Case managers sticking with use of acupuncture
Therapy provides alternative to pain medication
Increasing use of alternative therapies in the general population is leading to integration of modalities such as acupuncture in case management of injured employees, says Charlene C. Ossler, RN, PhD, director of health care and risk management for Innovus, an insurer in Concord, CA.
Speaking at the recent American Occupational Health Conference in Boston, Ossler, who formerly served as executive director of the American Board for Occupational Health Nurses, says traditional Chinese medicine healing modalities such as acupuncture and acupressure are becoming well-accepted add-on benefits for many self-insured employers in the private sector.
While referrals for alternative therapies vary geographically, "many people now use them as their primary source of care," Ossler says. "They will be incorporated more in occupational health because they are becoming part of mainstream medicine."
Thirty-eight states have legalized acupuncture and use certification by the Alexandria, VA-based National Commission for the Certification of Acupuncture and Oriental Medicine in the licensure process. (See contact information in editor’s note at end of article.) Licensure "makes a difference in terms of resources and acceptability" for occupational health referrals, Ossler tells Hospital Employee Health.
Musculoskeletal injuries and chronic pain are the most common conditions for which acu puncture or acupressure referrals are made from an occupational health department, she notes. Repetitive stress injuries and carpal tunnel syndrome are two conditions she says respond well to those treatments. However, the National Institutes of Health in Bethesda, MD, and the World Health Organization, which is based in Geneva, both have issued lengthier lists of common medical conditions for which acupuncture is effective. (See list, above.)
"[Chinese medicine] is truly a complementary art that can address some of the more chronic health problems we see for which Western medi cine has not been effective," Ossler says. "It certainly won’t ever replace Western medicine. Chinese medicine practitioners are starting to incorporate more Western medicine at the same time as many medical colleges are putting Chinese medicine courses in their curriculum. It’s a time when people are blending the two."
While acupuncture referrals may be made more frequently in private industry, some hospital practitioners support the use of acupuncture for certain cases, as well. Charlene M. Gliniecki, RN, MS, COHN-S, director of employee health and safety at Camino Healthcare in Mountainview, CA, points out that the workers’ compensation labor code in that state includes a provision allowing employees to be referred to acupuncturists.
Gliniecki says an acupuncture referral might be appropriate for employees seeking a way to manage pain from a musculoskeletal injury other than with medication or surgery. Between five and 10 employees have been referred for acupuncture in the past year, and the average number of treatments per employee is six. Workers are sent either to a traditional physician who is certified in acupuncture, or to a certified acupuncturist who is not an MD or a DO. In either case, it is best to find a practitioner "who understands treatment goals for workers’ compensation and who works well with conventional practitioners," she notes.
The number of acupuncture referrals has increased as employees learn more about it and as community resources increase, Gliniecki adds.
"We learn for whom these kinds of resources are appropriate. By and large, most people get better with time and don’t need this kind of service. However, any time you’re looking at someone whose predominant musculoskeletal issue is pain management, and you’re trying to find some alternatives to pain medication, or if you have a case for which surgery is recommended — not because of loss of function, but for the pain — there may be some other alternatives. [Acupuncture] is not an answer in and of itself, but it’s part of a variety of things people can do to try to manage their pain and their symptoms," she explains.
Gliniecki agrees that Western medicine has been less than effective at treating repetitive motion injuries and pain, with about 15% to 25% of those cases unresolved by conventional approaches.
"[Acupuncture] is not a miracle cure, but we think it’s something that can be helpful for people and are willing for them to give it a try," she says.
[Editor’s note: For a list of certified acupuncturists by state, contact the National Commission for the Certification of Acupuncture and Oriental Medicine, 11 Canal Center Plaza, Suite 300, Alexandria, VA 22314; telephone: (703) 548-9079; Web site: http://www.nccaom.org.]
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