Putting a Fine Point to Acupuncture

I am a huge fan of adjunctive, nonpharmacologic treatment for a lot of patients. As physicians, our instinct is to provide instant relief, and we do that typically by prescribing medications for every problem that patients bring to our attention. But I frequently remind patients that they need to do some of the work themselves. I am a huge proponent of physical therapy, weight loss and exercise, mental health therapy, and, lately, acupuncture.

Coincidentally, the American College of Rheumatology has just come out with new guidelines for the management of osteoarthritis, and acupuncture is on the list of nonpharmacologic interventions conditionally recommended for knee osteoarthritis.

But acupuncture treatments are not inexpensive. Insurance companies rarely cover these, and a session can easily set you back $100. So when a patient told me about Community Acupuncture, I got excited about the possibilities.

Community Acupuncture is a nationwide movement started by acupuncturists from Portland, Ore., and touted as the "calmest revolution ever staged." I think the best description of their vision comes from their website, www. pocacoop.com: "[I]t is not just those who practice, or are licensed to practice, or educated to practice acupuncture who get to define what acupuncture is and isn’t. With Community Acupuncture, the definition cannot only come from those delivering care, but those who are served by acupuncture must have also have a role in defining it. To define acupuncture as a technique, or part of a body of knowledge, leaves out its active role in those who are most affected by it: our patients."

With the goal of making acupuncture more affordable and accessible to a larger number of patients, the treatments are quite literally delivered in a community setting, with multiple patients in a treatment room. This allows for a larger volume of patients, which allows the treatment center to charge less. The website explains that it follows a social business model. "That means: The goal is not to accumulate a lot of money in the business, or for anyone to be able to take money out of the business in the form of profit. The goal is to do as much good as we can do, as long as we can break even and remain sustainable. If there happen to be profits, they will be reinvested into the business," according to the website.

I was intrigued by this idea. I had already started sending patients to my local Community Acupuncture center, but I wanted to have firsthand experience. So I made myself an appointment.

When I walked in, what struck me was how laid back the energy was. It did not feel at all like a stuffy doctor’s office. I suppose that’s the idea. The receptionist knew everyone who walked in the door by name. A sign on her desk tells of the "sliding scale" of payment – pay anywhere from $15 to $35, and pay only what you can. No questions, no need to present your tax return.

I walked into the treatment rooms. There were three of them, and each room had anywhere from four to eight recliners. It was later in the day so there were a lot of empty recliners. I situated myself in one and tried to get comfortable. I admit I picked a room that was empty, so I cannot speak to the experience of having other patients in the room. But I suspect part of the attraction for some people is that they’re in the treatment room with others, that they are not alone. There must be a feeling of solidarity or community.

Chris, my acupuncturist, then came to start the treatment. She understood that I was here for the experience, so there were no questions about my health (and truthfully I would have been hard-pressed to find something to complain about anyway). She felt my pulses – she called this "listening" to my pulses – I suppose to gauge the current state of my health.

She then proceeded to put the needles in me. The needles are tiny, so tiny she didn’t draw blood, so tiny they’re much smaller than the teriparatide or etanercept or tuberculin syringe needles. They’re probably a 40-gauge. With a quick light tap she put each one in place, three in each hand, three in each foot, and one on my forehead. This process was painless, though I did feel the needle that went into my glabella. The feeling is akin to getting an intramuscular injection, though on a much smaller scale. The pain did not last long though.

At Community Acupuncture, they let you sit in the treatment room for as long as you need to; you decide when your treatment is done. I suspect it must feel empowering for the patients to feel like they have some degree of control over the treatments, to be able to say when they feel they’re ready. Chris came and removed the needles after about 30 minutes.

I wish I could say I felt a difference after my treatment, but in truth I had not come in to be treated for anything. I just wanted the experience, and I got just that. My acupuncturist gave me a great overview of what acupuncture is, and what Community Acupuncture in particular can offer.

Some conditions lend themselves well to treatment with acupuncture. While acupuncture makes no claims about correcting a structural problem (it will not reverse your knee osteoarthritis), it might help with functional problems. Things like pain, irritable bowel syndrome symptoms, even allergy symptoms.

I am aware of studies that show that there is no difference between sham acupuncture and real acupuncture. But what of it? A placebo effect, after all, is still a therapeutic effect. This makes me think that there must be more to acupuncture than just the application of needles in the right places. Maybe it is the environment of the acupuncturist’s office. Maybe it is the aura of mystery that Eastern medicine inherently possesses, or the fact of being physically touched by the provider. These are intangibles that I think can make a difference. As Chris put it, "we’re all here to treat people, make them better somehow." That’s a nice ideal for physicians to strive for, don’t you think?

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I. Readers can write to her at [email protected].

