Combatting Chronic Pain with Acupuncture
Opioid use has reached epidemic proportions in military and civilian populations and in 2014 the Centers for Disease Control and Prevention (CDC) designated opioid overdose prevention one of the top five public health challenges[i].
Chronic Pain in the Military
In one Army infantry brigade, 44% of soldiers reported chronic pain, and 15.1% regularly used opioids three months after return from combat.[iv] These rates are much higher than the 26.0% and 4.0% respectively in the general civilian population.
Rates of chronic pain in veterans (estimated at 48%) exceed those of the general civilian population,[v] and in one study, almost half of the veterans being treated for chronic pain also met diagnostic criteria for PTSD.[vi]
Limitations in pain management both in terms of controlling severe pain states and reducing the duration of pain are two factors that have been hypothesized to contribute to related issues such as the chronification of pain, posttraumatic stress disorder (PTSD), anxiety, and insomnia.
As a result, military and veteran groups have a strong interest in finding non-drug treatments for chronic pain.
Acupuncture Emerges as a Promising Treatment
Acupuncture is a potentially promising treatment of interest to the Department of Defense (DoD) and Veterans Health Affairs (VHA). The Pain Task Force’s 2010 document identified acupuncture as a Tier I modality that has the potential to reduce medication overuse in pain management.
A number of studies have found that acupuncture decreases pain in civilian populations with a variety of chronic pain conditions—including back and neck pain.
In addition, studies have found that acupuncture may be helpful for wounded warrior’s and veterans’ most common non-pain complaints including insomnia and post-traumatic stress disorder.
Researchers Find Near Immediate Pain Relief with BFA
Samueli Institute and its military partners are interested in Battlefield acupuncture (BFA). BFA in particular has great military relevance due to its feasibility, portability, low side effect profile, and potential to decrease opioid reliance to achieve pain relief.
Designed to be practiced in both clinical and operational environments, BFA may be of particular value during critical military missions where the use of opioids is not possible.
In clinical environments, the introduction of BFA may help to reduce pain with less medication, thereby reducing the incidence of drug and pain related depression and the numerous side effects of chronic opioid use.
Moreover, both in clinical practice and observational studies of BFA in military populations have demonstrated near immediate pain relief that is durable over days-weeks in some cases.
A Simplified Treatment
Although traditional acupuncture is based on more than 2,000 points along 20 pathways in the body called meridians; Battlefield Acupuncture (BFA) simplifies the treatment by focusing on five easy-access points on the ear to provide pain relief.
The needles used, ASP needles, are small and do not interfere with day-to-day or military tasks.
BFA’s name captures its ability to be easily and rapidly practiced and trained, even in a battle environment. The treatment takes minutes; the patient can remain fully clothed; and the patient may be fully functional and able to stay in the field and complete his/her mission.
The BFA treatment is easy to learn and more than 1,500 DoD practitioners were trained as part of a two-year long pilot training program in BFA within the DoD and VA health care systems.
If found to be effective, the treatment could be quickly implemented across the Department of Defense (DoD) and Veterans Health Administration (VHA) at minimal cost.
Currently, acupuncture is often used as a treatment of last resort. More research is needed to help medical professionals to better integrate acupuncture into the treatment of pain and guide the allocation of training, staffing, scheduling and supplies.
[i] Kolodny A, Courtwright DT, Hwang CS, et al. The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health. 2015;36:559-574.
[ii] Muhuri P, Gfroerer J, Davies C. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. In: Administration SAaMHS, ed. Center for Behavioral Health Statistics and Quality Data Review 2013.
[iii] Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.
[iv] Toblin, R. L., et al. “Chronic Pain and Opioid Use in Us Soldiers after Combat Deployment.” JAMA Intern Med 174.8 (2014): 1400-1.
[vi] Pain Medicine News: High Prevalence of PTSD seen in Veterans with Chronic Pain (May 2009; 7(05))