Dry Needling and Acupuncture 2015 – The State of the Profession

Dry Needling wins again – it receives “the greatest threat to the profession” practitioner’s choice award.

In recent years, Acupuncturists have devoted more resources to this issue than to any other.

A (fairly accurate) review of legal and regulatory actions shows that we’re not having much success. (Here’s another review, APTA’s Dry Needling Resource Paper.)

Even our wins have been temporary. For example –

– the Georgia Acupuncture Board added language stating that Dry Needling is acupuncture. The PT’s then added Dry Needling to their scope via legislation. (Could Georgia PT’s now advertise they’re doing acupuncture?)

– the October 2014 ruling in Washington State against dry needling was widely celebrated. Now the PT’s have introduced bills which would add Dry Needling to their scope. With almost 5,000 PT’s in the state, and about 1,100 LAcs, it’s likely they’ll eventually succeed.

We say the PT’s:

  • are stealing our medicine! (But we don’t own it.)
  • are illegally expanding their scope. (The majority of states have ruled it is in the PT scope. Modifications to scope are common in health care.)
  • are using Regulation to do what should be done Legislatively. (Scope clarification is often done via Regulation, which gives the public and other professionals the opportunity to weigh in and is preferable to politically driven legislative action. The public is protected through regulation. The PT’s have been successful in passing Legislation allowing dry needling.)
  • are pursuing this because their own techniques don’t work. (Even if true, 1) why does that matter, and 2) does the argument apply to us when we add techniques lasers, essential oils, e-stim, herbs –  to our scope?)
  • can’t possibly know enough to do this technique safely. (Many clearly do.)
  • can’t possibly be providing good treatments. (Their patients disagree.)
  • wrongly say that dry needling isn’t acupuncture. (Is it better if they say it is? Is there a legal reason our definition should prevail?)
  • make the public fear acupuncture. (Insisting this technique is acupuncture will contribute to the problem. Don’t we have the same problem when we use the technique?)
  • should use hypodermic needles. (Does that show concern for public safety?)

We can continue the fight to stop dry needling – getting caught in the cycle of suit (complaint) (never-mind the SCOTUS ruling) and counter-suit (NC PT lawsuit). We can fight state by state, and attack any Acupuncturist who suggests anything other than “the PT’s must be stopped.” We can keep insisting that if we just devote more resources and fight harder, we’ll win.

Or, we can learn from our history and the history of all of the other professions that have fought to maintain a monopoly on technique or turf.

We could be fighting for strong regulations. Mandated adverse effect reporting, strict definitions of what dry needling is and what it isn’t (other than whether or not it is acupuncture), requiring direct supervision for all clinical hours, requiring PT’s to post their hours of training, requiring registration with the PT Board, requiring physician referral for dry needling – all of these are possible.

A PR campaign promoting acupuncture and helping the public find an Acupuncturist? That’s possible too. Supporting ease of licensure so that people in every state can find an LAc? We can work for that. Support for new practitioners so that the public can actually find an Acupuncturist? That’s a great goal. Building collaborative relationships with other professionals who want to decrease pain and suffering? That would serve everyone.

Putting our energy into stopping dry needling? Not so much. It’s our obsession with stopping dry needling that is the greatest threat to the profession.

 

 

Copyright —

© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2018. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.

16 thoughts on “Dry Needling and Acupuncture 2015 – The State of the Profession

  1. (This comment is an example of writing meant to divide and express anger rather than increase understanding. I approve it with misgivings.)

    PT… what a bunch of quacks all that schooling (hoop jumping for the AMA) just to cheer lead as someone jump up and steps down from a box.

    AMA are the chumps who created the PT profession. And who were found guilty “of a conspiracy to contain and eliminate the chiropractic profession.” Yes The have made it clear, DN is not within the scope of practice, because it penetrates the skin. In the AMA’s dogmatic world acpunks are preforming experimental procedures with Class II Medical Devices. It’s off the table for PT. If a PT bills for DN or whatever you call it… well thats lying or as the fancy pants like to say… fraud. Not a court in the good land that have any thing to say about ICD codes. That is in the hands of the corn-fed bums at the AMA.

