Why Hospitals Are Struggling to Add Acupuncture and Meditation to Pain Care—And What It Takes to Fix It

Hospitals want to offer acupuncture and guided relaxation to reduce opioid use, but adding these therapies to busy clinics requires far more than good intentions. New findings from the GRACE trial—a pragmatic clinical trial embedded in three large healthcare systems—reveal the hidden obstacles preventing integrative medicine from becoming standard care, even when evidence supports its effectiveness.

What Is the GRACE Trial and Why Does It Matter?

The GRACE trial is an NIH Collaboratory Trial designed to assess whether guided relaxation and acupuncture treatments can improve pain control for patients with sickle cell disease, a genetic blood disorder that causes severe, unpredictable pain crises. Sickle cell patients have historically relied heavily on opioid medications to manage pain, but clinical guidelines now emphasize nonpharmacological treatments to reduce opioid dependence and its associated risks.

Researchers conducted in-depth interviews with 13 hematologists, nurses, and pharmacists working at GRACE trial sites to understand what happens when you try to introduce complementary therapies into real-world clinical settings. The findings, published in Pain Management Nursing, paint a picture of well-intentioned healthcare systems running into practical roadblocks.

What Are the Main Barriers to Integrating Complementary Therapies?

The study identified two primary themes: the variable impact on clinic operations and the requirements for successfully introducing complementary and integrative health interventions into clinical practice. Clinicians and staff weren't rejecting these therapies outright—they were struggling with the logistics of fitting them into existing workflows.

Even seemingly minor changes can disrupt the delicate balance of a busy clinic. Healthcare workers highlighted several concrete challenges:

• Scheduling Conflicts: Acupuncture courses typically span multiple weeks, requiring flexible or extended clinic hours that many facilities cannot accommodate without restructuring their entire schedule.
• Space Limitations: Clinics need dedicated treatment areas where acupuncture can be administered without interrupting other patient visits or creating bottlenecks in patient flow.
• Administrative Burden: Ordering processes for new therapies can be cumbersome, adding paperwork and complexity that discourages both clinicians and patients from pursuing these options.
• Knowledge Gaps: Many clinicians remain hesitant to recommend complementary therapies due to insufficient training or familiarity with the evidence supporting them.

How Can Healthcare Systems Successfully Integrate These Therapies?

The GRACE trial researchers identified concrete strategies to overcome these barriers. The study emphasized that successful integration requires participatory approaches—meaning clinicians, patients, and staff must be involved in planning from the start—and significant adjustments to clinic workflows.

One critical finding was the need for robust patient and clinician education. While evidence exists for complementary and integrative health interventions, many clinicians remain uncertain about recommending them, and patients may feel wary of unfamiliar therapies. The solution isn't complicated: clear, accessible educational tools can bridge this gap.

• Educational Videos: Short, patient-friendly videos explaining how acupuncture and guided relaxation work and what to expect during treatment can reduce anxiety and build confidence.
• Mobile Apps: Digital tools that help patients track their pain, schedule appointments, and access guided relaxation exercises make these therapies more convenient and engaging.
• Printed Materials: Brochures and handouts provide tangible resources that patients can review at home and share with family members.
• Clinician Training Programs: Healthcare providers need structured education about the evidence supporting these therapies, how to integrate them into treatment plans, and how to discuss them confidently with patients.

Why Does This Matter for Sickle Cell Patients Specifically?

Sickle cell disease affects approximately 100,000 Americans, predominantly those of African descent. Patients experience unpredictable pain crises that can last days or weeks, and many have become dependent on opioids for survival. Finding effective, nonpharmacological pain management options could dramatically improve quality of life and reduce the risks associated with long-term opioid use.

The GRACE trial is supported by the NIH Pragmatic Trials Collaboratory through the NIH HEAL (Helping to End Addiction Long-term) Initiative, which reflects the federal government's commitment to addressing the opioid crisis by expanding access to evidence-based alternatives.

What's the Bigger Picture?

This research reveals an important truth: integrating complementary and integrative health interventions into standard medical care isn't just a clinical question—it's an operational and educational challenge. Healthcare systems that want to offer acupuncture, guided relaxation, and other nonpharmacological therapies need to invest in workflow redesign, staff training, and patient education alongside the clinical evidence.

The GRACE trial demonstrates that when these barriers are addressed thoughtfully, integrative approaches can become a realistic option for patients seeking alternatives to opioids. For sickle cell patients and others living with chronic pain, that shift could be transformative.