Acupuncture is a technique in which practitioners stimulate specific points on the body, most often by inserting thin needles through the skin. It may be used to alleviate pain and to treat various physical, mental and emotional conditions.
Low back pain is a common condition affecting many individuals at some point in their lives. Some individuals will develop chronic low back pain (CLBP), which is an episode of low back pain that has persisted for three months or longer.
In response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and that National Institutes of Health (NIH) are collaborating in this effort. The Agency for Healthcare Research and Quality published a systematic review of noninvasive, nonpharmacological treatment for chronic pain in June 2018 (https://effectivehealthcare.ahrq.gov/sites/default/files/cer-209-evidence-summary-non-pharma-chronic-pain.pdf). This review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for CLBP. The NIH recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain. The announcement can be found here: https://grants.nih.gov/grants/guide/rfa-files/RFA-AT-19-005.html.
CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program. CMS is soliciting public comment on this topic. We are particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements to provide acupuncture that improves health outcomes. In addition, for commenters recommending Coverage with Evidence Development, we are interested in comments related to appropriate outcomes and study designs. While CMS has conducted previous national coverage analyses on acupuncture, the scope of this current review is limited to acupuncture for chronic low back pain.