Use of Acupuncture in Pain Patients with Substance Use Disorder

man lying on acupuncture table with needles in his back

Can acupuncture help people with chronic pain and substance use disorder?

Over the past 24 years, the overdose, opioid, and substance use disorder crisis in the United States has claimed over a million lives, with roughly three-quarters of fatal overdoses attributed to opioids. That’s the latest data according to the Centers for Disease Control (CDC). The crisis knows no bounds and affects all demographic groups. From urban areas to rural areas, from CEOs to carpenters, and across racial and ethnic groups, the crisis causes ongoing harm to individuals, families, and communities across the country.

No one is immune.

Here are the statistics from the 2019 – 2021, including a provisional count for 2022.

The Overdose and Opioid Crisis: Latest Facts and Figures

  • 2019: 67,697
    • 50,178 opioid-related
    • That’s 74%
  • 2020: 78,056
    • 69,061 opioid-related
    • That’s 88%
  • 2021: 107,306
    • 80,997 opioid-related
    • That’s 75%
  • For the 12-month period ending in August 2022: 101,552
    • 76,683 opioid-related
    • That’s 75%

Although we don’t have the final data for 2022, the preliminary numbers indicate that the percentage of fatal overdoses related to opioids remained stable from 2021 to 2022, after a significant decrease between 2020 and 2021. What this tells us is that the all-of-the-above approach adopted by policymakers and treatment providers at the local, state, and federal level may be having an impact on the steady increase we’ve witnessed since 1999.

Around the country, a growing numbers of individuals and organizations working to mitigate the harm caused by opioids – which are responsible for a majority of overdose fatalities – understand that comprehensive, integrated treatment is the best approach to treating individuals diagnosed with substance use disorder (SUD), including those diagnosed with opioid use disorder (OUD).

The integrated treatment model includes:

This article will focus on the use of acupuncture in SUD and OUD treatment. This topic is particularly important, because of the following conundrum: opioids are the most powerful pain relieving medications we have, but for people with opioid use disorder who are also in chronic pain, this creates significant problems. Many people with OUD who are also in chronic pain believe they face a choice: remain in pain or relapse to opioid use?

Fortunately, they don’t have to make that choice, because there are options available – like acupuncture – that they may not know about.

The Role of Acupuncture in Treating Chronic Pain

We mention the core of the conundrum above: opioid works very well for relieving pain. But that leaves people with opioid use disorder who also experience chronic pain in a difficult position. How can they manage their pain without relapsing to opioids?

The best answer is in exploring alternative, non-opioid options for pain relief, such as acupuncture. The first question people in pain want answered is this:

Does acupuncture really relieve pain?

The article “Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning,” published in August 2022, presents evidence that answers this question. Researchers used data on approximately 87,500 adults in the U.S. collected in the 2019 National Health Information Survey (NHIS). The CDC conducts this survey every year to gather vital information on the health and well-being of citizens in the U.S.

Here’s what they learned about chronic pain in the overall population in the year 2019:

  • One-fifth (20.4%) of those interviewed reported chronic pain
    • That’s around 17,500 people
  • By gender:
    • Women: 21.7%
    • Men: 20.4%
  • Chronic pain is prevalent in all ethnicities
  • Incidence of chronic pain increases with age
  • Incidence of chronic pain differs by location type:
    • Rural areas: 28.1%
    • Urban areas: 16.4%

In addition, the study indicates that chronic pain is associated with:

  • Poor quality of life
  • Impaired ability to participate in school and work activities
  • Impaired ability to participate in social and recreational activities
  • High costs in treatment
  • Clinical complication
  • Risk of opioid misuse and opioid use disorder (OUD)
  • Poor mental health

For these reasons, pain experts recommend implementing multi-disciplinary biopsychosocial rehabilitation (MBR) at the beginning of the rehabilitation process. This approach integrate the following dimensions into pain rehabilitation and treatment:

  • Physical components, which may include:
    • Medication
    • Physical therapy
    • Complementary non-pharmacological support
  • Psychological components, which may include:
    • Therapy
    • Counseling
    • SUD/OUD treatment if needed
  • Social components, which may include:
    • Peer support
    • Lifestyle supports

This article will address one component above – the use of acupuncture – in its broad context as a pain-relieving approach, and in a more specific context as a pain-reliever for people in substance use disorder treatment and/or treatment for opioid use disorder.

