By Stephen Spotswood
JOINT BASE ANDREWS, MD – For many servicemembers, pain is an accepted consequence of military service.
Military personnel injured in theater can experience chronic pain long after their wounds have healed. An injury is not even necessary for pain to develop; joint and muscle pain develops over time from the rigors of carrying heavy packs and equipment day after day.
An attendee at the battlefield acupuncture clinic inserts acupuncture needles into a volunteer patient’s ear. Attendees at the workshop all had a chance to practice and to watch others practice the technique.
According to researchers studying servicemembers deployed in Iraq and Afghanistan, the return-to-duty rate for spinal pain and other musculoskeletal disorders is lower than for any other disease except psychiatric illness. Only 13% of servicemembers who left their units with back pain as the primary diagnosis returned to duty.
A high priority is to treat pain on the battlefield in a way that does not impact a servicemember’s ability to do his or her job. It’s also one of the reasons that the use of battlefield acupuncture has gained traction among military physicians in recent years.
If the application of small needles to a patient’s ear can provide relief where prescription painkillers have failed, patients and physicians are more than willing to try it.
A retired Air Force Colonel, Richard Niemtzow, MD, was a practicing radiation oncologist and chief of staff of the 27th
Medical Group at Cannon Air Force Base when someone put a brochure on his desk relating to acupuncture.
“What caught my eye was the fact that I usually treat certain problems using lasers on acupuncture points. That piqued my interest,” Niemtzow said. “I decided to take a course at UCLA, which was offering a medical acupuncture course for physicians.”
Finding the techniques he learned in the class to be effective when it came to pain management, he decided to open up an acupuncture clinic at McGuire Air Force Base in New Jersey. It quickly became one of the most popular clinics on base, Niemtzow said.
“There were a lot of referrals because I could treat chronic back pain problems and chronic headaches. Instead of referring them to Walter Reed, they were referring them to me,” he explained. Patients would walk out of the clinic experiencing diminishment or loss of pain for hours, days, weeks, or even longer.
In 2001 he developed the auricular (ear-only) acupuncture technique. He named it battlefield acupuncture because of the ability to perform it in less than optimal conditions. The technique involves putting five tiny gold needles into very specific points in a patient’s ear until the pain decreases.
A volunteer patient at the acupuncture clinic is used to demonstrate how five gold needles placed at specific points in the ear can be result in reduced pain.
“For physicians, it’s easy to get to the ear. And people don’t want to get undressed,” Niemtzow said. Although only 10 needles are used and in a very localized area, the technique still results in the diminishing or total relief of pain.
It is also a very easy entry point by which other physicians can learn acupuncture. Now working out of the Air Force Acupuncture Center at Joint Base Andrews, MD, Niemtzow has been tasked with training as many physicians as want to learn the technique and has been given $5.4 million in funding to help make that happen.
“Physicians can expect a three-to-four hour course, during which they learn a little about the history of the development of the technique, they learn where the points are located in the ear, and they handle these very small needles—millimeters in length—essentially injecting them into very specific points on the ear,” he explained. “They learn how to be safe and they learn about possible side effects.”
To date, approximately 500 physicians from the military services and VA have taken the course. Niemtzow even taught a course on battlefield acupuncture in Beijing where, as a guest lecturer, he made a goodimpression on the Chinese military. The Chinese invited Niemtzow and six other military physicians to visit a Chinese air force base to demonstrate the technique to their physicians.
Stemming The Tide Of Opioids
It might seem surprising that so many military physicians are willing to embrace what was, and is still by many, considered to be pseudo-science. Military physicians respond, however, that they are willing to try any alternative to stem the tide of opioid use and overuse in the military and among veterans.
Prescriptions for painkillers quadrupled from 2001 to 2009 and prescription painkiller abuse is the second most common reason servicemembers enter the military’s substance abuse programs.
“The main purpose of this whole project is to use acupuncture to reduce the use of opioids,” Niemtzow explained. “Is there a rapid return to duty? Will they be safe when returning to duty? Is it cost effective? And, can it replace certain habit-forming pain medication?”
The funding comes with a timeline of two years that Niemtzow will use to try to answer these questions. The center will track physicians taking the course and examine how they incorporate acupuncture into their own clinics.
“In the beginning, there was a resistance to acupuncture. It’s not taught in medical school, and a lot of people think of it as a pseudo-science,” Niemtzow said. “But healthcare providers want to see results. And when patients began to report they were getting better, [physicians paid attention]. It became popular because it was easy to learn, portable, inexpensive, could be taught in a couple of hours, and the results are reproducible.”
This does not mean that it works for everyone. For some patients, the treatment is ineffective. However, physicians using the technique have found it to be highly effective in patients for whom medication has not worked. Acupuncture has also been combined with prescription medication so that patients can take lower dosages of their painkillers.
“We’re getting requests every day from military bases around the country and even overseas asking to be taught the technique,” Niemtzow said. “They’ve seen it and they want more.”
VHA medical facilities should ensure that its providers are following three key opioid risk mitigation strategies, including conducting urine drug screening, a recent report recommended.
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.