Two Different Worlds Meet

Renee Lehman

(11/11) When you think of someone serving or who has served in the military, what characteristics come to mind? The military tends to create a culture of: toughness, self-sacrifice, honor, sense of duty, and willingness to accept pain.

When you think of complementary and alternative medicine, what comes to mind? It is a broad selection of healthcare systems, practices, and products (like acupuncture, meditation, yoga, herbs, etc.) that are not part of our conventional western medicine.

So what would you think if I told you that the military was now incorporating complementary and alternative medicine (CAM) into the healthcare for active and retired military personnel? Surprised? Since 2009, the military has been using acupuncture for post-traumatic stress disorder and pain control, and are looking to expand their usage of other CAM practices such as meditation and yoga.

Overview of Pain and Pain Management

You see, the military faces similar challenges to keep their service men and women healthy as other corporations/businesses do. This is especially true for pain management. In the United States, pain is the most frequent reason patients seek physician care, and more than 115 million Americans suffer from chronic pain. The annual cost of chronic pain is estimated from $560 to $635 billion (in 2010 dollars) in the United States, which combines the medical costs of pain care and the economic costs related to disability days and lost wages and productivity. The failure to adequately address pain in the health care system continues to result in unnecessary suffering, exacerbation of other medical conditions, and huge financial and personnel costs (Institute of Medicine).

Although there are many treatment modalities for pain management, one of the major components for the treatment of pain continues to be the use of Over-The-Counter and prescription medications. The use of medications is appropriate, required, and often an effective way to treat pain. However, the possible over reliance on medications to treat pain has other unintended consequences, such as the increased prevalence of prescription medication abuse and diversion throughout the United States. According to the Office of National Drug Control Policy, prescription opioid analgesics are the most commonly abused prescription drugs in the U.S., with the highest rate of abuse occurring among those ages 18-25. Finally, according to a 2008 Department of Defense survey, about one in nine active-duty service members (11 percent) reported past-month prescription drug misuse (http://www.tricare.mil/tma/studiesEval.aspx, September 2009).

The military also faces some unique issues because of its distinctive mission, structure and patient population. For example:

• The nation expects the military to provide the highest level of care to those carrying wars’ heaviest burdens.
• The transient nature of the military population, including patients and providers, makes continuity of care a challenge for military medicine.
• Pain management challenges associated with combat poly-trauma patients require integrated approaches to clinical care that cross traditional medical specialties, not all of which are universally available across the military.
• The "No pain, no gain" is a philosophy embraced by much of the Active Duty force and their leadership. This attitude often causes delays in seeking treatment, as Soldiers, Sailors, Airmen, and Marines attempt to work through their pain and "tough it out." This frequently results in relatively minor acute issues later becoming harder-to manage chronic conditions.

(2009 Army Pain Management Task Force)

The Air Force Improves Pain Management

In 2008, The U.S. Air Force started a first-of-its kind pilot program designed to train its active-duty physicians to provide battlefield acupuncture services, expanding health care services to personnel on the front lines in Iraq and Afghanistan. In its Winter 2008 newsletter, the Air Force Medical Corps announced: "The Air Force Surgeon General is pleased to announce a pilot program to train a cadre of active-duty physicians in the emerging discipline of medical acupuncture. This is a unique course whose goal is to incorporate acupuncture into the practice of military medicine in the clinic and battlefield environments."

"Another new tool in battlefield medicine is acupuncture. The Air Force acupuncture program, the first of its kind in Department of Defense, has expanded beyond clinic care to provide two formal training programs. Over 40 military physicians have been trained. We recognize the success of acupuncture for patients who are not responding well to traditional pain management. This is one more tool to help our wounded Soldiers and Airmen return to duty more rapidly and reduce pain medication usage."
          Lieutenant General (Dr.) Charles B. Green,

The Surgeon General of the Air Force on April 6, 2011 during United States Air Force Testimony before the Senate Appropriations Committee, Subcommittee on Defense regarding Defense Health Programs)

Battlefield acupuncture is a method Dr. Richard C. Niemtzow, Colonel USAF, MC, FS developed in 2001 that's derived from traditional ear acupuncture but uses the short needles (gold, titanium or stainless steel semi-permanent needles) to better fit under combat helmets so soldiers can continue their missions with the needles inserted to relieve pain. The needles are applied to five points on the outer ear.

Battlefield acupuncture has become so popular in Afghanistan that at the U.S. Marine Corp's largest base in Helmand province, a special treatment room was created for it to be administered with new age music playing and Christmas lights hung from the ceiling.

The Army Improves Pain Management

The Army Surgeon General LTG Eric B. Schoomaker chartered the Army Pain Management Task Force (TF) in August 2009 to make recommendations for a U.S. Army Medical Command (MEDCOM) comprehensive pain management strategy that was holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain. Task Force membership included a variety of medical specialties and disciplines from the Army, as well as representatives from the Navy, Air Force, TRICARE Management Activity, and Veterans Health Administration (VHA). The Final Report was given in May 2010.

The Pain Management Task Force developed 109 recommendations that lead to a comprehensive pain management strategy that is holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain.

The wide range of these CAM therapies and treatments, such as acupuncture and yoga therapy, have proven valuable in reducing an over reliance on use of medications to treat pain. There are many reasons individuals may seek the option to use CAM, not the least of which is the failure of current treatment to relieve their pain. Current research indicates that part of the appeal of CAM includes the opportunity for greater personal involvement in health maintenance, holistic health beliefs and, for those with chronic conditions, an active coping mechanism (Bishop, Yardley and Lewith, 2007; Sollner et al., 2000). To learn more about the task force and its recommendations go to http://www.armymedicine.army.mil/reports/Pain_Management_Task_Force.pdf.

The Future of Acupuncture in the Military

Acupuncture is currently being used to treat our service men and women with pain. Acupuncture will also be important in the successful treatment of traumatic brain injuries, concussions, and post-traumatic stress syndrome.

In January 2011, in Washington D. C., Defense Department personnel met with researchers and members of the National Institute of Health's (NIH) National Center for Complementary and Alternative Medicine to discuss the military's continued exploration of acupuncture (especially for traumatic brain injury, concussions, and post-traumatic stress syndrome).

Karen J. Sherman, an NIH-funded acupuncture researcher with the Group Health Research Institute in Seattle who attended the meeting, said that despite skepticism, the military remains interested.

"There's no doubt about it," Sherman said. "The addition of acupuncture to usual care seems to be beneficial (for traumatic brain injury), at least in the short term," from six to 12 months after treatment (http://www.military.com).

Also, the Army Vice Chief of Staff General Peter Chiarelli, while addressing military and civilian health care practitioners at a Traumatic Brain Injury forum in Washington, D.C. on September 22, 2011, stated that alternative therapies, like acupuncture, given near the frontlines after a concussion, are proving helpful to troops (http://www.armytimes.com).

Renee Lehman is a licensed acupuncturist, physical therapist, and Reiki Master with over 20 years of health care experience. Her office is located at 249B York Street in Gettysburg, PA.  She can be reached at 717-752-5728.