Jen Avery has had chronic pain in her neck, back and shoulders for 15 years.
BY EMILY STIFLER WOLFE
The 34-year-old grew up with three older brothers in a family of athletes. She had whiplash multiple times and in 2007, she injured her neck in a climbing fall. When she developed fibromyalgia while finishing her master’s in public administration at Montana State University in 2013, the pain was acute and unrelenting. After graduation, Avery moved to Big Sky, Montana, where she opened a yoga studio, waited tables and volunteered on ski patrol. A chiropractor helped relieve some pain, but always it simmered, worsening with stress.
In February 2016, her struggles came to a head. Avery and her husband went snowmobiling in Cooke City, Montana, and the first day, her neck felt stiff. That night she lost range of motion, and by the second day it radiated to her scapula. They drove home. The next day it was so intense she struggled to breathe, so she went to the emergency room.
The doctor who read the X-ray told Avery she had arthritis in her cervical spine, and prescribed anti-inflammatories and painkillers. But two days later, the pain became excruciating and her left thumb, index and middle fingers went numb. Her husband was working nights and she was too delirious to drive, so Avery walked a half-mile to the ER, crying.
This time, an MRI showed gliosis—scarring on the central nervous system often caused by multiple sclerosis. The doctor prescribed more hydrocodone and suggested Avery see an orthopedic surgeon. The pain pills made Avery nauseous and constipated, so she only took them to sleep. Holding a hand on top of her head relieved some of the nerve pressure.
After a month, she got into an orthopedist. He scheduled another MRI and prescribed pain meds targeting her central nervous system, which she didn’t take. Two weeks later, the MRI results confirmed arthritis and ruled out MS. Inflammation combined with disc degeneration had pinched a nerve, Avery said, creating extreme pain. The orthopedist prescribed physical therapy, which helped, but not enough. So, her pain still too acute for massage, Avery tried acupuncture.
“Instantly, there was a huge relief,” she said. That afternoon, the stabbing behind her shoulder subsided, and she could finally lower her hand from her head. Avery received acupuncture weekly for the next year, and she said it retrained her pain response, reduced anxiety and alleviated other aches.
Many studies, including several published in the prestigious Archives of Internal Medicine, have shown acupuncture as a safe, effective way to manage both chronic and acute pain. As the U.S. medical community seeks to reduce over-prescription of pharmaceuticals including opioids, the needle is moving toward acupuncture and other drug-free therapies. A recent endorsement by the American College of Physicians will likely encourage the trend. In February 2017, the ACP officially recommended acupuncture for back pain, alongside other non-drug treatments including heat, massage and spinal manipulation. The ACP gives acupuncture a “strong recommendation” and calls opioid painkillers a last resort.
An expanding body of data also shows acupuncture may be effective for treating numerous other ailments including nausea, seasonal allergies, infertility and neurological disorders.
Acupuncture is being used for reproductive health, addiction treatment and relief from chronic pain—with remarkable success.
Acupuncture is a practice in which thin needles are inserted into the skin and underlying tissues at specific points on the body to improve health and well-being.
A fundamental element of traditional Chinese medicine, it has been practiced for at least 2,500 years,according to the World Health Organization. Archaeological evidence in the form of polished stone needles and hieroglyphs indicate rudimentary forms may have developed thousands of years earlier, during the Neolithic Age. It is a standard of care in China today, used daily for many patients in large hospitals.
Acupuncture was introduced to mainstream America in the 1970s, when journalist James Reston had an emergency appendicitis while covering Secretary of State Henry Kissinger’s 1971 visit to China, prior to President Nixon’s historic 1972 visit that opened U.S. relations with China. Reston wrote about the acupuncture that eased his post-op pain, and The New York Times published his story alongside front-page news of the Apollo 15 liftoff.
But with acupuncture needles approved only as experimental devices by the FDA until 1996, the practice was slow to take off in the U.S., and many assumed it a placebo. However, in 1997, the National Institutes of Health concluded there was enough evidence to expand it to conventional medicine, and indeed, it has grown. The CDC’s National Center for Health Statistics estimated 1.5 percent of American adults—or 4.7 million people—received acupuncture in 2012, up 1.6 million from 2002. There are more than 17,000 acupuncturists board certified with the National Certification Commission for Acupuncture and Oriental Medicine, and 27,000 licensed through individual states.
The Mayo Clinic, a renowned teaching hospital and research center in Rochester, Minnesota, has used acupuncture since 2001, primarily for pain, and now has more demand than it can meet.
“We have had tremendous success [with acupuncture],” said Dr. Brent Bauer,director of Mayo’s Complementary and Integrative Medicine Program. “For intractable pain, patients with a chronic long history of pain, or chronic headaches, we might still see a 30 percent significant response where everything else absolutely failed.” Results are typically best before pain pathways are completely developed, he added. “If you’ve had pain for 20 years, it’s more difficult to get lasting great benefits.”
Mayo also uses acupuncture to treat gastrointestinal disorders, fibromyalgia, chemotherapy symptoms and other conditions.
