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N C C A M Research Blog

Pain and Opioid Use in U.S. Soldiers: The Imperative for Researching Effective Pain Management Options in the Military

July 14, 2014
Josephine P. Briggs, M.D.
Josephine P. Briggs, M.D.

Director
National Center for Complementary and Alternative Medicine

View Dr. Briggs' biographical sketch

A study published in last month’s JAMA Internal Medicine found an alarming high prevalence of chronic pain (44.0%) and opioid use (15.1%) in the U.S. military after combat deployment. These rates, much higher than estimated rates in the general public (26% and 4%, respectively), remind us of the burdens faced by returning soldiers after deployments, and their urgent and unmet needs for managing chronic pain. Opioids alone cannot be the answer. These findings reinforce our commitment to research how to improve pain management, a high priority in NCCAM’s Third Strategic Plan (2011–2015).

The Center has prioritized working with the military and Department of Veterans Affairs (VA) to study nonpharmacologic approaches to managing pain. NCCAM Program Director Dr. Kristen Huntley has previously blogged about the Center’s interest in supporting research on complementary approaches for pain management in military and veteran populations and the Center’s three related funding opportunity announcements for researching nonpharmacologic approaches to managing pain and comorbid conditions.

NCCAM has established a Working Group of our Advisory Council to advise us on collaborations with the Department of Defense and VA on research of these problems. The group is charged with advising our Center on developing a potential initiative, suggesting strategies for collaboration among Federal agencies, and providing recommendations for implementing such an initiative. The Working Group is currently engaged in a series of deliberations.

The members of the NCCAM Advisory Council Working Group are:

  • Chair
    • Lloyd Michener, M.D., Professor and Chair, Department of Community and Family Medicine; Director, Duke Center for Community Research, Duke School of Medicine
  • Members
    • Stephen Ezeji-Okoye, M.D., Deputy Chief of Staff, VA Palo Alto Health Care System
    • Tracy Gaudet, M.D., Director, Office of Patient-Centered Care and Cultural Transformation, Veterans Health Administration
    • Richard Niemtzow, M.D., Ph.D., M.P.H., Colonel (Ret), USAF, MC, FS, CAM Consultant USAF Surgeon General; director, USAF Acupuncture Center
    • Eric Schoomaker, M.D., Ph.D., Lieutenant General, U.S. Army Surgeon General (Ret), Scholar-in-Residence, Distinguished Professor of Military and Emergency Medicine, Uniformed Services University of Health Sciences

We are strongly committed to working with other Federal agencies to identify and support rigorous research that will aid military personnel and veterans. I’m looking forward to hearing from the Working Group soon.

Citations

Comments

i have lived with ic for over 30 yrs have had many treatment rinso stretches monitor botox every med u can think off now on elmiron stress meds and tens and actupunture not helping yet living with constant pressue sometimes i can realeave it but urge comes right back take sleeping pill too sleep cant go any were very depressed cant even baby sit my gransonlove to talk to peeps wth the same problem

Then challenge of opioid use in the military and veterans is multi dimensional including pain, trauma, and stress. If we add the issue of “moral injury”, we can then include the additional non-specific but affective component of suffering. In my work with active military, veterans, incarcerated veterans, and homeless veterans I have also seen that the scope of symptoms experienced, including frequency, severity, and debilitation decreases with an increase of caring.  This is quite different from a level of  treatment. The importance of providing care (compassion) can not be undervalued.For this patient population, I provide the NADA auricular acupuncture 5 point protocol as a first course of treatment. NADA was developed in the 1970’s for the treatment of addiction and was then utilized at St. Vincent’s hospital when the World Trade Center was destroyed. It has since been used around the world in the treatment of trauma and addictions; including PTSD.In addition to addressing trauma and addiction, NADA provides stress relief and pain relief. It also addresses moral injury and suffering through certain qualities (spirit) of the points. It is often utilized in a group setting thereby supporting cameraderie and addressing the issue of isolation. It is non-verbal thereby addressing the issue of confidentiality. I can personally treat more than 90 veterans in 1 day with NADA making it extremely cost effective and providing the relief and compassionate care urgently needed by this large patient population. Evan Shepherd Reiff, L.Ac. Health for Heroes, Sausalito, CA

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Anticipating update on complementary treatment for chronic pain.

Good move! - including the recent ones to bring Schoomaker and Gaudet into NACCAM.

lynne08 - Sorry to hear about your health issues.  Feel free to contact our information specialists if you have questions about research on therapies. 

Evan, Ruby, and John - Thanks for taking the time to comment. We are hopeful that our collaborative efforts with the military will make an impact.

Yea for your support of research programs.  As a service connected disabled veteran, currently a patient at the rehabilitation and physical therapy departments at the VA’s James J. Peters Medical Center, Bronx, New York.   I am currently benefiting from both acupunture and custom designed physical therapy to reduce pain.  I totally avoid opiods and only make occasional use of NSAIDs.I am also a Tai-Chi for Arthritis certified instructor (Arthritis Foundations - New York) and am both teaching and using this form to reduce pain and improve flexibility.I will be proposing a study of this CAM techniques to this facility.  Hopefully it will meet the requirements and expectations of this program to find options to reduce Opiod use.  I wish the best of luck and success to the Advisory Working Group and hope they get wide support throughout the community of VA & DoD researchers, providers and patients.

As I understand it, there is acupuncture available at the Boston VA hospital, but for such limited days and hours relative to the demand, that the waiting lists for an appointment is 6 months or more. I suspect many VA’s have none. It is such a healthy and cost-effective way to deal with pain, PTSD. opioid overuse, etc., that one would think the VA hospitals and/or outpatient units would be hiring enough acupuncturists to run clinics 5 days week. 

I am sorry to hear about the long wait for acupuncture services at the Boston VA.   Some interesting research findings about pain relief can be found in the following: Acupuncture the Newest Battlefield Tool, JANUARY 2011 • FEDERAL PRACTITIONER • 29, where the DoD found that Opiod needs for back injuries, and return to combat improved through this application.  The Air-Force has a full time acupuncture center at Andrews Air Force Base.The more we can encourage credible research in CAM and communicate the benefits to our associates and patients, the greater the acceptance and implementation of these very cost effective and patient beneficial programs in facilities nationwide.  IRB’s will also be more receptive to academic center research because funding sources may be more forthcoming to support CAM pain research.

As a service connected disabled veteran, currently a patient at the rehabilitation and physical therapy departments at the VA’s James J. Peters Medical Center, Bronx, New York.   I am currently benefiting from both acupunture and custom designed physical therapy to reduce pain that one would think the VA hospitals and/or outpatient units would be hiring enough acupuncturists to run clinics 5 days week. 

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