Acupuncture and Chronic Pain

First, to establish the validity of acupuncture for pain relief in general, let’s look at the evidence base for the use of acupuncture for chronic pain. A wide-range meta-analysis published in 2018 that examined data from 20,827 patients across 39 studies showed acupuncture is effective for:

  • Chronic musculoskeletal pain
  • Headache, including migraines
  • Osteoarthritis
  • Low back pain
  • Knee pain

Those studies all involved acupuncture treatment in individual clinical settings. Additional evidence shows acupuncture is effective in group clinical settings, as well. These results are important because most intensive treatment for SUD and/or OUD occurs in group treatment settings. When studying acupuncture in group treatment settings for in patients with chronic neck, back, or shoulder pain and/or osteoarthritis, researchers found acupuncture is effective for:

  • Reducing pain severity
  • Decreasing pain interference with daily activity
  • Reducing symptoms of depression
  • Decreasing pain associated with diabetic neuropathy
  • Reducing need for pain medication
  • Improved levels of self-care
  • Improved quality of life

There are two more things to consider with regards to acupuncture. First, the effects are long-lasting. The studies above report positive results can persist for as long as 24 weeks. Second, there is a very low instance of adverse reactions to acupuncture. Data shows adverse effects occur in approximately 0.01 percent of treatment cases, or one in ten thousand.

Those findings are relevant to our discussion in that the positive outcomes reported are the types of outcomes SUD treatment professionals look for. Increased self-care and quality of life alongside reduce pain severity, reduced interference with daily life, and decreased symptoms of mental health disorders such as depression make the use of acupuncture a compelling option in treating patients with SUD, SUD/OUD, and comorbid chronic pain.

Now let’s look at the data on the use of acupuncture in SUD and OUD treatment.

Acupuncture, Substance Use Disorder Treatment, Opioid Use Disorder Treatment, and Chronic Pain

It’s important to understand the use of acupuncture has become more commonplace in the U.S. over the past few years.

Regular citizens know about it, and understand that in some situations, it works very well. This is a change from not long ago, when it was considered a fringe approach, at best. We’ve also changed in the past decade, when articles like “Pain Management in Patients with Substance-Use Disorders” endorsed acupuncture with statements like:

“Acupuncture can be applied by needling, heat, pressure, or electrical stimulation. Acupuncture modulates nerve fiber firing and stimulates release of endorphins. Recent studies support the use of acupuncture in osteoarthritis and fibromyalgia. There is more evidence to support the use of acupuncture for somatic pain than for neuropathic pain. Acupuncture is a safe and viable treatment option for patients with addiction.”

Studies like that one, while limited in their assessment of acupuncture, paved the way for studies like the one we’ll focus on in this article.

Published in August 2021, the article “Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning” evaluates the effectiveness of using acupuncture in treating patients with opioid use disorder.

The authors of the article examined several large-scale studies and meta-analyses on that offered data acupuncture on “the role of acupuncture as a nonpharmacological approach to pain management as well as a component of comprehensive strategies to address opioid use disorder (OUD).”

After a thorough review of the available research, authors reported that an overwhelming abundance of evidence shows that for people in recovery from opioid use disorder (OUD), integrating acupuncture into comprehensive treatment plans is associated with positive outcomes.

Benefits of Acupuncture for People with OUD

  • Decreased severity of withdrawal symptoms
  • Reduced opioid cravings
  • Increased treatment retention
  • Increased treatment completion
  • Reduced comorbidity
  • Reduced mortality
  • Improved sleep
  • Reduced symptoms of anxiety
  • Reduced symptoms of depression

In addition, it’s important to note the following:

  • 88% of Veterans Administration (VA) hospitals incorporate acupuncture into pain treatment and substance use disorder treatment protocols
  • The U.S. military includes acupuncture in their officially recommended pain management and substance use disorder treatment protocols
  • 25% of hospitals in the U.S. incorporate acupuncture into pain treatment infrastructure

When we consider all of the data above as a whole, we find that acupuncture is a safe and effective approach to the treatment of chronic pain, improves outcomes for people with chronic pain and comorbid substance use disorder (SUD) and opioid use disorder (OUD), and has minimal negative side-effects.

