Acupuncture in the United States

Chinese/Traditional East Asian medicine is one of the oldest forms of healthcare, and represents a system that has a 3,000 year old history. The field of Acupuncture medicine is widely used across the world and has a robust history in the United States.

America’s first exposure to acupuncture came in the 1800’s with the people that came from Asia to help build the transcontinental railroad. In the 1960’s, acupuncture became more popular and started its integration into the American healthcare systems. At that time, James Reston, a reporter traveling with President Nixon to China on a diplomatic trip, suffered from appendicitis. He needed surgery and the operation was performed with acupuncture as the anesthetic. Reston was so impressed and charmed with his treatment that he published an article in the New York Times about his experience. This article made acupuncture more widely known in the U.S.

By the 1990’s, schools and colleges started opening to teach this medicine, and standards for accreditation, education, and certification were created. Now there are many schools and colleges teaching between 3,500 and 4,000 hours of masters and doctorate level training, including over 700 hours in supervised clinical practice.

An acupuncturist and Chinese medicine practitioner training includes western biomedicine, as well as Asian medical didactic theory, point location and indications, pathology, diagnosis, nutrition, herbal medicine, exercise and movement (Qi Gong and Tai Chi), and intense practical and clinical training.

Pain is very common in the United States and is a reported medical problem for over 50 million Americans each year. When accounting for physician visits, analgesics, and loss of productivity, pain management costs more than $600 billion per year. Mixed-modalities, multidisciplinary pain management, and nonpharmacologic pain management methods, including acupuncture, improve patient outcomes and reduce adverse events.

Modern research has shown that acupuncture stimulates multiple physiologic mechanisms, including anti-inflammatory actions, antioxidant effects, autonomic Vagus nerve regulation; increased endogenous opioids; action on cannabinoid CB2 receptors; neuromodulation via neurotransmitter actions; neuroendocrine actions; HPA axis regulation; neuroimmune regulation via mast cell activation; neuroplastic brain changes visible on fMRI; neural growth and regeneration/apoptosis reduction; whole-brain impacts via the default mode network, microbiome changes which affect mood and pain perception; microcirculatory changes, and nociceptive/analgesic, pain-relieving actions. 

Acupuncture is currently used for treatment of both chronic and acute pain. Uses include post-operative and chemotherapy-induced nausea and vomiting, postoperative dental pain, myofascial pain, neck pain, back pain, low back pain, headaches, knee osteoarthritis, shoulder pain, carpal tunnel syndrome, tennis elbow, menstrual cramps and many others.

In 2023, there were 34, 524 licensed acupuncturists in the United States, with a density of 10.36/100,000. Acupuncturists see 95 patients per month and 1,140 per year. In 2023, licensed acupuncturists saw over 6.56 million patients in the United States, or 39 million visits.

This medicine has become one of the fastest-growing forms of integrative healthcare practiced in every state. Forty- seven (47) states (and the District of Columbia) require state certification or national certification (by the National Commission for the Certification of Acupuncture & Oriental Medicine) for state licensure. Alabama, Oklahoma, and South Dakota are the three states without an acupuncture practice act.

In addition, some states required national certification as provided by the National Certification Commission for Acupuncture and Oriental Medicine. The Accreditation Commission for Acupuncture & Oriental Medicine approves Doctoral programs with the national standard being a move towards this higher level of training.

Licensed acupuncturists provide higher levels of patient service by enhancing their skills through continuing education. Acupuncture is a cost-effective therapy for the treatment of pain and many other ailments when used as a complement to standard care.

References 

1.     Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. In: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Appendix C. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92521/

2.     Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896.

3.     Nahin RL. Use of Multimodal Multidisciplinary Pain Management in the US. JAMA Netw Open. 2022;5(11):e2240620. doi:10.1001/jamanetworkopen.2022.40620

4.     Ruixin Zhang, Lixing Lao, Ke Ren, Brian M. Berman; Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain. Anesthesiology 2014; 120:482–503 doi: https://doi.org/10.1097/ALN.0000000000000101

5.     Jung-Sheng Yu, Bai-Yun Zeng, Ching-Liang Hsieh, Chapter Six - Acupuncture Stimulation and Neuroendocrine Regulation. Editor(s): Bai-Yun Zeng, Kaicun Zhao, Fan-Rong Liang. International Review of Neurobiology. Academic Press. Volume 111. 2013. Pages 125-140. ISSN 0074-7742. ISBN 9780124115453. https://doi.org/10.1016/B978-0-12-411545-3.00006-7.

6.     Lin JG, Kotha P, Chen YH. Understandings of acupuncture application and mechanisms. Am J Transl Res. 2022 Mar 15;14(3):1469-1481. PMID: 35422904; PMCID: PMC8991130.

7.     Jiang Y, Wang H, Liu Z, Dong Y, Dong Y, et al. (2013) Manipulation of and Sustained Effects on the Human Brain Induced by Different Modalities of Acupuncture: An fMRI Study. PLOS ONE 8(6): e66815. https://doi.org/10.1371/journal.pone.0066815

8.     Bai, Lijun; Qin, Wei; Liang, Jimin; Tian, Jie; Liu, Yijun. Current Medical Imaging, Volume 5, Number 3, 2009, pp. 167-173(7). Bentham Science Publishers. https://doi.org/10.2174/157340509789000589

9.     V. Napadow, N. Kettner, J. Liu, M. Li, K.K. Kwong, M. Vangel, N. Makris, J. Audette, K.K.S. Hui. Hypothalamus and amygdala response to acupuncture stimuli in carpal tunnel syndrome. PAIN. Volume 130, Issue 3. 2007. Pages 254-266. ISSN 0304-3959. https://doi.org/10.1016/j.pain.2006.12.003.

10.  Nina Theysohn, Kyung-Eun Choi, Elke R. Gizewski, Ming Wen, Thomas Rampp, Thomas Gasser, Gustav J. Dobos, Michael Forsting, and Frauke Musial. Acupuncture-Related Modulation of Pain-Associated Brain Networks During Electrical Pain Stimulation: A Functional Magnetic Resonance Imaging Study. The Journal of Alternative and Complementary Medicine.  Vol. 20, No. 12. 2014. https://doi.org/10.1089/acm.2014.0105

11.  National Institutes of Health Public Health Service U.S. Department of Health and Human Services. (1998). Acupuncture: Consensus Development Conference Report. Journal of Pharmaceutical Care in Pain & Symptom Control, 6(4), 67–90. https://doi.org/10.1300/J088v06n04_05

12.  Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654

13.  Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists' Collaboration. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2. PMID: 29198932; PMCID: PMC5927830.

14.  Hugh MacPherson, Richard Hammerschlag. Acupuncture and the Emerging Evidence Base: Contrived Controversy and Rational Debate. Journal of Acupuncture and Meridian Studies. Volume 5, Issue 4. 2012. Pages 141-147. ISSN 2005-2901. https://doi.org/10.1016/j.jams.2012.05.001.

15.  Ward-Cook K, Reddy B, Mist SD. A snapshot of the AOM profession in America: demographics, practice settings, and income. Meridians J Acupunct Orient Med 2017;3:13-20

16.  Mahrer, Gold, Luu & Herman. NICM, 2010; AMI Group 2016; 2018.