Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project

Niemtzow, Richard C.; Baxter, Jamie; Gallagher, Rollin M.; Pock, Arnyce; Calabria, Kathryn; Drake, David F.; Galloway, Kevin T.; Walter, Joan; Petri, Richard; Piazza, Thomas; Burns, Stephen A.; Hofmann, Lew; Biery, John; Buckenmaier, Chester C.

doi:10.1093/milmed/usy028

Cited by 29 publications

(22 citation statements)

References 34 publications

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“…Recently the military received a grant to train military providers in battlefield acupuncture (BFA), a standardized auricular therapy protocol, to aid in reducing the reliance on opioids in the military 50. While they were successful in training more than 2500 clinicians, less than 30% of trainees could practice BFA on returning to their institutions, due to barriers in licensing, credentialing, and supervision 51…”

Section: Discussionmentioning

confidence: 99%

“…In states where specific training requirements are minimal, choosing a standardized protocol, such as BFA, may be an efficient strategy to get your program started. BFA, with just five ear points, can be taught in 1 day with high post-course skills confidence 51 52. It can easily be taught to physicians and physician extenders alike, expanding the number of providers able to offer treatment 51.…”

Section: Discussionmentioning

confidence: 99%

“…BFA, with just five ear points, can be taught in 1 day with high post-course skills confidence 51 52. It can easily be taught to physicians and physician extenders alike, expanding the number of providers able to offer treatment 51. Additionally, one can be confident in the safety of a protocol like BFA, as auricular needling is far from critical neurovascular structures and internal organs.…”

Section: Discussionmentioning

confidence: 99%

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Integrating complementary medicine in the perioperative period: a simple, opioid-sparing addition to your multimodal analgesia strategy?

Kelleher

Kirksey

et al. 2020

Reg Anesth Pain Med

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The current US opioid health-related crisis underscores the importance for perioperative physicians to optimize various approaches to pain management. Multimodal techniques and enhanced recovery after surgery (ERAS) protocols are frequently cited as the most effective strategies for improving the experience of pain and reducing opioid exposure. Complementary medicine (CM) techniques, while frequently shown to be effective at reducing opioid and other pharmacologic agent use, are rarely discussed as part of these multimodal strategies. In general, CM therapies are low-cost with minimal associated risk, making them an ideal choice for incorporation into ERAS and other opioid-sparing protocols. In this Daring Discourse, we discuss the benefits and challenges of incorporating CM therapy into anesthetic practice. We hope that anesthesiologists can become more familiar with the current evidence regarding perioperative CM therapy, and begin incorporating these therapies as part of their comprehensive multimodal approach to perioperative pain management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Integrating complementary medicine in the perioperative period: a simple, opioid-sparing addition to your multimodal analgesia strategy?

Kelleher

Kirksey

et al. 2020

Reg Anesth Pain Med

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“…VA and active military settings have implemented battlefield acupuncture (BFA), a rapid auricular acupuncture protocol that involves inserting semipermanent needles on 5 specific points. 23 – 25 Anecdotal and early scientific evidence has demonstrated that BFA can significantly and immediately reduce pain symptoms 26 – 28 and is effective for treating both chronic and acute pain. 27 However, research on BFA’s impact on pain is limited to a few studies with small sample sizes.…”

mentioning

confidence: 99%

“… 27 , 28 Because of the simplicity of the protocol, it is easy to administer and can be performed by multiple types of providers. 24 , 25 , 27 On the basis of early scientific evidence, starting in 2016, the Veterans Health Administration (VHA) has trained over 2800 providers to deliver BFA. 29 …”