That’s a compelling case for the inclusion of acupuncture in any treatment program for SUD or OUD. Now let’s take a look at how many SUD/OUD treatment centers in the U.S. take advantage of this effective pain-management strategy.

How Common is Acupuncture in Substance Use Disorder Treatment Centers in the U.S.?

The study “The Prevalence of the Offering of Acupuncture as a Service for Treatment of Pain and the Characteristics of United States Substance Use Treatment Facilities Associated with its Offering,” published in March 2022, used data from the 2019 National Survey of Substance Abuse Treatment Services (NSSATS) to answer the question we pose in that heading.

The study authors identified the characteristics that increased the likelihood a treatment center would offer acupuncture as a complementary treatment approach for chronic pain, SUD, or OUD. We’ll offer those results, then the prevalence data.

Treatment centers with an acupuncture component most often:

  • Offer a wide variety of treatment services
  • Offer treatment services for other a wide variety of SUDs
  • Provide special programs for veterans
  • Provide MAT with MOUD services with buprenorphine, naloxone, or methadone:
    • Programs with buprenorphine had a 63% higher likelihood of offering acupuncture
    • Programs with naloxone had a 37% higher likelihood of offering acupuncture
    • Data on availability of acupuncture in methadone programs n/a
  • Receive funding or grants from local, state, or federal government:
    • Federally funded facilities were 4 times more likely to offer acupuncture in SUD treatment than state-funded SUD treatment centers
    • Federally funded facilities were 3 times more likely to offer acupuncture in SUD treatment than private non-profit organizations
    • Tribal facilities were five times more likely to offer acupuncture than state-fudned treatment facilities
  • Obtain accreditation form the Joint Commission (JCOH)

Now let’s look at the prevalence data. Here’s what the researchers found in their comprehensive analysis of treatment services offered at substance use disorder (SUD) treatment facilities in the U.S.

Prevalence of Acupuncture in SUD Treatment Facilities

  • 2019:
    • 977 of 15,961 reported use of acupuncture
    • That’s 6.12%
  • 2018:
    • 814 of 14,809 facilities reported using acupuncture
    • That’s 5.5%
  • 2017:
    • 741 of 13,585 reported using acupuncture
    • That’s 5.4%

After reading this report, we examined the data from 2020 and found that out of 16,066 treatment centers, a total of 950 offered acupuncture. That’s 5.9 percent, which is an increase from 2017 and 2018, but a decrease from 2019. It’s possible that the COVID-19 pandemic impacted the prevalence of acupuncture offered by treatment centers, but the NSSATS offers no explanation – that’s our take on why the prevalence of acupuncture in SUD treatment centers may have decreased in 2020.

Whatever the reason, the fact that the numbers for acupuncture are decreasing, rather than increasing, means that – as a nation united in its goal of reducing the harm caused by the opioid crisis – we need to reconsider the data on acupuncture and incorporate acupuncture into more SUD and OUD treatment programs.

It’s that simple: the absence of acupuncture in close to 95 percent of treatment programs is something we need to correct. And it’s something that’s attainable. In addition to the data we report above, evidence also shows that acupuncture is affordable for patients and cost-effective for providers. In other words, acupuncture for chronic pain for people with OUD is a positive choice from almost any point of view.

We’ll give the final word to the study authors.

Here’s what they conclude, after a thorough analysis of the available data:

“The prevalence of acupuncture as a service for treatment of pain among substance use facilities nationwide remains low and unchanging. Given the prevalence of underlying pain, policy interventions should be considered to encourage use of acupuncture for treatment of underlying pain by substance use treatment facilities.”

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