Battlefield Acupuncture Proves Highly Effective in Treating Chronic Pain among Veterans

BACKGROUND:
Among the 5.7 million unique patients seen annually within the VA healthcare system, more than half experience chronic pain. In 2017, VA and the DoD published an updated guideline on opioid therapy for chronic pain that strongly recommends against the initiation of long-term opioids – but does recommend alternatives, including non-pharmacologic therapy (i.e., acupuncture, yoga, cognitive behavioral therapy). Battlefield acupuncture (BFA) involves a small needle inserted into parts of the ear that have a "central effect" on the nervous system and an area of the brain that processes pain. This study examined the use and effectiveness of BFA for pain in group and individual sessions at a large VA medical center in West Haven, CT. Between October 2016 and December 2017, 284 Veterans with pain (71% had been previously diagnosed with a chronic musculoskeletal condition) received BFA during a group or individual visit. Investigators used the Defense and Veterans Pain Rating Scale (DVPRS) to assess self-reported pain immediately before and after each BFA administration.

FINDINGS:

• Battlefield acupuncture (BFA) was highly efficacious in immediately reducing pain for a significant majority of Veterans in this study, whether BFA was done individually or in group clinics. Of 753 total patient encounters, a decrease in self-reported pain occurred in 616 (82%), no change occurred in 73 (10%), and an increase occurred in 62 (8%).
• Absolute levels of pain reduction were greater in Veterans with the highest self-reported pain and did not seem to decrease in those who underwent repeated procedures.

IMPLICATIONS:

• Group clinics may be an effective and efficient way to deliver battlefield acupuncture. Whether this can lead to durability, an increased quality of life, and decrease in pharmacotherapy – especially opioid use among Veterans, remains to be explored.

LIMITATIONS:

• Since many Veterans were self-referred, those undergoing BFA might have been predisposed to having a more favorable effect than if they had presented with pain and been randomly assigned to either BFA or another treatment.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA's Quality Enhancement Research Initiative (QUERI) as part of QUERI's Complementary and Integrative Health Evaluation Center (PI: Stephanie Taylor). Dr. Federman and Mr. Carbone are with the VA Connecticut Healthcare System, Dr. Zeliadt and Ms. Thomas are part of HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care, and Dr. Taylor is part of HSR&D's Center for Healthcare Innovation, Implementation and Policy.

Federman D, Zeliadt S, Thomas E, Carbone G, and Taylor S. Battlefield Acupuncture in the Veterans Health Administration: Effectiveness in Individual and Group Settings for Pain and Pain Comorbidities. Medical Acupuncture. September 5, 2018; Epub ahead of print.