When Will Acupuncture Become a First-Line Treatment for Acute Pain Management?

Abstract

Acupuncture has a long history in traditional medicine, including strong evidence for effective pain management. The physiological basis of this pain relief has been examined but many important questions remain to be answered. A review jointly sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) and the National Center for Complementary and Alternative Medicine (NCCAM) concluded that this is a relatively mature technology and outlined additional research to refine and improve understanding and application of the treatment. There are numerous techniques that appear to provide effective pain management for many individuals including the use of standard acupuncture points on the extremities, the scalp, and the ear. In October 2011, a NATO panel met in Bologna, Italy, and developed a consensus that the “battlefield acupuncture” technique involving five points in the ear stimulated with sterile 1 cm needles recapitulated some of the most powerful points based on Korean, Japanese, French, and other traditional acupuncture practices for pain management. A new program funded through a special congressional appropriation will roll out a process for DoDwide acupuncture training and credentialing over the next few years. This is led by the Defense and Veterans Center for Integrative Pain Management (DVCIPM) and enacts Army Pain Management Task Force recommendations to adopt acupuncture practices in military pain management. These recent events represent a confluence of deliberate actions to address concern about overmedication of soldiers for acute pain and pain syndromes, an issue that has been raised in the media for several years. The question on everyone’s mind should be “what is holding us back from providing this alternative treatment today when it is so desperately needed?” The answer is that we have started and the initial results are a resonating success. In a small demonstration project at Camp Lejeune, 37 special operations independent duty corpsman (SOIDC) and allied health professionals were trained by Colonel (Ret.) Richard Niemtzow and his team in the technique of battlefield acupuncture, based on readily accessible points located in the ear (“auricular” acupuncture). Dr Niemtzow, with the assistance of the Samueli Institute, has been training physicians throughout the Air Force and within the Department of Defense (DoD) for the past decade in this technique that involves five points on the ear: “cingulated gyrus,” “thalamus,” “omega 2,” “point zero,” and “shenmen”. The SOIDC training is a first foray into providing this tool to nonphysician medical providers and putting it in the hands of the individuals that are usually the first line of treatment for acute pain. The training has been successful in terms of the wide acceptance and interest in the Navy medical community at Camp Lejeune. Initially skeptical users have provided reports of pain relief that had not been obtained from medication, ability to continue in training or with the mission because of the improved pain control, lack of confounding drug effects, and no reported adverse consequences. Objective data on usage and acceptance are being gathered from its use by SOIDC in Afghanistan and at Camp Lejeune. This is where we should all stand up and salute the Marine Corps Special Operations Command (http://www .marsoc.marines.mil/) for their willingness to be the early adopters of good ideas. Over the years, Marine Corps representatives have stated in open forum that they are more than willing to adopt a commonsense solution that may benefit Marines, and they will count on their Army friends to follow up with a decade of research that further tests, refines, or invalidates the approach. This use of the best available solutions represents a very pragmatic “just do it” view. The fact that we did not have a complete understanding of the mechanism of action of aspirin until the 1970s did not prevent its useful application. Similarly, it may be years before we have a good understanding of the mechanisms of pain relief provided by acupuncture and other forms of peripheral nerve stimulation. Conceivably, even running exercise is a form of peripheral nerve stimulation Telemedicine and Advanced Technology Center, U.S. Army Medical Research Center, Fort Detrick, MD 21702-5012. The opinions and assertions in this editorial are those of the authors and do not necessarily represent the official views or position of the Department of the Army or the Department of Defense. doi: 10.7205/MILMED-D-13-00119