Acupuncture has been around for thousands of years and today millions swear by its ability to ease pain, reduce stress, relieve allergies, relieve fertility issues and promote better sleep. However the practice still faces uncertainty and misconceptions in the U.S. despite being widely available through certified and licensed practitioners in almost every state. Let’s face it. The idea of having someone sticking needles in a patient sounds, well, painful. Not so, claims Dr. Nell Smircina, an acupuncture advocate and practitioner. She spoke to WellWell recently about the state of the practice in the U.S., how traditional medicine is dealing with acupuncture and what benefits it offers—all in hopes of (yes, forgive the pun) moving the needle on the public’s perception. Read on.
Tell us a little bit about yourself and how you got involved in acupuncture, herbal and alternative medicine.
I was always into more conventional medicine, even growing up. I was an athlete. I think that my first stint in physical therapy, I was six years old with a sprained ankle from gymnastics, so being very familiar with healthcare for a long time and allied health specifically, I wanted to be a surgeon. I did pre-med and started looking at what my life was going to look like as a surgeon and started looking into other career options. I did a little bit in physical therapy and in working at a physical therapy office, I met an acupuncturist. I knew absolutely nothing about it, but I was frustrated with the limitations around my scope of practice and I wanted to talk to patients about things outside of the exercises they could be doing. Acupuncture not only allowed me pain relief from chronic injuries that I was experiencing, but it opened me up to a new career path. And so, with the herbal medicine component, acupuncture is one modality in a much larger system of traditional medicine. And herbal medicine is part of that. A lot of practitioners will do that specifically or exclusively, but it’s meant to effortlessly flow together to best support a patient.
Acupuncture is thousands of years old. What are some of the misconceptions people still have about acupuncture?
I always knew I wanted to be involved in the advocacy space because there are so many misconceptions. As a healthcare provider, growing up and into my 20s I had no exposure to evidence-based and practical medicine where you’re not experiencing side effects. And you help coach the body toward a state where it is in homeostasis. The body is really intelligent and knows how to heal. You need a gentle nudge in that direction. And I think all aspects of healthcare and medicine have their place. When it comes to acupuncture, I like to refer to it as an adaptogenic medicine. It helps the body adapt to different stressors that it experiences, physical or mental, as well. We know that mental stressors also have a physiological impact on the body. So, it just helps nudge people in the right direction.
But a misconception around that is that oh well, if there’s no medicine on these needles or oh if it’s needles, it must be painful. Acupuncture does not have to be painful to be effective. Most of the needles are as thin as a human hair and so you’re not puncturing the skin like you would with an injection. It’s a very different sensation. People often just feel a little bit of tingling or pressure or sometimes nothing at all. Generally, even the most fearful patients end up relaxing on the treatment table in that first initial session because of the way that it helps the body adapt. Another misconception is the education around acupuncture. I’m often asked, Oh, do you have to go to school for that or oh, you have a doctor in front of your name, you must be some type of medical doctor. Acupuncture and traditional medicine in that integrative realm is more of a specialty. And if you look at acupuncture worldwide, it has a medical focus. Acupuncture is newer in the U.S. than in other countries, so people will be educated in traditional healthcare and then kind of add on that acupuncture element. And we have very robust education for acupuncture and traditional medicine specifically. In the U.S., I did a four-year master’s program on top of my undergrad and then I did a two-year doctorate on top of that. So, there is a lot of education that goes into this medicine.
With traditional medicine, you get sick, you’re unwell, you’re injured and then you’re treated. Is that why there are misconceptions about acupuncture because it can take a different approach?
It’s becoming more conventional in that you have medical doctors who will get certified and trained in acupuncture. There’s an increase in nurse practitioners and a lot of chiropractors and physical therapists have needling within their scope. Not necessarily acupuncture, but dry needling, where you’re not retaining the needles. You are working on musculoskeletal conditions and so it’s a very narrow scope for the type of needling that happens with dry needling compared to acupuncture. Every acupuncturist is educated on how to do dry needling. But it’s a very tiny part of what we do. So, you are seeing a lot of healthcare providers that want to utilize this medicine. Obviously, there’s efficacy there, but I do think there’s a shift and also, some international biases as well. In America, we like to think that things that are American or that we’re familiar with are best. But this goes back thousands of years in Asia and other continents that utilized this medicine. It’s not something we’re super familiar with from a long-term standpoint in the U.S. I do think as these other providers are utilizing needles and people are talking more about acupuncture, that certainly helps. We’ve seen the utilization of complementary care increase almost double in the last few years. We’re still only at six percent. But that is millions of people who are interested.