I am a huge fan of adjunctive, nonpharmacologic treatment for a lot of patients. As physicians, our instinct is to provide instant relief, and we do that typically by prescribing medications for every problem that patients bring to our attention. But I frequently remind patients that they need to do some of the work themselves. I am a huge proponent of physical therapy, weight loss and exercise, mental health therapy, and, lately, acupuncture.

Coincidentally, the American College of Rheumatology has just come out with new guidelines for the management of osteoarthritis, and acupuncture is on the list of nonpharmacologic interventions conditionally recommended for knee osteoarthritis.

But acupuncture treatments are not inexpensive. Insurance companies rarely cover these, and a session can easily set you back $100. So when a patient told me about Community Acupuncture, I got excited about the possibilities.

Community Acupuncture is a nationwide movement started by acupuncturists from Portland, Ore., and touted as the "calmest revolution ever staged." I think the best description of their vision comes from their website, www. pocacoop.com: "[I]t is not just those who practice, or are licensed to practice, or educated to practice acupuncture who get to define what acupuncture is and isn’t. With Community Acupuncture, the definition cannot only come from those delivering care, but those who are served by acupuncture must have also have a role in defining it. To define acupuncture as a technique, or part of a body of knowledge, leaves out its active role in those who are most affected by it: our patients."

With the goal of making acupuncture more affordable and accessible to a larger number of patients, the treatments are quite literally delivered in a community setting, with multiple patients in a treatment room. This allows for a larger volume of patients, which allows the treatment center to charge less. The website explains that it follows a social business model. "That means: The goal is not to accumulate a lot of money in the business, or for anyone to be able to take money out of the business in the form of profit. The goal is to do as much good as we can do, as long as we can break even and remain sustainable. If there happen to be profits, they will be reinvested into the business," according to the website.

I was intrigued by this idea. I had already started sending patients to my local Community Acupuncture center, but I wanted to have firsthand experience. So I made myself an appointment.

When I walked in, what struck me was how laid back the energy was. It did not feel at all like a stuffy doctor’s office. I suppose that’s the idea. The receptionist knew everyone who walked in the door by name. A sign on her desk tells of the "sliding scale" of payment – pay anywhere from $15 to $35, and pay only what you can. No questions, no need to present your tax return.

I walked into the treatment rooms. There were three of them, and each room had anywhere from four to eight recliners. It was later in the day so there were a lot of empty recliners. I situated myself in one and tried to get comfortable. I admit I picked a room that was empty, so I cannot speak to the experience of having other patients in the room. But I suspect part of the attraction for some people is that they’re in the treatment room with others, that they are not alone. There must be a feeling of solidarity or community.

Chris, my acupuncturist, then came to start the treatment. She understood that I was here for the experience, so there were no questions about my health (and truthfully I would have been hard-pressed to find something to complain about anyway). She felt my pulses – she called this "listening" to my pulses – I suppose to gauge the current state of my health.

She then proceeded to put the needles in me. The needles are tiny, so tiny she didn’t draw blood, so tiny they’re much smaller than the teriparatide or etanercept or tuberculin syringe needles. They’re probably a 40-gauge. With a quick light tap she put each one in place, three in each hand, three in each foot, and one on my forehead. This process was painless, though I did feel the needle that went into my glabella. The feeling is akin to getting an intramuscular injection, though on a much smaller scale. The pain did not last long though.

At Community Acupuncture, they let you sit in the treatment room for as long as you need to; you decide when your treatment is done. I suspect it must feel empowering for the patients to feel like they have some degree of control over the treatments, to be able to say when they feel they’re ready. Chris came and removed the needles after about 30 minutes.

I wish I could say I felt a difference after my treatment, but in truth I had not come in to be treated for anything. I just wanted the experience, and I got just that. My acupuncturist gave me a great overview of what acupuncture is, and what Community Acupuncture in particular can offer.

Some conditions lend themselves well to treatment with acupuncture. While acupuncture makes no claims about correcting a structural problem (it will not reverse your knee osteoarthritis), it might help with functional problems. Things like pain, irritable bowel syndrome symptoms, even allergy symptoms.

I am aware of studies that show that there is no difference between sham acupuncture and real acupuncture. But what of it? A placebo effect, after all, is still a therapeutic effect. This makes me think that there must be more to acupuncture than just the application of needles in the right places. Maybe it is the environment of the acupuncturist’s office. Maybe it is the aura of mystery that Eastern medicine inherently possesses, or the fact of being physically touched by the provider. These are intangibles that I think can make a difference. As Chris put it, "we’re all here to treat people, make them better somehow." That’s a nice ideal for physicians to strive for, don’t you think?

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I. Readers can write to her at [email protected].

