美国针灸界传来两项振奋人心的重磅消息

美国针灸界传来两项振奋人心的重磅消息过去的一周有些不平凡，美国针灸界接连收获两个好消息，提示针灸在美国进入一个更高的应用平台，获得更好、更有利的发展。

一、美国科学院、工程科学院、医学科学院三个顶级学术机构发布有利针灸的报告。

三院联合建议使用包括针灸在内的非药物疗法治疗疼痛，以减少应用阿片类镇痛剂。

报告中有41处提及针灸。

阿片滥用及疼痛治疗管理委员会美国科学院、工程科学院、医学科学院2017 报告疼痛的治疗和阿片药流行：处方阿片类药物与社会及个人的风险和效益的平衡注：从奥巴马政府开始意识到美国处方阿片类药滥用问题，并提出反滥用止痛处方药战略计划以来，美国白宫、参众两院及特朗普新政都一致支持要这个国家计划，并投入大量资金。

美国科学及医学界众多组织和专家推荐针灸作为疼痛的常规一线治疗方法。

这次美国最高学术机构“三院”（美国科学院、工程科学院、医学科学院，2017 报告）的报告里多次提到针灸疗法治疗疼痛的内容，对针灸发展意义重大，被视为针灸发展的历史机遇。

值得提及的是，上一次美国“三院”有关针灸的联合报告发表于1976年，题目为《针刺麻醉在中华人民共和国》。

经“三院”派出的联合专家组到中国实地考察3周，专家组的最后结论是，针刺麻醉是真实的，此麻醉方法只适合少数患者，但针刺镇痛的临床意义重大，需要深入研究。

可惜，报告发表时，正值中国文革结束和改革开放的开始，针灸疗法因政治原因被遗弃，西医西药因开放而涌入，美国“三院”专家对针灸的中肯意见没有受到中国有关方面的重视，甚至这份报告至今没有中文版（见《美国针灸热传奇》，157页）。

希望这一次，中国不要错过加入世界反滥用止痛药的行动，用中国古老的针灸术为世界人民服务。

附针灸疗法有关的部分摘要。

（原文共393页）非药物疗法治疗：针灸Page 2-27 NONPHARMACOLOGIC TREATMENTS Acupuncture The use of acupuncture for the treatment of pain has become widespread in recent decades. Acupuncture is a key component of traditional Chinese medicine that involves insertion of needles through the skin to acupuncture points. Pressure, heat, electrical current, laser light, and other means also may be used to stimulate these points. Investigations have demonstrated that the nervous system, neurotransmitters, and other endogenous substances respond to the needling stimulation to induce analgesia (Foster and Sweeney, 1987). It has been shown that acupuncture analgesia is mediated by opioids produced in the periaqueductal gray and can be reversed by naloxone, an opioid antagonist (Cheng andPomeranz, 1980). Recent studies also suggest activation of cannabinoid receptors as a possible mechanism of action (Gondim et al., 2012). 非药物疗法，建议小结Page 2-32 Summary Nonpharmacologic interventions for pain treatment, including acupuncture, physical therapy and exercise, CBT, and mindfulness meditation, represent powerful tools in the management of chronic pain. Many are components of successful self-management. While further research is needed to better understand the mechanism of action and the appropriate dosage and delivery for some nonpharmacologic approaches, they may provide effective pain relief for many patients in place of or in combination with pharmacologic approaches.政府及保险支付建议Page 5-46 the committee recommends that states, with assistance from relevant federal agencies, particularly the Substance Abuse and Mental Health Services Administration, provide universal access to evidence-based treatment for opioid use disorder (OUD), including use of medication, in a variety of settings, including hospitals, criminal justice settings, and substance use treatment programs. Efforts to this end should be carried out with particular intensity in communities with a high burden of OUD. State licensing bodies should require training in treatment for OUD for all licensedsubstance use disorder treatment facilities and providers (Recommendation 5-6). The committee recommends that schools for health professional education, professional societies, and state licensing boards require and provide basic training in the treatment of opioid use disorder for health care providers, including but not limited to physicians, nurses, pharmacists, dentists, physician assistants, psychologists, and social workers (Recommendation 5-7). The committee recommends that the U.S. Department of Health and Human Services and state health financing agencies remove impediments to full coverage of medications approved by the U.S. Food and Drug Administration for treatment of opioid use disorder (Recommendation 5-8). Page 5-59 Recommendation 5-3. Facilitate reimbursement for comprehensive pain management. Public and private payers should develop reimbursement models that support evidence-based and cost-effective comprehensive pain management encompassing both pharmacologic and nonpharmacologic treatment modalities.二、美国医院联合认证委员会向其认证的4000多家医院发出通告，从2018年1月1日起，为疼痛病人提供非药物疗法成为认证条件之一。

这些非药物疗法必须是有证据支持的治疗方法。

针灸当列其中。

Dear Colleagues and Friends of the Consortium, I am pleased to share with you news of an exciting and important advancement in field of integrative medicine and health. A few days ago The Joint Commission (TJC), the largest U.S. accreditation body for health care facilities, announced a revision of hospital performance measures for pain management that included the requirement of providing nonpharmacologic pain treatment modalities, effective January 1, 2018. The specific standard (LD.04.03.13) is now a 'scorable' Element of Performance, meaning accredited facilities will be required to provide nonpharmacologic modalities for pain. The Introduction to LD.04.03.13 provides examples ofevidence-based nonpharmacologic strategies that could be provided, including acupuncture therapy, osteopathic manipulation, and massage therapy. The Consortium and its members have played key roles in advocating for this change.In 2013, Arya Nielsen PhD LAc, Ben Kligler MD MPH, and Marsha Handel MLS requested a review of TJC's 2000 pain mandate to require nonpharmacologic therapies effective for pain. TJC's response was immediate and positive. They recruited experts and convened stakeholder panels. Dr. Nielsen served as a consultant stakeholder. This resulted in a 2015 statementemphasizing the importance in pain management of nonpharmacologic therapies, such as acupuncture, chiropractic, osteopathic manipulation, massage, physical therapy, relaxation therapy, and cognitive behavioral therapy. However, this statement was not yet 'scorable' and therefore did not carry the weight needed to mandate this change. In 2016, under the leadership of Dr. Nielsen, current chair of the Policy Working Group, the Consortium appealed to TJC to make nonpharmacologic modalities a 'scorable' Element of Performance. With the new standard issued last month, this will now go into effect as of January 1, 2018. Hundreds of individuals and organizations contributed by providing comments on the TJC pain mandate draft. Further, the efforts of many researchers went into building the evidence that supported our advocacy. Over time, these changes will facilitate patient access to care options, reduce patient suffering, and lower the risk of over-reliance on opioids with their side effects and abuse liability. It will also result in the inclusion of more licensed integrative care practitioners among other professionals in the inpatient and outpatient setting. Please join me in congratulating Dr. Nielsen and her colleagues for this important step. Warm regards, Rob Robert B. Saper, MD MPHChair, AcademicConsortium for Integrative Medicine & Health针灸治疗痛症疗效显著已是不争的事实。