By: Jennifer H. Svan | Stars And Stripes
RAMSTEIN AIR BASE, Germany – About 50 flight surgeons from 21 countries wrapped up a day of training at an international medical conference here this week with matching gold-plated studs set in their ears.
Their ears sparkled in the name of medicine: This was a hands-on workshop on battlefield acupuncture, an alternative therapy that's vying to become a standard practice of care at Defense Department and Veteran Affairs medical centers for acute and chronic pain.
Battlefield acupuncture, a form of auricular or ear acupuncture so named because the tiny needles can be administered quickly in combat without removing so much as a helmet, has been around for more than 15 years.
But use of the technique, once practiced by fewer than a 100 military doctors across the services, is rapidly expanding through a vigorous training program supported by DOD and the VA.
In 2013, the agencies received $5.4 million for a three-year project to develop and implement an education and training program in battlefield acupuncture to address concerns about overmedication of service members.
Funding came from the Joint Incentive Fund, a pot of money designated for DOD/VA medical-sharing initiatives to improve quality and cost savings at their facilities.
Training under the pilot program was expanded to physicians, physician assistants, nurse practitioners, registered nurses, medics, corpsmen, and physical and occupational therapists.
About 2,800 providers have been trained as part of the initiative, said Thomas Piazza, the director of the Air Force Acupuncture Program at Joint Base Andrews, Md.
In the Air Force, where the therapy was pioneered by physician and retired Air Force Col. Richard Niemtzow in 2001, close to 60 percent of its bases "are trained up" in battlefield acupuncture, Piazza said. "We're looking to get battlefield acupuncture as part of standard of care versus a separate thing where we say 'you can have an alternative medicine.'"
He added: "Sometimes people just want a Motrin and that's fine, great, we've got that, too. But some people just don't want to take medicines; they just want something else for a change."
Piazza was at Ramstein last week to teach battlefield acupuncture to U.S. and NATO flight surgeons attending an annual international medical conference. One of the appeals of battlefield acupuncture is simplicity. The training is boiled down into a few hours of academic and clinical instruction. In one afternoon, the flight surgeons at Piazza's workshop could find the five points on each ear — with names like cingulate gyrus and shen men — corresponding to where the needles go, in a particular order.
The training is standardized to ensure it's done right, Piazza said. "Most of the people we're teaching to aren't acupuncturists," he said. "We say follow this recipe, follow these steps."
NATO personnel were unsure whether they'd be able use battlefield acupuncture on their patients.
"The problem in Germany, if you want to do acupuncture, you have to do more than one of these courses. You have to get a license," said Lt. Col. Katrin Thinnes, an anesthesiologist and intensive care unit specialist with the German air force.
But she's interested in the concept and practicality. "In case of emergency and being deployed, it's a good way to have another tool," she said.
Thinnes and others in the workshop practiced poking needles in their partner's ears at specific points and getting pricked in turn.
Lt. Col. Stefanie Watkins-Nance, a resident in the Air Force's aerospace medicine program at Wright-Patterson Air Force Base, Ohio, grimaced when the first stud popped into her ear.
"It just feels like a pinch. When it discharges, you're not used to that pressure," she said as she steadied for the next pop.
The needles resemble tiny gold barbs about the size of a ballpoint pen tip. A long plastic inserter with a plunger releases the needle. They fall out after three to five days.
Someone in the class suggested practicing at home with an uncooked broccoli stalk "to give you the same sensation as putting a needle in the ear."
Though side effects and risk of infection are minimal, Piazza told the flight surgeons that one of the hurdles they might face is convincing patients to try a treatment involving needles. "Who likes needles? Most of your patients don't like needles.
"You're going to learn this is much less painful than getting your ears pierced," he said.
"It's a little uncomfortable but it's not like being shot," said Col. Anthony Mitchell, an aerospace medicine resident at Wright-Patterson who was using the training as a refresher.
While deployed to Afghanistan in 2013, Mitchell used battlefield acupuncture on wounded patients during air evacuation.
"This was just an adjunct, to see if they didn't need as much medicine" during transport, he said. "It seemed like a reasonable thing to do. You can get to the ear, you're not taking any body armor or equipment off and it might help."
Acupuncture in general, including battlefield acupuncture, has been assailed by some in Western medical circles as quackery with no real benefits. Tricare, DOD's own health care system, doesn't cover the procedure for its beneficiaries on the economy.
Harriet Hall, a retired family physician and U.S. Air Force flight surgeon, was quoted last year in a Scientific American article debunking the practice as saying, "We have no evidence that [acupuncture] is anything more than theatrical placebo."
Piazza said the therapy is backed by more than half a dozen randomized control trials and a number of case reports.
In one study, conducted by Air Force doctors at Nellis Air Force Base, Nev., and published in 2015, battlefield acupuncture was compared to standard pain treatment in 54 DOD patients with an acute sore throat. Acupuncture was associated with reduced sore throat pain for 24 hours and decreased use of pain medication for up to 48 hours. There was no apparent effect on hours missed from work.
Piazza said a group of doctors reported a 64 percent decrease in the rate of medical groundings for deployed pilots who received battlefield acupuncture instead of pain killers for lower back pain.
"We're not looking to replace medicine," Piazza said, but the procedure has been shown to reduce the use of narcotics.
The effects initially last only a few days, but subsequent treatments can last longer, he said.
Air Force Lt. Col. Patricia Macsparran, the aerospace medicine consultant to the Air Force Surgeon General, incorporates acupuncture into her practice daily.
She's a licensed acupuncturist with more than 300 hours of training.
She explains the science behind it with a reference to Dr. Seuss. When the body perceives pain, it sends a lot of fluid with anti-inflammatory products to fix it, she said. Under a microscope, those products "look a lot like Dr. Seuss monsters," she said, and the body has a hard time clearing them out. "Acupuncture is sort of like a traffic cop," she said. "If you know where to place those needles to push ionic flow to get things moving, you basically release that traffic jam so the body can heal itself."
Battlefield acupuncture "is just scratching the surface," she said. "Every organ in the body, including the brain, is represented on the ear. It's a micro system."
Results at the workshop were mixed. Maj. Thomas Weme, a doctor in the Royal Norwegian Air Force, didn't notice his back pain ease after getting the procedure.
"I just feel warmth on the ears," he said.
But Sylvain Hourlier, a physician from France who was one of the workshop volunteers to receive battlefield acupuncture, said his chronic back pain, lingering from a motorcycle accident 20 years ago, had "vanished."
"I feel the pressure where I have the pain, but the pain is gone," he said. "It's crazy."
Mitchell said a small crick in his neck was feeling better.
"I may be giddy," he said, after all five needles were in, in each ear. "You feel a surge. It's interesting. It's very interesting."