Auricular Acupuncture: Convenient Technique for Battlefield Pain

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.

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.

Auricular Acupuncture

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.

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.”


Comments (11)

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  1. Catherine Ohrin-Greipp says:

    With all due respect, Dr. Niemtzow did not develop auricular acupuncture. It was developed in the 1970’s and used extensively on addicts at Lincoln Hospital in NY. It became known as the 5 point NADA protocol. Dr. Niemtzow developed what he calls “Battlefield Acupuncture.” The National Acudetox Association (NADA) has strict guidelines on training, as well as clinical experience in order to be certified, well beyond just 4 hours. We are using the NADA protocol in our Mental Health Clinic.

    • Julia says:

      Thank you very much for posting/clarifying that, and applying credit where it is due. I am well aware of the NADA protocol and its history (which you state quite clearly) and accuracy is important. On another very important note, I am very happy that it is being used to help our troops who deserve care, health and comfort.

    • Tamera Edwards says:

      I agree with Catherine Ohrin-Greipps. I am trained and certified in the NADA protocol. While it could take 4 hrs for training of where to place the needles, to be thoroughly trained in this protocol developed at the Lincoln Hospital where I trained, a person needs the full required time frame for training recommended by NADA. To be named by Dr. Niemtzow as “Battlefield Acupuncture” is fine by me, however, professionals who are trained by NADA understand the importance of knowing how to do this treatment and knowing why it works for many people. I am glad service men and women are able to receive help from Dr. Niemtzow and those in his profession.

  2. Chester Dickerson says:

    According to Catherine Ohrin-Greipp, auricular acupuncture began in the 1970’s, when in reality it was introduced to Western medicine, in 1950, by a French doctor, Paul Nogier. He observed a lay doctor, Mme. Barriinto, who used ear cauterization to treat sciatica. He, too, tried this same technique, but felt that needles could do the same. He began using needles oh his patients and found the results were just as effective.

    In this article, there is no claim that Dr. Neimtzow discovered ear acupuncture. It states he developed the ear acupuncture “technique”, for which he coined the term Battlefield Acupuncture.

    His discovered technique is very effective, and after researching and implementing it for my pain patients, it has become standard protocol. It has shown incredible results from seeing a 50-100% decrease in pain level. I have patients who, after the insertion of the first cingulate gyrus, have 100% pain relief, and to be certain, a follow-up visit was scheduled. Upon those follow-up visits, these patients continued to be pain free. I see these patients on a 1-2 monthly visit to reassess.

    It is not a protocol to replace our Western counterpart, but an adjunct to their pain management. I have used it in those where pain meds were not effective, and in those who needed to wean themselves off due to addictions to the over-prescribed opiates. These patients receive alternate treatments of both Battlefield one week, then NADA, the following week.

    I have degrees in both Western medicine (MD) and Eastern medicine. Overall, I find the Battlefield to be more effective than the opiates prescribed, which have side effects not found in the BFA protocol. Rarely, a patient may experience euphoria, a vaso-vagal response, or headache. If anything, slight bruising is the more common side effect, yet on occasion.

    The overall protocol is cost-effective, less time is required than with TCM, and has become covered by most insurance coverage. In the long run, this has a positive effect on helping bring down the overall cost of healthcare, and addictions would not be an issue, with regard to pain management.

    Any licensed acupuncturist who does not make use of this protocol, is negligent to a patient’s pain. It is unprofessional not to offer all options available.

    Dr Neimtzow deserves high accolades, and in am testament to his protocol.

    C Dickerson, MD, DOM, LAc, ADS, Dipl OM

  3. Joe says:

    I received battlefield acupuncture from the V.A. 3 times since they implemented the program. I received it every 6 weeks to 2 months. Unbelievable. I have severe back pain from an aircraft incident in 1971. I also have been informed due to injuries both my knees need to be replaced. Based on a very weak heart the knee replacement has been put on the back burner. After acupuncture my knee pain has gone from a pain level of 9 to a pain level of 1. My back pain has gone from a level of 9 to a level of 3-4. I no longer use my cane after acupuncture nor have I been taking any pain killers. After the 2 months the pain escalates to 8-9-10, both back and knees. I have been told it does not work for everyone, it sure does on this retired old vet.

  4. Mark says:

    I have received battlefield acupuncture from the V.A. twice and although the pain relief was limited and not long term it did very much help with the problem I have with swallowing food due to nerve damage which has enabled me to eat many of the foods I was no longer able too and considering this response happened both times I had it done I believe it will continue to help in future procedures

  5. Kristine says:

    I’m retired military fortunate enough to still be seen on-base. I’ve had fibromyalgia in remission for about 9 years but just had flare-up. I made an appointment because I hurt so badly although I really didn’t expect much could be done for me. The on-call provider offered BFA and described the procedure. What amazing surprise! I felt better before she even finished; within the hour I felt like a new person; the pain was gone and I felt more with-it. It’s been almost a week; I’m getting a few aches on and off but nothing compared to how I felt. I am so grateful this was offered to me.

  6. Elizabeth Crovo RN says:

    I have been an RN for over 25 years in Maryland and certified to do the five point protocol since 2011. As part of my clinical experience, I worked at a men’s long term recovery program where this was done every day as part of restorative treatment. I would very much like to be involved in a program that offers and believes in this treatment. Thank you.

    • Tamera Edwards says:

      Since I was trained in the NADA protocol in 1993 and have provided the 5 point treatment over the years and am now starting an acudetox clinic I am very interested in what the difference is between NADA Protocol and Battlefield Acupuncture. How are the points different? Does anyone know?
      Thanks for any reply.

  7. V.R. Walker says:

    Got it 2 days ago. Juiced acupuncture (needles with electricity) in the mid-back weren’t working much. The name led me to think it would be done with finger pressure and didn’t know I’d be walking out with needles in my ears. Can’t be sure if it’s helping or not, right now. I’d like to see evidence and a mechanism. It would also be nice if I didn’t have pruritis, didn’t sleep on my side, didn’t wear glasses. Try to scratch my ears and OUCH!

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