Acupuncture’s use in reproductive health has soared since a 2002 study published in Fertility and Sterility showed women who received acupuncture after in vitro fertilization were significantly more likely to become pregnant: 42.5 percent of participants who received acupuncture following IVF became pregnant, as compared to 26 percent of the group that received only IVF. In the 16 total studies the journal has published on the topic, 11 reported improved chances of pregnancy with acupuncture.
It is also used for addiction treatment. Approximately 500 medical centers in the U.S. use the National Acupuncture Detoxification Association protocol, according to NADA Executive Director Sara Bursac. She cited clinical experience and research showing it eases withdrawal symptoms, prevents craving, and increases participation rates in long-term drug treatment programs. The protocol, which uses five acupuncture points in each ear, is also used to treat behavioral and mental health issues, emotional trauma and post-disaster symptoms.
MRI scans show specific acupuncture points activate distinct parts of the brain. Needle Si Guan, a set of points on the hands and feet traditionally used for pain relief, and it calms the regions of the brain that register pain, according to 2014 research published in the Journal of Complementary and Alternative Medicine. What’s more, the painkilling effects often outlast the treatment session.
From a traditional Eastern perspective, the principles of acupuncture are based on the concept that life force, known as qi (pronounced “chee”), circulates the body on distinct pathways called meridians. Issues like injury, disease and stress can block or disrupt qi, leading to poor health. Hundreds of acupuncture points are located along the meridians, each corresponding to an organ or body system. By boosting the flow of qi, blood and other fluids, acupuncture restores balance to the person.
When viewed through a Western scientific framework, acupuncture’s effects—reducing inflammation, increasing circulation and releasing natural painkillers, among others—have been well documented, but how it works on a physiological and biochemical level is not understood. There are many theories.
Zoe Strauss, owner of a community acupuncture clinic in Bozeman, People’s Republic of Health, and the practitioner who treated Jen Avery’s neck pain, has two ways of explaining it.
The first is easy to picture. “When you get a splinter on your finger, the body recognizes a foreign object and immediately sends white blood cells to the area to clean out debris and regenerate healthy cells,” Strauss said. “Often with pain, whether back pain or surgery or a broken bone, we put a bunch of [needles] locally to do exactly that.”
The second translates the concept of qi to nerve impulses jumping from spot to spot, which Strauss equates to acupuncture points. “When you have an injury, the nervous system … flashes a ‘crisis’ pattern and short circuits the way it normally works. The brain holds that message, so the [body] has time to recover. Sometimes with pain, opiate addiction [and grief], the brain will hold onto that message for too long.” By reconnecting the qi impulses, she said acupuncture can reset the nervous system.
Some theories suggest it releases opioids and other peptides in the central nervous system and alters neuroendocrine function, while others equate qi to potential energy in terms of quantum physics. Like any medicine, acupuncture is both a science and an art. There are many schools of practice—Japanese acupuncture, for instance, uses thinner needles and shallower insertion as compared with Chinese, in which practitioners often manipulate needles to incite de qi—or the heavy, sore feeling of vital energy being activated.
“Very rarely is there ever a one-size-fits-all approach with acupuncture,” said Carissa Hill, an acupuncturist practicing in both Big Sky and Bozeman. Because it focuses on personalized care, she added, acupuncture can address a patient’s unique issues.
"For intractable pain, patients with a chronic long history of pain, or chronic headaches, we might still see a 30 percent significant response where everything else absolutely failed."
Today, nearly 50 years after the Times article, acupuncture still isn’t part of our popular consciousness.
“It’s hard for hospitals to create a mechanism to offer it, because it’s devalued by the government,” said Mayo’s Dr. Bauer, referring to the fact that neither Medicare nor Medicaid cover it.
The Affordable Care Act requires private health insurance companies to cover acupuncture, but the number of treatments may be limited, and it’s typically out of network, says Gena Gaub of Rocky Mountain Insurance in Bozeman. “It may as well not be covered, because [the] insured get little or no help when they go.”
While some Army Medical Centers offer it for veterans suffering from chronic pain and PTSD, the Army’s insurance company, Tricare, won’t cover it outside those centers.
And it’s a socio-economic issue. Acupuncture is time-consuming and often costs significantly more than a prescription painkiller.
Strauss wants it to be available to everyone and offers a sliding payment scale at her clinic. “Sometimes what we’re doing is training the body to function in a different way, and that can take multiple treatments over time,” she said.
With funding going into research—an average of $17.9 million annually in NIH grants over the last decade—and new data emerging from conservative facilities like the Mayo Clinic and the American College of Physicians, there is a snowball effect.
And results talk.
“What gets people in the door is back pain that doctors and medication have not been able to resolve. That, and grief,” Strauss said. “What gets them to stay, [are] the results of those things, and on top of that, amazing improvement in their digestion, sleep, mood and energy.”
Emily Stifler Wolfe is a writer, climber and skier who lives near Bozeman, Montana. She and her husband are raising a 2-year-old daughter and a spotted donkey colt, although who is schooling whom is still up for debate. She was the founding editor of Mountain Outlaw.