I am a huge fan of adjunctive, nonpharmacologic treatment for a lot of patients. As physicians, our instinct is to provide instant relief, and we do that typically by prescribing medications for every problem that patients bring to our attention. But I frequently remind patients that they need to do some of the work themselves. I am a huge proponent of physical therapy, weight loss and exercise, mental health therapy, and, lately, acupuncture.

Coincidentally, the American College of Rheumatology has just come out with new guidelines for the management of osteoarthritis, and acupuncture is on the list of nonpharmacologic interventions conditionally recommended for knee osteoarthritis.

But acupuncture treatments are not inexpensive. Insurance companies rarely cover these, and a session can easily set you back $100. So when a patient told me about Community Acupuncture, I got excited about the possibilities.

Community Acupuncture is a nationwide movement started by acupuncturists from Portland, Ore., and touted as the "calmest revolution ever staged." I think the best description of their vision comes from their website, www. pocacoop.com: "[I]t is not just those who practice, or are licensed to practice, or educated to practice acupuncture who get to define what acupuncture is and isn’t. With Community Acupuncture, the definition cannot only come from those delivering care, but those who are served by acupuncture must have also have a role in defining it. To define acupuncture as a technique, or part of a body of knowledge, leaves out its active role in those who are most affected by it: our patients."

With the goal of making acupuncture more affordable and accessible to a larger number of patients, the treatments are quite literally delivered in a community setting, with multiple patients in a treatment room. This allows for a larger volume of patients, which allows the treatment center to charge less. The website explains that it follows a social business model. "That means: The goal is not to accumulate a lot of money in the business, or for anyone to be able to take money out of the business in the form of profit. The goal is to do as much good as we can do, as long as we can break even and remain sustainable. If there happen to be profits, they will be reinvested into the business," according to the website.

I was intrigued by this idea. I had already started sending patients to my local Community Acupuncture center, but I wanted to have firsthand experience. So I made myself an appointment.

When I walked in, what struck me was how laid back the energy was. It did not feel at all like a stuffy doctor’s office. I suppose that’s the idea. The receptionist knew everyone who walked in the door by name. A sign on her desk tells of the "sliding scale" of payment – pay anywhere from $15 to $35, and pay only what you can. No questions, no need to present your tax return.

I walked into the treatment rooms. There were three of them, and each room had anywhere from four to eight recliners. It was later in the day so there were a lot of empty recliners. I situated myself in one and tried to get comfortable. I admit I picked a room that was empty, so I cannot speak to the experience of having other patients in the room. But I suspect part of the attraction for some people is that they’re in the treatment room with others, that they are not alone. There must be a feeling of solidarity or community.

Chris, my acupuncturist, then came to start the treatment. She understood that I was here for the experience, so there were no questions about my health (and truthfully I would have been hard-pressed to find something to complain about anyway). She felt my pulses – she called this "listening" to my pulses – I suppose to gauge the current state of my health.

She then proceeded to put the needles in me. The needles are tiny, so tiny she didn’t draw blood, so tiny they’re much smaller than the teriparatide or etanercept or tuberculin syringe needles. They’re probably a 40-gauge. With a quick light tap she put each one in place, three in each hand, three in each foot, and one on my forehead. This process was painless, though I did feel the needle that went into my glabella. The feeling is akin to getting an intramuscular injection, though on a much smaller scale. The pain did not last long though.

At Community Acupuncture, they let you sit in the treatment room for as long as you need to; you decide when your treatment is done. I suspect it must feel empowering for the patients to feel like they have some degree of control over the treatments, to be able to say when they feel they’re ready. Chris came and removed the needles after about 30 minutes.

I wish I could say I felt a difference after my treatment, but in truth I had not come in to be treated for anything. I just wanted the experience, and I got just that. My acupuncturist gave me a great overview of what acupuncture is, and what Community Acupuncture in particular can offer.

Some conditions lend themselves well to treatment with acupuncture. While acupuncture makes no claims about correcting a structural problem (it will not reverse your knee osteoarthritis), it might help with functional problems. Things like pain, irritable bowel syndrome symptoms, even allergy symptoms.

I am aware of studies that show that there is no difference between sham acupuncture and real acupuncture. But what of it? A placebo effect, after all, is still a therapeutic effect. This makes me think that there must be more to acupuncture than just the application of needles in the right places. Maybe it is the environment of the acupuncturist’s office. Maybe it is the aura of mystery that Eastern medicine inherently possesses, or the fact of being physically touched by the provider. These are intangibles that I think can make a difference. As Chris put it, "we’re all here to treat people, make them better somehow." That’s a nice ideal for physicians to strive for, don’t you think?

Dr. Chan is a rheumatologist in private practice in Pawtucket, R.I. Readers can write to her at [email protected].