Comparative Effectiveness of Acupuncture for Chronic Pain and Comorbid Conditions in Veterans
Abstract
Peer Reviewed Medical Research Program Areas: Acupuncture, post-traumatic arthritis. Chronic pain is the most common medical issue treated in outpatient settings in the United States and is a major medical problem affecting the health of our Soldiers and Veterans. While a number of analgesic medications are in use, they often are insufficient to manage chronic pain effectively. Opioids (e.g., Percocet, morphine) are associated with considerable risk of abuse, dependence, and overdose; non-steroidal anti-inflammatory drugs or NSAIDS (e.g., Motrin, Aleve) are associated with increased risk for heart, kidney, and gastrointestinal diseases; and acetaminophen (e.g., Tylenol) is associated with increased risk for liver disease. There is clearly a need for additional therapeutic approaches to pain management that help minimize risk and expand treatment options for providers and Veterans. Acupuncture is a non-pharmacological approach that has been shown to be effective for chronic pain in nonmilitary populations. We propose a randomized controlled clinical trial titled Personalized Electro-acupuncture vs. Auricular-acupuncture Comparative Effectiveness (PEACE) to evaluate the effects of acupuncture on patient-reported pain (primary outcome), physical functioning, and comorbid symptoms (fatigue, sleep disturbance, anxiety, depression, and post-traumatic stress disorder) among Veterans experiencing chronic musculoskeletal pain (e.g., arthritis, low back pain). The intent of the proposed study is to validate findings on acupuncture from civilian studies in Veteran populations, to understand which type of acupuncture style best addresses pain and pain-related symptoms, and to determine if there is a link between a patient s genetics and his or her response to acupuncture. Preliminary studies conducted by our team have shown that one specific type of acupuncture, known as electro-acupuncture (EA), reduces the severity of pain, increases physical functioning, and reduces the amount of pain-related symptoms (including fatigue, poor sleep quality, and anxiety/depression). EA uses the same principle as traditional acupuncture, but delivers a small, measured electric current via the acupuncture needles, stimulating the tissue around the needle insertion. EA will be compared to Battlefield Acupuncture (BFA), the style of acupuncture that originated in the U.S. military, which applies acupuncture needles to the ear (free of electrical charge). BFA has gained popularity in military settings with good empirical success. During this trial, we will also research how a person s expectation of outcomes and genetic background affect his/her response to acupuncture. Such knowledge will help patients and providers choose the best acupuncture therapy to improve pain and symptom management. Chronic pain is highly prevalent among Veterans and is associated with psychological comorbidities and functional disabilities. There are approximately 9.7 million patients in the Military Health System (MHS) and 5.5 million patients in the Veterans Health Administration (VHA) (approximately 15 million total). As in the civilian community, pain is the most common outpatient complaint in military and Veteran populations. A conservative estimate would be that 1.5 million MHS and VHA patients per year seek care for pain. Over time, a large percentage of the total 15 million patients would be impacted by the findings of our research. Over a period of years, it would not be unreasonable to assume that 6-8 million patients might choose acupuncture at some point in his/her care. Thus, our proposed clinical trial will provide important evidence to guide the personalized integration of acupuncture to improve pain and comorbid symptoms, physical functioning, and quality of life for millions of military personnel and Veterans who suffer from chronic pain.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510245
Entities
People
- Jun Mao
Organizations
- Memorial Sloan Kettering Cancer Center
- United States Army