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Provider Perspectives of Battlefield Acupuncture

et al. 2020

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Objectives: Nonpharmacological options to treat pain are in demand, in part to address the opioid crisis. One such option is acupuncture. Battlefield acupuncture (BFA) is an auricular needling protocol currently used to treat pain in the Veterans Health Administration. We aimed to identify the advantages and disadvantages of BFA from providers’ perspectives. Methods: We rely on an inductive qualitative approach to explore provider perceptions through thematic analysis of semistructured interviews with 43 BFA providers across the nation. Results: We identified the following themes. Disadvantages included: (1) clinical guidelines are insufficient; (2) patients often request multiple BFA visits from providers; (3) BFA can be uncomfortable; (4) BFA may not be an effective treatment option unless it can be provided “on demand”; and (5) BFA can promote euphoria, which can have deleterious consequences for patient self-care. Perceived advantages included: (1) BFA can simultaneously effectively control pain while reducing opioid use; (2) BFA may alleviate the pain that has been unsuccessfully treated by conventional methods; (3) BFA gives providers a treatment option to offer patients with substance use disorder; (4) BFA helps build a trusting patient-provider relationship; (5) BFA can create the opportunity for hope. Conclusions: Providers perceive BFA to have many benefits, both clinical and relational, including ways in which it may have utility in addressing the current opioid crisis. BFA is easy to deliver and has potential clinical and relational utility. Efforts to better understand effectiveness are warranted.

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Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors

et al. 2021

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IMPORTANCEThe opioid crisis creates challenges for cancer pain management. Acupuncture confers clinical benefits for chronic nonmalignant pain, but its effectiveness in cancer survivors remains uncertain.OBJECTIVE To determine the effectiveness of electroacupuncture or auricular acupuncture for chronic musculoskeletal pain in cancer survivors. DESIGN, SETTING, AND PARTICIPANTSThe Personalized Electroacupuncture vs Auricular Acupuncture Comparative Effectiveness (PEACE) trial is a randomized clinical trial that was conducted from March 2017 to October 2019 (follow-up completed April 2020) across an urban academic cancer center and 5 suburban sites in New York and New Jersey. Study statisticians were blinded to treatment assignments. The 360 adults included in the study had a prior cancer diagnosis but no current evidence of disease, reported musculoskeletal pain for at least 3 months, and self-reported pain intensity on the Brief Pain Inventory (BPI) ranging from 0 (no pain) to 10 (worst pain imaginable).INTERVENTIONS Patients were randomized 2:2:1 to electroacupuncture (n = 145), auricular acupuncture (n = 143), or usual care (n = 72). Intervention groups received 10 weekly sessions of electroacupuncture or auricular acupuncture. Ten acupuncture sessions were offered to the usual care group from weeks 12 through 24. MAIN OUTCOMES AND MEASURESThe primary outcome was change in average pain severity score on the BPI from baseline to week 12. Using a gatekeeping multiple-comparison procedure, electroacupuncture and auricular acupuncture were compared with usual care using a linear mixed model. Noninferiority of auricular acupuncture to electroacupuncture was tested if both interventions were superior to usual care. RESULTS Among 360 cancer survivors (mean [SD] age, 62.1 [12.7] years; mean [SD] baseline BPI score, 5.2 [1.7] points; 251 [69.7%] women; and 88 [24.4%] non-White), 340 (94.4%) completed the primary end point. Compared with usual care, electroacupuncture reduced pain severity by 1.9 points (97.5% CI, 1.4-2.4 points; P < .001) and auricular acupuncture reduced by 1.6 points (97.5% CI, 1.0-2.1 points; P < .001) from baseline to week 12. Noninferiority of auricular acupuncture to electroacupuncture was not demonstrated. Adverse events were mild; 15 of 143 (10.5%) patients receiving auricular acupuncture and 1 of 145 (0.7%) patients receiving electroacupuncture discontinued treatments due to adverse events (P < .001). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial among cancer survivors with chronic musculoskeletal pain, electroacupuncture and auricular acupuncture produced greater pain reduction than usual care. However, auricular acupuncture did not demonstrate noninferiority to electroacupuncture, and patients receiving it had more adverse events.

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Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project

Cited by 29 publications

References 34 publications

Integrating complementary medicine in the perioperative period: a simple, opioid-sparing addition to your multimodal analgesia strategy?

Integrating complementary medicine in the perioperative period: a simple, opioid-sparing addition to your multimodal analgesia strategy?

Provider Perspectives of Battlefield Acupuncture

Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors

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