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Study details differences in physician and nonphysician acupuncture treatment for chronic low back pain

Although up to a third of the 10,000 acupuncturists in the United States are medical doctors, little is known about how their practices compare with those of nonphysician licensed acupuncturists. The first study on the topic, supported in part by the Agency for Healthcare Research and Quality (HS09989), offers some revealing insights. For instance, patients seeking acupuncture treatment are likely to receive markedly different tests and treatments depending on whether they see a physician or licensed nonphysician acupuncturist, even though they may be needled at the same body points.

Researchers compared survey responses from a random national sample of 137 physician acupuncturists with survey data published from a similar survey of nonphysician licensed acupuncturists in Washington State. Both groups of acupuncturists use similar acupoint selection (primarily the bladder and kidney meridians) to treat low back pain, and agree that a minimum of seven treatments are appropriate to treat the condition. However, physicians use a host of Western medical diagnostic technologies such as imaging and electromyographic studies and favor Western diagnostic labels such as herniated disk and spinal stenosis. They also use prescription medications and invasive procedures such as spinal injections and nerve blocks, and often refer patients for physical therapy, massage, and psychological counseling.

In contrast, nonphysicians use traditional Chinese diagnostic techniques such as tongue and pulse diagnosis, and are more likely to use Chinese diagnoses, especially Chi (circulating life energy) and/or blood stagnation and Bi syndrome (wind/cold/ damp). They also employ adjuncts to needling, such as cupping, herbs, warming needles, and moxibustion (burning of a "moxa" herb on or near acupressure points to stimulate the flow of Chi. The addition of electrical stimulation to the needles after placement is used by about two-thirds of both types of acupuncturists.

More details are in "A comparison of physician and nonphysician acupuncture treatment for chronic low back pain," by Donna Kalauokalani, M.D., M.P.H., Daniel C. Cherkin, Ph.D., and Karen J. Sherman, Ph.D., in the September 2005 Clinical Journal of Pain 21(5), pp. 406-411.

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