— Despite its efficacy, cost and policy barriers limit access
by Molly Candon, PhD, and Stephanie Cheng, MD
November 23, 2025
Chronic pain can be a miserable journey. Many pain patients relied on opioids until they became much harder to get. Others took drugs like gabapentin (Neurontin), approved for seizures and chronic pain after shingles, but it wasn’t always sufficient. Non-drug treatments like physical therapy are costly. Physicians often feel unprepared to treat pain, studies show, making medical visits awkward and unproductive. When treatment fails, pain patients get discharged — metaphorically — to the Island of Misfit Toys.
One of us is an anesthesiologist. The other is a health economist and a pain patient. We’ve seen many people get trapped on this journey. Despite our nation’s long struggle with opioids, our system offers few options for pain management. We desperately need more alternatives.
One remedy hides in plain sight. Acupuncture, which involves inserting thin, sterile needles into specific points, treats pain well, studies show, with almost no side effects. Acupuncture performed better than sham care for pain, according to a 2018 analysis of nearly 21,000 patients from 39 trials. And its effects persisted over time. More recent studies show that the treatment can decrease short-term tobacco cravings, help people lose weight, lessen anxiety, improve sleep quality among Parkinson’s patients, and reduce the frequency of chronic tension-type headaches. It can also reduce painkiller use following joint replacements.
Patients appreciate acupuncture when they can get it. But they often pay out-of-pocket at prices higher than that of many medications. Our system expresses a love-hate relationship with acupuncture. We acknowledge its effectiveness in medical guidelines but then tie it up in rules that make it impractical for most patients.
A classic example is Medicare’s approval of acupuncture for chronic low back pain in 2020. In a historic move, the nation’s largest health insurer made acupuncture available to seniors — with the right diagnosis. But the agency said it would reimburse only approved Medicare providers, which means most licensed acupuncturists cannot bill directly for services they are trained to provide. Medicare reimbursement is low, creating another disincentive. As a result, few patients use it.
Still, there are glimmers of hope. The Joint Commission requires health organizations to offer non-drug options for pain management that may include acupuncture.
At the Hospital for Special Surgery in New York, we have three staffers doing intraoperative acupuncture. The care can be covered by Medicare, private insurance, or the patients themselves, and the response has been robust. Acupuncture during surgery has quadrupled over the course of 3 years for joint replacement patients, growing from 290 cases in 2021 to 1,408 in 2024. It remains a fraction of all cases, but patients clamor for it when they hear about it because it helps them avoid painkillers. The surgeons like it because they can help patients get better more quickly.
Which brings us to our first recommendation: acupuncture needs to be given early in the pain journey, before it becomes a chronic condition. Medicare requires that the chronic low back pain last for at least 12 weeks before it will pay. But that delay can make pain harder to treat. We need to intervene earlier to help the greatest number of people.
We should also allow licensed acupuncturists to bill Medicare directly. A bipartisan bill sponsored by Reps. Judy Chu (D-Calif.) and Brian Fitzpatrick (R-Pa.) would finally enable Medicare to reimburse licensed acupuncturists.
Taking this a step further, Medicare should raise the reimbursement rate and expand payments beyond chronic low back pain to more conditions that are evidence-based, such as headaches and migraines, neck pain, fibromyalgia, post-operative pain, and nausea and vomiting.
Other public and private insurers should consider expanding their coverage of acupuncture. Some state Medicaid programs already cover acupuncture, including Ohio and California. But most do not. Unfortunately, states may find it much harder to expand care amid the largest-ever Medicaid cuts coming from the “One Big Beautiful Bill” passed this summer.
One step patients can take is to ask their employers to cover acupuncture in their health plans. We know of at least one big organization that agreed to do this at an employee’s request.
Acupuncture must also be brought into hospitals to benefit a whole range of patients, from the cancer units to the emergency department. Right now, the four insurance billing codes for acupuncture are usually used only for outpatient care. We don’t know of any hospital that is sustainably billing for acupuncture.
All this must change to free more people from the Island of Misfit Toys.