    • This is not the type of dialogue I strive for here. I’d stick to Facebook of I wanted emotion-drive comment wars. But for the sake of avoiding the censor label I’ll approve it. I think it is nonsense.

      1) Dismissing any entire profession as “a bunch of quacks” is lazy. PT’s run the range, as do LAcs and MD’s and just about any other profession.

      2) You’ll need to provide some sources for your history of the profession. PT has been around for hundreds of years, and developed organically into a profession to fill a need.

      3) PT’s have been allowed to do EMG in a number of states for a number of years. Also, wound debridement. This idea that they can’t penetrate the skin is incorrect. Not to mention scopes of all professions change over time.

      4) Any professional using incorrect codes to get payment for a non-covered procedure is engaging in fraud. It is not fraud to bill for DN, as long as the correct codes are used.

      Feel free to comment again if you have something useful to add. Name-calling won’t be tolerated.

    • Thank you! In but sure I struck the same nerve among my colleagues. I’ve been writing posts similar to this for years and can’t say they’ve had much of an impact. Then again, I do see some signs that perhaps more acupuncturists are beginning to see there are better ways to spend our energy. Here’s to a better future of increased collaboration and understanding.

    • Jan,
      I would be cautious of your enthusiasm. There are more acupuncturist who disagree with Elaine than agree. I was ambushed at a lunch (with peers) when I disagreed with this focus on dry needling. I truly think the concern about insurance dollars are a driving force on this topic. Elaine, what started all of this to begin with?

      In the end, I enjoy working with PTs. Clients get amazing results with the combination of TCM and PT. it’s a shame we can’t align more of our work together, instead of fighting.

      • Samantha, I think it is a result if fear and misunderstanding, and the lack of any respected, strong acupuncture group willing to point out that our sense of unfairness and outrage is based on ignorance of how health care regulation works. It’s really similar to what we see now national politics. Life isn’t what I expected, it’s somebody else’s fault, and I will listen to a leader who will jump on the blame game with me.
        People blame it on insurance, but since DN is typically not a covered modality, it seems like a red herring to me. LAcs are struggling, and it’s easy to blame someone else.

      • Samantha,

        I am well aware that many acupuncturists do not agree, but in my humble opinion, financial concerns are the bottom line issue, coupled with insecurity, insufficient revenue by many practicing acupuncturists, a lack of education of what dry needling by PTs actually entails, etc. I just posted 20 obvious flaws in the arguments acupuncturists used in opposition of SB 6374 in Washington State earlier this week (https://www.facebook.com/Myopain-Seminars-140476359304079/?fref=nf). I find it hard to imagine that acupuncturists are so poorly educated that they do not know any better than bringing up flawed concepts. The acupuncturists I work with in a collaborative effort to help our mutual patients do not share the views of the oppositional acupuncturists.

        • It’s difficult to get a sense of how many LAcs are deeply invested in this fight. Social media enables small numbers to make a big impression. And those with the unpopular opinions often decide their energy is better spent staying out of the argument completely.
          But it is clear that significant numbers will continue making the same arguments, even when the flaws are exposed. We see it with many other issues. People believe what fits with their worldview.

          • I started studying Travell’s and Mark Seem’s and Chan Gunn’s works while I was still in acu-school, back in 1998. To me, this always seemed like the natural progression for our profession was to embrace these ideas and start incorporating more of a contemporary biomedical framework as a rationale for acupuncture. Although this has been my personal endeavor, this has been an unpopular stance for a long while, although that may be changing.
            As far as dry needling by PT’s, whatever I feel about it emotionally, intellectual honesty compels me to admit the PT’s are by far well-enough trained to have dry-needling in their scope. I’m not going to mention the complaints other acupuncturists put forward here, other than to say I have often been quite embarrassed by them. To me, the wisest strategy would be, instead of trying to block dry-needling by PT’s, we should work towards having dry-needling explicitly included in the ACUPUNCTURE scope of practice. This is something we might actually be able to accomplish, and if dry-needling becomes a reimbursable code, should we not be able to use it? Also, research that validates dry-needling then automatically validates acupuncture as well. This could have been a great win for us. This requires sacrificing some idealism and thinking strategically. I’ve said before, history is cruel, lots of professions have refused to adapt and have been wiped out. There is nothing sacrosanct about our profession and we are not immune from the forces of capital and technological change.

