Utilization of Reimbursed Acupuncture Therapy for Low Back Pain

This large cross-sectional study analyzed health insurance data from nearly 7 million American adults with low back pain between 2010 and 2019, revealing important patterns regarding the use of reimbursed acupuncture. The research used the Optum Clinformatics database, which includes patients with Medicare Advantage and commercial insurance, representing one of the largest analyses ever conducted of acupuncture utilization for low back pain at the population level. Results show that, although the use of reimbursed acupuncture increased steadily from 0.9% in 2010 to 1.6% in 2019, it remains relatively rare. Only 106,485 patients (1.6%) used traditional acupuncture and 61,503 (0.9%) used electroacupuncture during the study period.

The user profile reveals significant disparities: they are predominantly women (64.9%), younger (mean of 46.9 years versus 54.7 years), with higher educational attainment and household income above $100,000 annually. Asian patients were 3.26 times more likely to use acupuncture compared to White patients, while Black patients were less likely (OR 0.88). Geographically, 42.9% of users resided in the Pacific region, mainly California, which has the largest number of licensed acupuncturists. A clinically relevant finding is that acupuncture users adopted more integrated approaches to pain management: they were more likely to use physical therapy (39.2% vs 29.3%) and chiropractic care (45.1% vs 23.1%), but less dependent on pharmacological treatments.

Notably, 41.4% of acupuncture users used opioids, compared with 52.5% of non-users, suggesting that acupuncture may be part of opioid-reduction strategies. Patients with chronic low back pain (defined as two or more diagnoses separated by 90 days) were 2.39 times more likely to use acupuncture. The study identified several barriers to access: significant socioeconomic disparities, with low-income patients 41% less likely to use acupuncture; limited geographic availability of acupuncturists; and inconsistent insurance coverage. Clinical implications are important given the context of the opioid epidemic and the need for non-pharmacological alternatives for pain.

Acupuncture is recommended as a first-line treatment by major American medical organizations, including the American College of Physicians. However, limitations include the retrospective nature of the study, the inability to capture out-of-pocket visits paid directly by patients (estimated at 50-60% of the total), and the absence of data on pain severity and clinical outcomes. The study could not assess the comparative effectiveness of acupuncture versus other treatments.