On Thursday, Jan. 20, the Oregon Board of Chiropractic Examiners is scheduled to vote whether to let the state's 1,805 licensed chiropractors engage in what's call "dry needling."
The term refers to the fact that the therapeutic needles chiropractors want to use are solid and do not transmit liquids as hypodermic needles do. Advocates for the change say dry needling is different from acupuncture and they should be allowed to do it for patients' benefit.
"It is trigger-point therapy," says Sharron Fuchs, a Portland chiropractor. "It's not based on Chinese medicine."
But the proposal has inflamed acupuncturists, another large group in Oregon's vibrant world of alternative medicine. Oregon has more naturopaths per capita than any other state, and was the second state to license acupuncturists. Tens of thousands of Oregonians visit acupuncturists annually, and that means the financial stakes in this dispute are substantial.
Malvin Finkelstein, a Eugene acupuncturist, disagrees with Fuchs' assertion. He says dry needling is a primitive version of acupuncture that chiropractors want only to expand the scope of their practice by intruding on the state's 1,110 licensed acupuncturists' area of expertise.
His objection is that chiropractors lack the training to use needles safely and effectively.
"There are two levels of risk," Finkelstein says. "First, doing some damage anatomically by not knowing where to put needles—puncturing the lung, for instance. Second, they could discredit the profession of acupuncture because, without proper training, they may not achieve [beneficial] results."
In Oregon, medical regulation Balkanizes different practitioners. The Oregon Medical Board regulates medical doctors, osteopaths and acupuncturists; chiropractors, naturopaths and physical therapists each have their own regulatory boards.
The battle between chiropractors and acupuncturists follows closely on the heels of a similar scrap in 2009 between Oregon acupuncturists and physical therapists.
Chiropractors, like physical therapists before them, argue that dry needling is simply another method of physiotherapy and therefore within their scope of professional practice. To buttress the claim they can work "under the skin" with needles in addition to manipulating patients, they point out that Oregon law already permits them to perform minor surgery such as proctology.
But acupuncturists say state law clearly defines acupuncture and specifically prohibits practicing it without a license.
In December 2009, Finkelstein, chairman of the Medical Board's Acupuncture Advisory Committee and OMB Executive Director Kathleen Haley laid out their case to the Physical Therapy Board because that board's members also wanted to do dry needling.
"Acupuncture and 'dry-needling' use the same tool (acupuncture needles), the same points, the same purpose (treating pain) and the same needling techniques," they wrote. "Dry-needling is the practice of acupuncture."
The Oregon Physical Therapist Licensing Board decided to back off telling its members "until training and education can be determined, the Board strongly advises its licensees to not perform dry needling of trigger points."
To earn an acupuncture license in Oregon, practitioners must complete an accredited program, typically including 3,000 hours of training. Naturopaths who also want to practice acupuncture must complete about 1,400 hours of training in acupuncture to gain dual licensure.
The Board of Chiropractic Examiners, in consultation with Portland's University of Western States (formerly Western States Chiropractic College), is working to develop training standards for dry needling.
But in a Dec. 20, 2010, memo to his members, Chiropractic Board Executive Director Dave McTeague warned such standards might be moot. "Given the level of controversy and opposition from the Oregon Medical Board, the Acupuncture Advisory Committee and the acupuncturist's association, I would advise the Board to expect legal and legislative challenges," McTeague wrote.
Stephen Kafoury, a lobbyist for the acupuncturists, says there's plenty of precedent for medical turf battles.
In the 2009 legislative session, psychologists fought to gain some of the prescription privileges reserved for psychiatrists. In the past, optometrists have battled ophthalmologists and naturopaths have battled medical doctors.
Kafoury says practitioners make varied arguments about why they should get to broaden their scope of practice, but finances are often a factor.
"You make more money if you get to do things you didn't used to do," Kafoury says.
Acupuncturists have not introduced legislation to block chiropractors.
"Lawmakers hate 'scope of practice' bills," Kafoury says, adding he hopes there can be some resolution without resorting to litigation.
"State agencies aren't supposed to sue each other," he says. "It's bad form."
The Oregon Board of Chiropractic Examiners meets Thursday, Jan. 20, at 8:30 am on the second floor, 3218 Pringle Road SE, Salem.