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Information for Occupational Medicine Physicians
Acupuncture Medical Treatment Guidelines

On June 15, 2007, the Division of Workers’ Compensation’s (DWC) medical treatment
utilization schedule (MTUS) final regulations were approved by the Office of Administrative
Law (OAL). The MTUS regulations, commonly referred to as "medical treatment guidelines,"
are now finalized.

A new subdivision 9792.21(a) (2) setting forth another component of the MTUS has been added to the text of the regulations. This subdivision sets forth the Acupuncture Medical Treatment Guidelines as follows:

The Acupuncture Medical Treatment Guidelines set forth in this subdivision shall supersede the text in the ACOEM Practice Guidelines, Second Edition, relating to acupuncture, except for shoulder complaints, and shall address acupuncture treatment where not discussed in the ACOEM Practice Guidelines. The new guidelines omit "shoulder complaints" on the grounds that the ACOEM guidelines address acupuncture as it relates to such complaints. The ACOEM guidelines (2nd edition, p.204) state, "Some small studies have supported using acupuncture, but referral is dependent on the availability of experienced providers with consistently good outcomes." Because the new MTUS omits shoulder complaints, this section of the ACOEM guidelines remains presumptively correct and may be used to justify acupuncture treatment of the shoulder when medically necessary.

(A) Definitions:
(i) "Acupuncture" is used as an option when pain medication is reduced or not tolerated, it may be used as an adjunct to physical rehabilitation and/or surgical intervention to hasten functional recovery. It is the insertion and removal of filiform needles to stimulate acupoints (acupuncture points). Needles may be inserted, manipulated, and retained for a period of time. Acupuncture can be used to reduce pain, reduce inflammation, increase blood flow, increase range of motion, decrease the side effect of medication-induced nausea, promote relaxation in an anxious patient, and reduce muscle spasm.

(ii) "Acupuncture with electrical stimulation" is the use of electrical current (micro- amperage or milli-amperage) on the needles at the acupuncture site. It is used to increase effectiveness of the needles by continuous stimulation of the acupoint. Physiological effects (depending on location and settings) can include endorphin release for pain relief, reduction of inflammation, increased blood circulation, analgesia through interruption of pain stimulus, and muscle relaxation. It is indicated to treat chronic pain conditions, radiating pain along a nerve pathway, muscle spasm, inflammation, scar tissue pain, and pain located in multiple sites.

(iii) "Chronic pain for purposes of acupuncture" means pain that persists for at least 30 days beyond the usual course of an acute disease or a reasonable time for an injury to heal or that is associated with a chronic pathological process that causes continuous pain (e.g., reflex sympathetic dystrophy). The very definition of chronic pain describes a delay or outright failure to relieve pain associated with some specific illness or accident.
The final acupuncture treatment guidelines explicitly allow the use of acupuncture and electro- acupuncture for a wide range of musculoskeletal conditions, specifically:

Neck and Upper Back Complaints
Elbow Complaints
Forearm, Wrist, and Hand Complaints
Low Back Complaints
Knee Complaints
Ankle and Foot Complaints
Pain, Suffering, and the Restoration of Function.

The frequency and duration of acupuncture and acupuncture with electrical stimulation may be performed as follows:

Time to produce functional improvement: 3 to 6 treatments.
Frequency: 1 to 3 times per week
Optimum duration: 1 to 2 months