          • Frank, it is unnecessary to do anything to add dry needling to acupuncture scope. It is clearly within our scope. My position is not that dry needling and acupuncture are completely separate things, but that this specific type of treatment is something within the scope of two professions. I don’t think we help ourselves if we create the impression that we can’t already use the technique. (Although I admit many LAcs need additional training took use it effectively.)

  2. Thank you for this article. I am a Doctor of Physical Therapy certified by Myopain seminars in Dry Needling. I currently practice in TN where I cannot needle due to this argument. PTs have spent 2 years putting through the legislation needed to needle again in my state. In that time my patients have driven to MS to receive treatments from a PT there. I have also referred Patients to acupuncture for other issues that I did not believe TP DN would aid. I have asked a patient to hold off on acupuncture for some of the course of our PT to help distinguish what is helping and how to better their treatment. I have never told a patient who was seeing benefit from acupuncture to quit all together. If we are truly in the practice of aiding our patients to get well, we need to realize that cooperation between healthcare practitioners in imperative to our goal!

    • I too have sometimes suggested to a patient that they hold off on a modality or two while we track their response took treatment. I am aware, though, that it can lead to upset, and that patients don’t always convey the message clearly to other providers. It’s something we all need to be aware of. Probably more interprofessional communication would be good for all of us.

  3. As a doctor of physical therapy that teaches trigger point dry needling for Myopain Seminars, as well as Carolina Rehabilitation’s post-doctoral residency program in Orthopaedic physical therapy, I applaud your efforts here. I am honored to have trained several LAc’s in trigger point dry needling and all have stated, “Dry Needlng, at least as taught and practiced by Myopain Seminars, is not a threat to acupuncture.” Those that live and work near me actually see me as a referral source for post-rehab clients that never before would have ever considered acupuncture. I invite you to come and spend some time observing me in clinic to explore how we might better understand each other and function in the best collaborative effort for the public.

    Dr. Andrew Ball, PT, DPT, PhD, OCS, CMTPT

  4. Well said Elaine. Sorry to sound like a broken record. Why aren’t we educating people about our “medicine”. Geeze, all the energy wasted on “dry needling”. Let’s tell people about how our medicines works and heals. That is what sets us apart from PTs.

    Several years ago, I had a PT tell me, she was an acupuncturist. She could needle points. Even the PT had no clue we do more than needle trigger points. I’m sure she didn’t help people with fertility or irritable bowel. We need to educate the public on the medicine. We are so much more than trigger points. Let the PT do dry needling and let’s focus on patient education.

    There’s enough potential clients in the market place to share. Why are we wasting energy on this petty battle?

  5. Thank you for another acupuncture observer post. I practice in Washington state and so far I have not heard of any PT practicing dry needling around me. What’s disconcerting is that once an established acupuncture patient is referred by their doctor to a PT, they drop acupuncture therapy and are gone like the wind never to be seen again, in most instances. Some years ago, I even heard from a prospective patient that the PT advised the patient NOT to get acupuncture while receiving PT.
    Therefore, I’m not fond of PT’s though I met some very honest ones along the way.

    • I can understand your frustration. My thoughts – if a patient has been seeing us and drops us after a visit to a PT 1) I’d question whether maybe I want as good a practitioner as I thought and/or trust the patient got what they needed. And 2) sounds like there was an opportunity to reach out to the PT and discuss how the treatments could complement each other.

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