I also think that if you are looking at trends in healthcare, there is such a blurring that’s occurring in the traditional health and wellness space where you have consumer-driven healthcare happening right now. People are being more proactive with what healthcare looks like or having different discussions about access when it comes to telehealth or med spas. I think we’re going to see more utilization in the future as that health and wellness market continues to merge with healthcare in general.
How has the practice evolved?
We have seen a shift in how medicine is delivered from thousands of years ago. Needles were not surgical stainless steel, they weren’t single-use and they weren’t as small as a human hair. They were made from bone or stone and that was just a matter of the resources that were available at that time. There were a lot of things that changed. Also, regulations changed, So when we talk about HIPPA, that’s not something that’s been around forever. When we talk about sterilization techniques that have not been around forever. It’s continued to improve and get safer over time. And then also we’re able to measure efficacy better. There’s a different standard that people want to see, knowing that tools are available and we can look at a functional MRI and see that acupuncture is working and causing an effect in the brain and the body. We can look at lab results and say, oh, hey, I treated a patient with these herbs for three months and this is how their liver enzymes improved or whatever the metric is that you are looking at for that time. So, there is just more validation that’s happening and safer practices.
Can we identify causality with acupuncture at this point?
I think more so from a functional MRI perspective where you can limit some of those other interventions. When you send people home and you’re not directly measuring, it’s really hard to say like, oh, well, is this even in a treatment scenario? When I ask people to look at pain skills or I take their vitals before and after, you can say OK, how much of this were the needles and how much of this was because you were in a dark room away from your kids for 30 minutes and had some alone time. I think that’s a challenge with any type of intervention. But there has certainly been more research done to identify different neurochemicals and different physiological shifts in the body and eliminate some of those other potentials. And on top of that, you can also look at very tangible things like scar tissue. Where you’re like, OK, this person is not doing anything else other than getting acupuncture. And we’ve seen this percentage reduction and these other types of changes.
Acupuncture has always been cited for allergy relief, pain relief, improved sleep, issues with fertility and stress among other things. Are there other benefits that aren’t as recognized?
You’re absolutely right that pain is what most people are familiar with. Even if they haven’t tried acupuncture before, they’re like, oh, yeah, my friend had back pain and he tried all this other stuff for 20 years and he finally went to acupuncture and it worked. I actually don’t think a ton of people are familiar with it being used for allergies. I had an experience when I was pregnant and I relocated and suddenly developed allergies. And I was like, what is going on? And you’re limited with the medications you could take. And after three treatments, I was feeling completely better.
We don’t know a ton about how heavily utilized acupuncture is from a sports performance perspective. I think practitioners talk about it. People still think that’s not mainstream. That is a big part of a lot of pro athletes’ recovery regimens. Recovery is a full-time job, so they’re not just like leaving their football game and getting an ice pack or taking a nap. They are on a very specific protocol of many different modalities to address root cause concerns that they have and facilitate their recovery. That recovery piece has been my biggest interest with acupuncture stemmed from being in physical therapy and seeing these post-surgical patients recovering at different levels. I think everyone in modern society needs some level of recovery because we just are not operating like we did many years ago. There are so many things, whether it’s toxins or working 80 hours a week or not having family support, so many different stimuli. Everyone’s body needs that recovery. It’s just an understanding of what level of recovery you need. I would say that’s a really big area that people are not thinking about when it comes to acupuncture.
Can you explain why acupuncture works or what it’s supposed to be doing to the body?
Acupuncture utilizes a mapping system. You hear about energy, channels or meridians and it’s most heavily overlapped with the nervous system. So, if you look at a map of the nervous system, there is over a 90 percent overlap when it comes to acupuncture channels and the nervous system. There’s a huge correlation there. I had an instructor once who really encouraged me to think of the nervous system as a gland rather than just a map because you can stimulate the nervous system to do different things to release certain chemicals in the body. So, when we are placing needles in acupuncture points, we’re not just stimulating things on a local level. Yes, you insert a needle, there’s going to be increased circulation in that area. But the immune system is also going to wake up and say, oh, I need to pay attention here. It’s going to start sending signals in that way. But at that point, you’re really priming your nervous system to pay attention to something. You can release different neurotransmitter chemicals into the body, depending on where you’re placing things.
Essentially, acupuncture is the act of stimulating, releasing and triggering the nervous system as a gland to respond to either pressures, stress or injuries; is that correct?
