Physical Therapists Win Latest Battle in Turf War with Acupuncturists

Lilo H. Stainton | October 16, 2018 | Health Care
Although acupuncturists are vehemently opposed, a measure allowing certain PTs to use “dry needling” to help relieve pain has advanced in the state Assembly

Credit: Air Force Medical Service
Dry needling
Patients, several large healthcare systems, and even the New York Giants joined physical therapists yesterday in support of a measure to allow certain trained physical therapists licensed in New Jersey to perform dry needling, a drug-free technique used to reduce pain.

But acupuncturists and some doctors continued to oppose the legislation, which they said would weaken the state’s regulatory standards — rules that currently allow only licensed acupuncturists to perform this kind of work — and could endanger patients.

The Assembly Regulatory Professions Committee sided with the physical therapists, however, voting yesterday to advance the bill to expand the use of dry needling, although several members stressed it was not a slight on the work of acupuncturists. The bill establishes training and other requirements for these PTs and would define the technique as something separate from acupuncture.

“As a patient of both entities, this is really not a step on anybody’s toes,” said Assemblywoman Angelica M. Jimenez (D-Hudson), a lead sponsor of the bill who chaired the hearing, which involved more than an hour of passionate testimony from advocates on both sides of the issue, and letters of support from the Giants and two of the state’s largest health systems, RWJBarnabas Health and Atlantic Health. The Medical Society of New Jersey was one of several physicians groups that opposed the bill.

Acupuncturists say PTs not properly trained for it

Monday’s hearing was the latest round in a longstanding turf battle over who can use the technique, which involves the insertion of dry, or “empty” hollow-tipped needles into key muscle points. Acupuncturists, who use these tools and a technique based on ancient Chinese principles, to treat pain, behavioral health issues and other conditions, insist physical therapists are not properly trained to pierce the skin with these needles.

“Dry needling is just another name for acupuncture. It’s been relabeled,” said Jason Sargis, president of the New Jersey Association of Acupuncture and Oriental Medicine, noting that by using a different term, PTs are in fact providing treatments outside the scope of their practice. With the legislation, the state is “actually lowering the standards, and that’s going to present a risk to the public,” he added.

But physical therapists insist there is a difference in how the needles are used and they stress that, with proper education, they should also be able to provide this popular therapy — especially given the growing need for nonaddictive pain treatment. For close to a decade they have been pushing state officials to change the regulations and allow them to use dry needling, after receiving certain training.

“We look at acupuncture as a profession and dry needling as a technique,” said Daniel Klim, who heads the American Physical Therapy Association of New Jersey. “The association supports this (expansion bill) because it is an additional tool in the physical therapy toolkit,” he said.

Patients say they’ve suffered

In fact, several hundred of the roughly 11,000 PTs in New Jersey offered dry needling for years, some dating back to 2008. But this ended in September 2017, after the state Attorney General found that the technique was outside the scope of practice for physical therapists here. The state’s more than 1,000 licensed acupuncturists could still offer the procedure, but some PT patients told the committee they have been suffering without treatment ever since.

“I teared up. I could not believe someone would take away this miracle,” recalled Patti Heffner, a nurse who benefited from dry needling in her battle against chronic pain, when she learned of the AG’s ruling. “I cannot stress enough how much this technique matters. It works.”

(Acupuncturists suggested to the committee this period of unregulated dry needling by physical therapists could have been dangerous to patients, although PTs note there were no complaints filed with state officials. “It was the Wild West, for lack of a better term,” said Paul Bent, the lobbyist for the acupuncture association.)

In July 2018, former Gov. Chris Christie signed legislation that updated the scope of practice for PTs, allowing them to diagnose and treat balance disorders, perform wound care — a technique that involves removing dead skin with a scalpel — and assisting patients with general health and wellness goals. But, despite advocacy from the profession, the changes did not include dry needling.

Fifty-four hours of training

The legislation (A-392) — introduced in January by Assembly members Jimenez, committee chair Thomas P. Giblin (D-Essex), Tim Eustace (D-Bergen) and former Assembly speaker and member Vincent Prieto (D-Bergen), who stepped down last year — seeks to reinstate the practice among willing PTs, under certain conditions.

The bill would require PTs to complete a 54-hour continuing education course on dry needling, that they are certified in cardio-pulmonary resuscitation, have two years’ experience in the field and hold an active, unrestricted license in New Jersey. Under current licensing regulations, acupuncturists must complete at least 2,500 hours of professional training, on top of course work.

The measure also provides a definition of the practice — something now lacking in state law — and makes clear that dry needling is distinct from acupuncture. It would require patients to sign a consent form acknowledging they have been informed of the risks and that they understand they are receiving dry needling, not acupuncture. It also calls for PTs to document their training and treatments carefully, or risk losing their permission to practice the technique.

“It’s a great technique. The dry needling is just a tool that blows the doors off any other (muscular-skeletal pain) technique that’s out there,” Steve Curtis, a licensed PT for three decades who also became an acupuncturist 18 years ago, told the Assembly panel. “Why deny it to anyone? I don’t know why there has to be such a turf war.”

A companion version of the measure, led by Sens. Nellie Pou (D-Passaic) and Richard J. Codey (D-Essex), cleared the Senate Commerce Committee in February and awaits action by the Senate Budget Committee.