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Battlefield Acupuncture

An Emerging Method for Easing Pain

Levy, Charles E., MD; Casler, Nicholas, BS; FitzGerald, David B., MD

American Journal of Physical Medicine & Rehabilitation: March 2018 - Volume 97 - Issue 3 - p e18–e19
doi: 10.1097/PHM.0000000000000766
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From the Physical Medicine and Rehabilitation Service, and Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, Florida (CEL); Department of Occupational Therapy, and Center for Arts in Medicine, University of Florida, Gainesville, Florida (CEL); Florida State University College of Medicine, Tallahassee, Florida (NC); Neurology Service and the Brain Rehabilitation Research Center, Rehabilitation Research and Development Service, Office of Research and Development, Department of Veteran Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida (DBF); and Department of Neurology, University of Florida, Gainesville, Florida (DBF).

All correspondence should be addressed to: Charles E. Levy, MD, Physical Medicine Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd (#117), Gainesville, FL 32608.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Chronic pain is a serious problem for combat veterans and soldiers. In a sample of 2597 soldiers who had served in Afghanistan and Iraq, 44% reported pain lasting for more than 3 months, half of whom reported pain for 1 year or more.1

Pain medications, including opioids, often have limited efficacy and may impose unwanted adverse effects. These limits explain the Department of Defense and the Veterans Administration's interest in nonpharmacologic interventions including acupuncture.2 As traditionally practiced, acupuncture involves a complex assessment and individualized treatment by trained providers (300 hrs required for physicians), which are barriers to widespread implementation in military and veteran settings.

In 2001, Niemtzow3 developed “battlefield acupuncture” (BFA), a form of auriculotherapy where a sequence of gold aiguille semipermanent needles (Sedatelec, Irigny, France) are placed at up to five specific sites in one or both ears. Battlefield acupuncture is purported to influence central nervous system pain processing through its effects on a somatotopic organization of the body represented in the auricle. It has been suggested that auricular therapies cause the release of β-endorphins to elicit short-term analgesia or anti-inflammatory cytokines for long-term effects.4 The BFA needles (more accurately described as tiny conical darts) pierce the ear in designated locations in a particular order (Figs. 1 and 2 show the technique and the locations of needle placement). They stay in place until they fall out typically within 3–4 days.2





Although there is some support for auricular therapy in general, the evidence base for BFA is relatively meager.2,4 Regardless, the Defense and Veterans Center for Integrative Pain Management and the Veterans Health Administration National Pain Management Program Office recently completed a 3-yr $5.4 million acupuncture education and training program, which deployed certified BFA trainers to receptive Department of Defense and Veterans Administration medical centers. Over 2800 providers were trained to provide BFA. At the author's Veterans Administration facility, approximately 60 practitioners have been trained, producing approximately 2500 patient BFA encounters in the past 2 yrs. In the first author's experience with nearly 30 veterans, BFA has reduced pain for those with headaches, acute and chronic back and musculoskeletal pain, and neuropathic pain.

Besides obvious questions regarding the mechanisms of action, the comparative efficacy, and duration of effects, the Department of Defense and Veterans Health System embrace of BFA presents an opportunity to study the adaption and implementation of this most fascinating complementary technique into traditional western practice. If the promise of BFA holds true, it will add an important treatment option in physiatrists' arsenal to treat acute and chronic pain.

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1. Toblin RL, Quartana PJ, Riviere LA, et al: Chronic pain and opioid use in US soldiers after combat deployment. JAMA Intern Med 2014;174:1400–1
2. Walker PH, Pock A, Ling CG, et al: Battlefield acupuncture: opening the door for acupuncture in Department of Defense/Veteran's Administration health care. Nurs Outlook 2016;64:491–8
3. Niemtzow R: Battlefield acupuncture. Med Acupunct 2007;19:225–8
4. Yeh CH, Chiang YC, Hoffman SL, et al: Efficacy of auricular therapy for pain management: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2014;2014:934670
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