This article provides an introduction and background to the review, summarizes the methodological processes involved, details the initial results, and identifies strengths and weakness of the review. Specific results of the review as well as overall recommendations for moving this field of research forward are detailed throughout the current Pain Medicine supplement.
BackgroundCo-morbid symptoms (for example, chronic pain, depression, anxiety, and fatigue) are particularly common in military fighters returning from the current conflicts, who have experienced physical and/or psychological trauma. These overlapping conditions cut across the boundaries of mind, brain and body, resulting in a common symptomatic and functional spectrum of physical, cognitive, psychological and behavioral effects referred to as the ‘Trauma Spectrum Response’ (TSR). While acupuncture has been shown to treat some of these components effectively, the current literature is often difficult to interpret, inconsistent or of variable quality. Thus, to gauge comprehensively the effectiveness of acupuncture across TSR components, a systematic review of reviews was conducted using the Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) methodology.MethodsPubMed/MEDLINE, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, and PsycInfo were searched from inception to September 2011 for systematic reviews/meta-analyses. Quality assessment was rigorously performed using the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Adherence to the Standards for Reporting Interventions in Clinical Trials in Acupuncture (STRICTA) criteria was also assessed.ResultsOf the 1,480 citations identified by our searches, 52 systematic reviews/meta-analyses, all high quality except for one, met inclusion criteria for each TSR component except post-traumatic stress disorder (PTSD) and sexual function. The majority of reviews addressed most STRICTA components, but did not describe safety.ConclusionsBased on the results of our review, acupuncture appears to be effective for treating headaches and, although more research is needed, seems to be a promising treatment option for anxiety, sleep disturbances, depression and chronic pain. It does not, however, demonstrate any substantial treatment benefit for substance abuse. Because there were no reviews on PTSD or sexual function that met our pre-defined inclusion criteria, we cannot comment on acupuncture’s effectiveness in treating these conditions. More quality data are also needed to determine whether acupuncture is appropriate for treating fatigue or cognitive difficulties. Further, while acupuncture has been shown to be generally safe, safety was not described in the majority of studies, making it difficult to provide any strong recommendations. Future research should address safety reporting in detail in order to increase our confidence in acupuncture’s efficacy across the identified TSR components.
Background: Currently, opioids are the predominately prescribed treatment for wounded warriors being transported by the United States Air Force aeromedical evacuation system. Objective: It is not known whether Battlefield Acupuncture (BFA), a type of ear acupuncture, would be an acceptable and utile therapy for patients and medical staff for pain control in the aeromedical evacuation system. The primary aim of this study was to examine the feasibility of introducing BFA into the aeromedical evacuation system. Design and Setting: This was a feasibility and observational study involving patients with pain who were treated with BFA while being transported by the aeromedical evacuation system from the Landsthul Regional Medical Center (LRMC), in Landstuhl, Germany, to Joint Base Andrews ( JBA), in Maryland. Participants: The participants were patients with pain who were being transported from LRMC to JBA and nurses and physicians providing the BFA treatment for these patients. Intervention: The intervention was BFA. Main Outcome Measures: The outcome sought was knowledge of the feasibility and acceptability of BFA trial among the medical staff members and the patients. Results: It was feasible to train nurses without any previous acupuncture knowledge or skills to implement BFA. In addition, medical staff members stated that the trial did not interfere with their preflight duties or during the flight. Patients reported an average pain rating of 4.07 before BFA and pain scores 1 hour post treatment and post flight of 2.17 and 2.76, respectively ( p < 000.1).
Background: In recent years, both the Department of Defense (DoD) and Department of Veterans Affairs (VA) have begun to turn to complementary and integrative medicine (CIM) therapies to help address chronic physical (pain) and psychological (post-traumatic stress disorder, anxiety, depression) conditions. One of the most prominent CIM therapies for these conditions is acupuncture. While there has been considerable acupuncture research performed in civilian populations, the level of research conducted within military and veteran populations is unclear. Objective: The main objectives of this review were to survey the number of published acupuncture studies in military and veteran populations and to assess and summarize the quality of the included studies. Design: A Rapid Evidence Assessment of the Literature (REAL # ) was conducted to identify, assess, and characterize published studies of acupuncture among military and veteran populations (from inception until March 2011). Results: A total of 340 citations were reviewed. Studies that met the criteria for inclusion were evaluated for study quality and bias using the Scottish Intercollegiate Guidelines Network 50 (SIGN 50) checklist for randomized controlled trials (RCTs). Only 2 RCTs that fit the inclusion criteria were found and were able to be assessed using the SIGN quality scoring tool. Conclusions: This review shows that, although there have been several studies examining acupuncture efficacy and effectiveness in a military and/or veteran population, only one of the published studies had a sound methodological design. At present, there is a paucity of acupuncture research in military and veteran populations.
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