Yes, and I think it’s important to note that the body already knows how to respond, but it’s because of the different issues that we’re facing day-to-day, the trauma or the injuries or whatever the case may be that blocks some of that from being an easy thing. So just really giving it a gentle nudge in that direction, and that is why it’s milder. It’s why we recommend more than one treatment, especially for chronic conditions. I think that’s the part that sometimes is lost on people. As practitioners, we’re not doing a good enough job educating our patients and the public on this and it has a cumulative effect. It’s dose-dependent. People will be like why do you want me to come in three times this week and I say well, how many times did you take your pain medication? Well, twice a day for the last 10 years. Well, you’re doing 2 doses a day. Every single day I’m asking for three in a week. I think we need to be more mindful about how we’re communicating that because within conventional medicine, that’s not how treatments are done.
What level do you see that integration, how has it evolved and what type of resistance is still out there? Where are we at with acceptance?
Within the U.S., it’s variable. I was educated in California. I had my private practice in Beverly Hills. I relied primarily on surgeons for referrals. Over 90 percent of our practice was from surgeons referring to us. After moving to Chicago, I had people telling me, oh yeah, I’m having a hard time explaining to medical doctors why this is working. I think that is so strange because of the experience I had in California. I will say when it comes to integrative care, California’s healthcare is 8 to 10 years ahead of the rest of the country and then coastal areas like New York and DC have really thriving practices. I know that acupuncture is possible everywhere and that there is that increased interest and we see medical doctors who are getting trained in how to do acupuncture. That is not slowing down. You have the AMA, their own association for medical acupuncture. So, I think we’ll see increased acceptance, especially as education is more out there and we’re able to do more research.
Do you see resistance or indifference among practitioners or part of the medical community that isn’t accepting of acupuncture?
I would say it’s more indifference. because what happens is a lot of times an MD will get asked by a patient about acupuncture. And they may brush off those questions. But I had surgeons who would have no problem with me doing acupuncture on a patient the day after surgery understanding it’s safe. They know it’s helping their patients with pain relief. They’re getting off their pain meds faster. They’re healing better. They’re sleeping better. And they are seeing the value in that. But again, healthcare is a business. So, if you’re a practitioner, you need to network with other providers. You need to be explaining the value proposition. But, they have the mentality of what’s in it for me. So being able to articulate that and address those pain points is also really important from a patient advocacy perspective.
What does it take to be a licensed acupuncturist in terms of training? How does this licensing system work? Is it nationwide or is it done on the state level?
In order to get a license for acupuncture in any average state you’re going to need to have attended an accredited program. There is a body that is accredited by the Department of Education. The level of and length of education varies by state. California, for example, is a four-year master’s program. You have some programs that are more at that three-year mark because they don’t include herbal medicine and they’re more focused on acupuncture and other modalities. And then states do issue the licenses, but you need to sit for a board exam. Generally, there is a national certifying body and you take their four exams if you want to be able to do all modalities including herbal medicine. Some states do not require the fourth exam, which is herbal medicine. But you essentially take their exams. That’s a prerequisite for licensure in the state. You pay the state’s licensure fee and anything else, like fingerprinting background checks, all that good stuff. Sometimes they’ll have an additional safety course.
So, you have to be licensed to be an acupuncturist across the country?
Yes, with the exception of three states that do not have a practice act and that is really challenging. Alabama is one of them and that’s something that certainly can be looked up through the NCCOM, the organization that has a great provider directory. They also have a really interesting map of the U.S. where you can see what the different requirements are by the state if they require NCCOM certification. This way you’re able to get guidance on how credentialed is this provider that I’m seeing. But yes, the grand majority of states require licensure.
How do you make sure you’re with an accredited and licensed person? What are the warning signs that people need to be aware of to make sure they’re getting qualified support?
Any state that requires licensure has publicly available information. So, you can literally look at the practitioner’s name and license verification on Google and it should point you to the appropriate website. California’s Department of Consumer Affairs is the Board of Medicine. So, it’s very easy to find if someone’s license is active, if there’s any action against that license or if they just don’t have a license at all. NCCOM is a great resource just because they have a lot of robust data that is updated. You can see the level of education and where someone’s at and find an appropriate provider. If you’re not familiar with where to find one, you could find one on their website. Most states also require acupuncturists to have their license visible and posted, similar to when you go and get your eyebrows waxed or your hair done, they have their certification displayed.
About Nell Smircina, DAOM, LAc, Dipl. OM
Dr. Nell Smircina has served on both the Advocacy Committee and Medicare Taskforce for the American Society of Acupuncturists. In addition to her state and national experience, she also is an advocate at an international level. As the Director of Development for the American Acupuncture Council, she actively works to support the profession through many strategic initiatives, including work to further develop the implementation of ICD11 codes, established by WHO, which include Traditional Medicine diagnostics.
Please visit the American Society of Acupuncturists and DrNell.com to learn more.
