctors' appointments start, employment isn't guaranteed, and I was just so afraid our family would fall through the cracks and we would end up homeless,” says Brandy, a single mother to 13-year-old Gloria and 11-year-old Grace.

Eventually, they received diagnoses: amplified musculoskeletal pain syndrome, a set of disorders most common in young girls, which can stem from injury, illness, psychological stress or a combination of factors. They entered the Comprehensive Pain Management Clinic at Nationwide Children's Hospital. The multidisciplinary clinic's program involves monthly appointments with a medical provider and biweekly sessions of physical therapy, psychology, acupuncture and massage, as well as aromatherapy if appropriate.

“The acupuncture, it always helps, more than just a little bit, whenever I do it,” Gloria says from the family's northeast side home. Her pain normally ranges anywhere from 4 to 10 on a 10-point scale, but after treatment it's at 1 to 3 for about two hours. Grace is now pain-free for stretches of time. “Sometimes it will [only] go up to one hour,” she says, “but the longest I've ever had pain-free is one day.”

The girls are two of the many patients, young and old, who are benefiting from the availability of an ancient practice in modern health care settings. A form of traditional Chinese medicine, acupuncture commonly involves inserting thin needles into specific points to balance the body's energy, or qi. “Our body has processes for healing, processes for dealing with pain, but they don't always work as well as they should, and acupuncture can stimulate them to work better,” says Jared West, the president of the Ohio Association of Acupuncture and Oriental Medicine. New research has shown that it's especially effective for those with chronic pain, he continues, and it's also been integrated into cancer treatments and used to help with depression, anxiety and PTSD, among other ailments.

At its campuses on the South Side and in Westerville, Nationwide Children's acupuncturists treat between 25 and 50 pain clinic patients a week, says Sharon Wrona, the administrative director of comprehensive pain and palliative care services. Nurse and acupuncturist Andy Lee educates the public about what acupuncture is and isn't while in the pain clinic; she says people are becoming more accepting.

For many years, the fact that acupuncture wasn't covered by many insurance carriers was a significant obstacle to widespread availability. That too is beginning to shift, due in part to the ongoing opioid crisis. In September, the National Association of Attorneys General sent a letter to America's Health Insurance Plans urging the insurers' trade association to prioritize coverage of non-opioid pain treatments like acupuncture. Ohio Attorney General Mike DeWine wasn't one of the 37 state attorneys general to sign the letter; his spokesperson Dan Tierney says that DeWine instead formed the Insurer Taskforce on Opioid Reduction in October.

In a recent victory for acupuncture's proponents, Ohio's Medicaid program will start covering the practice for lower back pain and migraines at the beginning of 2018. The Ohio Association of Acupuncture is continuing to push Medicaid to cover it for a wider range of conditions, like post-operative pain, West says.

The pain clinic at Nationwide Children's has offered acupuncture since it opened about a decade ago, Wrona says. “I think in the pediatric arena for chronic pain, we've always been more about minimizing medications and maximizing [treatments] like acupuncture, massage, physical therapy and psychology,” Lee adds. But just like medication, acupuncture doesn't always work for everyone, or the pain might not be entirely eliminated. The hope is that it allows children some amount of normalcy.

For Gloria and Grace, the pain changes constantly. It's discouraging, their mother says, because they'll improve for a while and then their conditions will worsen again. But after months of watching them stricken, it means so much to see them get some relief. Brandy remains optimistic because the pain clinic treatments are still working, and she hopes that Medicaid-backed insurance plans like those her daughters use will continue to cover these programs. She's been assured she wasn't at fault for her daughters' conditions, which doctors tell her will eventually go away, though there's no timetable for when that will happen.

“It's been a very scary and emotional journey,” Brandy says. “I can't imagine what we would do if these therapies weren't available.”