ASHEVILLE, N.C. -- People struggle with all kinds of life-altering pain every day, from foot pain, to back pain, to neck pain.
Some turn to alternative therapies like acupuncture. But now, hundreds of physical therapists across North Carolina are also treating patients for pain using needles.
Some acupuncturists allege patients are getting injured by physical therapists doing the technique, called dry needling. Cases involving both physical therapists and acupuncturists are heading to court.
The lawsuit filed by the North Carolina Acupuncture Board alleges an Asheville physical therapist doing dry needling caused a patient to suffer a collapsed lung. But in a federal lawsuit filed by individual physical therapists, the allegations focus on anti-trust complaints, including allegations that acupuncturists serving on the North Carolina Acupuncture Board are using their government position to keep physical therapists from competing in an open marketplace.
News 13 reached out to numerous Asheville-area physical therapists to interview. Not one would talk on camera, citing the current litigation.
So we traveled to a physical therapy clinic in South Carolina to watch a physical therapist demonstrate dry needling. The physical therapist has his PhD in physical therapy and a certification in dry needling.
"I'm going to get the needles prepped," said the physical therapist at the Spine, Sports, and Industrial clinic. The patient, Marian Coggins, had been treated for months using dry needling.
"I have been experiencing migraines for quite a few years," said Coggins.
The physical therapist placed multiple needles in the base of Coggins' neck. Coggins said the therapy has been her salvation.
"It's dramatically increased my ability to live," said Coggins. "I have gone as far as three to four weeks without a migraine."
Coggins said her insurance initially covered the therapy for a period of time, but then refused. She said her migraines came back until she began dry needling therapy again.
But Asheville acupuncturist Cissy Majebe maintains physical therapists don't have enough training to safely use needles to treat patients for pain. She also feels physical therapists should be licensed by the Acupuncture Board.
"Dry needling is acupuncture, where you use acupuncture needles," said Majebe.
In fact, the needles at the clinic in Greer where News 13 watched dry needling were labeled acupuncture needles on the packaging outside.
"This is not something that is taught in their program," said Majebe.
Majebe is a board-licensed acupuncturist with over 30 years of training.
She also sits on North Carolina's Acupuncture licensing board. I t's the same board suing to stop North Carolina physical therapists from doing dry needling.
The suit cites Asheville physical therapist Jessan Hager, who it states "in or around 2014" performed dry needling on a patient while at Asheville's Cornerstone Physical Therapy that "caused a patient to suffer a collapsed lung."
Majebe said she knows the patient injured at Cornerstone was hospitalized and required surgery.
Neither Cornerstone's owner, Seth Fabraio, nor physical therapist Jessan Hager, who now works at another area clinic, returned calls for comment to News 13.
Their attorney, Drew Erteschik, would not confirm or deny the alleged patient injury, citing patient confidentiality laws.
Attorney Matt Sawchak represents the Physical Therapy Board, and disputes allegations that dry needling and acupuncture are the same.
"Dry needling does not use the same diagnostic techniques that acupuncturists use," said Sawchak. "These and other differences show that dry needling is physical therapy, not acupuncture. Physical therapy school gives physical therapists the great majority of the skills involved in dry needling."
"It's misleading to compare the entire length of acupuncture school with the length of supplemental educational programs for practicing physical therapists,'" he continued.
Erteschik, who filed the federal anti-trust lawsuit on behalf of North Carolina's Physical Therapist Association, said the issue is more about money, and giving patients options.
"This is an issue of patient access to care," said Erteschik. "More than 110 million Americans, a third of the country, suffer from chronic pain. In North Carolina, when people suffer from pain, they can see a physical therapist to get intramuscular manual therapy, generally known as dry needling. At the end of the day, the government doesn't get to tell the patient which healthcare provider they can see. The choice belongs to the patient."
The federal anti-trust lawsuit cites an email written by North Carolina acupuncturist Sam Townsend, and dated January 9, 2015. The email is used as evidence acupuncturists are concerned about losing business.
"If our potential patients believe that dry needling is the same as what we offer," wrote Townsend, "why would they come to us when insurance will cover dry needling? It's not just taking business away from us, it is preventing the patients from getting the proper care."
But those involved in the suit filed by the North Carolina Acupuncture Board cite evidence that until recently, North Carolina's Physical Therapy Board didn't consider dry needling a therapy physical therapists should do.
In 2002, the NCPTB published a Q&A on the back of their newsletter:
Question: Is dry needling within the scope of practice of physical therapists in North Carolina?
Answer: No. It's a form of acupuncture.
The board has since changed its stance. Physical therapists who want to do dry needling therapy can get certified by taking post-degree courses.
"I went to two very long weekends," said the physical therapist News 13 spoke to in South Carolina. "There was hands-on training. There was practicum work. There was research involved."
He said he's confident in his skills after 54 hours of training in Atlanta in 2012.
The Spinal Manipulation Institute offered the classes. The two courses required for dry needling certification cost $795 each.
"We're not trying to take business away from acupuncturists," said Amanda Somers, who owns the physical therapy clinic in Greer. "We use dry needling as one small intervention in our toolbox."
Somers said her malpractice insurance underwriter reaffirmed to her that dry needling isn't dangerous. "It has put out a statement, with those dry needling, that there's been no increase in claims data, no increase in malpractice, and no significant injury or death to a patient because of it."
Cissy Majebe said licensed acupuncturists have 1000 hours of training before working on a patient without supervision. She maintains her sole concern is patient safety.
"After that class they return home and start doing acupuncture without ever having had any clinical training or supervision," said Majebe. "This is a three-day class. It is our duty to protect the public."
As patients continue to get dry needling treatment in North Carolina, the current legal battles heading to court will set a legal precedent for practitioners nationwide.