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27NONPHARMACOLOGICTREATMENTSAcupunctureTheuseofacupunctureforthetreatmentofpainhasbecomewidespreadinrecentdecades.AcupunctureisakeycomponentoftraditionalChinesemedicinethatinvolvesinsertionofneedlesthroughtheskintoacupuncturepoints.Pressure,heat,electricalcurrent,laserlandothermeansalsomaybeusedtostimulatethesepoints.Investigationshavedemonstratedthatthenervoussystem,neurotransmitters,andotherendogenoussubstancesrespondtotheneedlingstimulationtoinduceanalgesia（FosterandSweeney,1987）.Ithasbeenshownthatacupunctureanalgesiaismediatedbyopioidsproducedintheperiaqueductalgrayandcanbereversedbynaloxone,anopioidantagonist（ChengandPomeranz,1980).Recentstudiesalsosuggestactivationofcannabinoidreceptorsasapossiblemechanismofaction(Gondimetal.,201非药物疗法，建议小结32SummaryNonpharmacologicinterventionsforpaintreatment,includingacupuncture,physicaltherapyandexercise,CBT,andmindfulnessmeditation,representpowerfultoolsinthemanagementofchronicpain.Manyarecomponentsofsuccessfulself-management.Whilefurtherresearchisneededtobetterunderstandthemechanismofactionandtheappropriatedosageanddeliveryforsomenonpharmacologicapproaches,theymayprovideeffectivepainreliefformanypatientsinplaoforincombinationwithpharmacologicapproaches.政府及保险支付建议46thecommitteerecommendsthatstates,withassistancefromrelevantfederalagencies,particularlytheSubstanceAbuseandMentalHealthServicesAdministration,provideuniversalaccesstoevidence-basedtreatmentforopioidusedisorder(OUD),includinguseofmedication,inavarietyofsettings,includinghospitals,crimjusticesettings,andsubstanceusetreatmentprograms.EffortsthisendshouldbecarriedoutwithparticularintensityincommunitieswithahighburdenofOUD.StatelicensingbodiesshouldrequiretrainingintreatmentforOUDforalllicensedsubstanceusedisordertreatmentfacilitiesandproviders(Recommendation5-6).Thecommitteerecommendsthatschoolsforhealthprofessionaleducation,professionalsocietiandstatelicensingboardsrequireandprovidebasictrainingiithetreatmentofopioidusedisorderforhealthcareproviders,includingbutnotlimitedtophysicians,nurses,pharmacists,dentists,physicianassistants,psychologists,andsocialworkei(Recommendation5-7).ThecommitteerecommendsthattheU.S.DepartmentofHealthandHumanServicesandstatehealthfinancingagenciesremoveimpedimentstofullcoverageofmedicationsapprovedbytheU.S.FoodandDrugAdministrationfortreatmentofopioidusedisorder(Recommendation5-8).59Recommendation5-3.Facilitatereimbursementforcomprehensivepainmanagement.Publicandprivatepayersshoulddevelopreimbursementmodelsthatsupportevidence-basedandcost-effectivecomprehensivepainmanagementencompassingbothpharmacologicandnonpharmacologictreatmentmodalities.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。DearColleaguesandFriendsoftheConsortium,IampleasedtosharewithyounewsofanexcitingandimportantadvancementinfieldofintegrativemedicineanAhealth.fewdaysagoTheJointCommission(TJC),thelargestU.S.accreditationbodyforhealthcarefacilities,announcedarevisionofhospitalperformancemeasuresforpainmanagementthatincludedtherequirementofprovidingnonpharmacologicpaintreatmentmodalities,effectiveJanuaryThe2018.specificstandard(LD.04.03.13)isnowa'scorable'ElementofPerformance,meaningaccreditedfacilitieswillberequiredtoprovidenonpharmacologicmodalitiesforTphaein.IntroductiontoLD.04.03.13providesexamplesofevidence-basednonpharmacologicstrategiesthatcouldbeprovided,includingacupuncturetherapy,osteopathicmanipulation,andmassagetherapy.TheConsortiumanditsmembershaveplayedkeyrolesinadvocatingforthischange.In2013,AryaNielsenPhDLAc,BenKliglerMDMPH,andMarshaHandelMLSrequestedareviewofTJC's2000painmandatetorequirenonpharmacologictherapieseffectiveforpain.TJC'sresponsewasimmediateandpositive.Theyrecruitedexpertsandconvenedstakeholderpanels.Dr.Nielsenservedasaconsultantstakeholder.Thisresultedina2015statementemphasizingtheimportanceinpainmanagementofnonpharmacologictherapies,suchasacupuncture,chiropractic,osteopathicmanipulation,massage,physicaltherapy,relaxationtherapy,andcognitivebehavioraltherapy.However,thisstatementwasnotyet'scorable'andthereforedidnotcarryth(weightneededtomandatethischange.In2016,undertheleadershipofDr.Nielsen,currentchairofthePolicyWorkingGroup,theConsortiumappealedtoTJCtomakenonpharmacologicmodalitiesa'scorable'ElementofPerformance.Withthenewstandardissuedlastmonth,thiswillnowgointoeffectasofJanuary1,Hi20difedsofindividualsandorganizationscontributedbyprovidingcommentsontheTJCpainmandatedraft.Further,theeffortsofmanyresearcherswentintobuildingtheevidencethatsupportedour