BAMBERG, Germany -- Health care, as defined by Merriam-Webster's dictionary is, "efforts made to maintain or restore health especially by trained and licensed professionals." Webster's online dictionary further describes alternative medicine as "the practice of medicine without the use of drugs; may involve herbal medicines or self-awareness or biofeedback or acupuncture."
Within the realm of alternative treatment lies acupuncture, an ancient Chinese practice of using needles inserted in the skin on different parts of the body to relieve pain. Although experts still disagree on the exact physiological process by which acupuncture relieves pain, studies have shown positive quantitative and qualitative results of the treatment.
Army health care providers have been using this ancient Chinese technique for active duty Soldiers downrange for several years, since Air Force doctor Richard C. Niemtzow was credited with developing Battlefield Acupuncture nearly 10 years ago. The healing method is not available to most military community members and TRICARE has yet to approve coverage for acupuncture from off-post providers.
However, times are changing. According to an Army News Service article published June 25, a report released by the Army's surgeon general June 23 recommended more than 100 changes in the Army's health care system.
The article stated that "The Pain Management Task Force's final report, which was initiated by Lt. Gen. Eric B. Schoomaker in August of 2009, addresses the lack of a comprehensive pain-management strategy across the Army, and suggests alternative treatments to medication such as acupuncture, meditation, biofeedback and yoga.
Also noted in the report is the fact that pain management has changed very little since the discovery of morphine in 1805.
"This and further concerns about combining medications in drug therapy have led to an increase in alternative medicine throughout Army health care communities. I believe that the 'spread' going on reflects the fact that more and more physicians are pursuing training in acupuncture," said Lt.Col. Larry R. Patterson, Bamberg Health Clinic commander. "Treatments become more available because of a larger pool of trained physicians."
Warner Barracks is one of a few Army health clinics to respond to the pain-management strategy with the use of auricular acupuncture for mild Traumatic Brain Injury patients. Auricular acupuncture refers to points located on the ears.
Dr. Kuno P. Zimmermann, a licensed acupuncturist who has practiced for more than 12 years, is administering this method treatment.
"Magnets and metal pellets, gold, silver, stainless steel, are preferred over ear needles because they are noninvasive and can be left on for several days," Zimmermann said. "Specialized ear needles, known as asp needles, can also be left in for several days, but carry a small risk of infection which is not worth taking with patients who may be spending extended time periods in relatively unsanitary or outdoor conditions."
Though an approved treatment for mTBI patients, auricular acupuncture has yet to extend to the greater community.
"Currently, the mTBI clinic offers auricular acupuncture only, to mTBI clients only, as an alternative to pharmacological treatments for problems commonly encountered after concussions," Patterson said. "Expansion of the MTBI services to include body acupuncture is not planned, as the physical plant currently cannot accommodate it."
The offering of auricular and/or body acupuncture to the broader Bamberg Health Clinic populations requires management decisions and resource allocations from a higher level, he said.
Dr. Natalia Whitman, a neurologist and medical director of Vilseck's mTBI clinic, is planning on attaining credentials in acupuncture. The research she has seen in the past years has convinced her that this method of treatment would greatly benefit patients suffering a variety of ailments.
Whitman said that often patients receive medications through a pharmacy from multiple providers.
"I'm always looking for something nontraditional," Whitman said. "Many medications may have interactions."
Drugs dealing with neurological issues or prescribed by a behavioral health physician, may interfere or interact with some pain medications, so having drug-free options to manage pain is important, she said.
"I'm trying to avoid interactions with other medications, side effects and for young, Army strong men to remain Army strong," she said.
Whitman is encouraged by findings published in "The American Family Physician." Volume 80, number five of the journal published Sept. 1, 2009 reads, "Acupuncture was found to improve headaches and health-related quality of life when added to medical management in patients with chronic daily headache."
"I plan on expanding to include acupuncture when I receive the classes," Whitman said. "Ninety-eight percent of my patients have headaches."
As policymakers review American health care practices, cutting costs is a top priority. According to a study published by the American Association of Acupuncture and Oriental Medicine, acupuncture and other alternative treatment methods are extremely cost effective. Studies are convincing some medical professionals that implementation of acupuncture could greatly reduce costs and benefit their patients. According to studies, acupuncture saves approximately $15,000 respectively for headaches, lower back and neck pain, each per year, Whitman said.
Acupuncturists still hope to push new legislation to incorporate acupuncture into regular and reimbursed pain treatment. If passed, a new policy, entitled Bill HR 646, could greatly affect availability of acupuncture services in the United States. Issue 51 of "The American Acupuncturist Journal," published last spring, discussed the bill.
"Passage of this Bill HR 646 will provide federally endorsed national recognition of acupuncture as a reimbursable modality when practiced by a licensed acupuncturist," the journal reads. "From this vantage point, acupuncture will become more accessible to the public and health professionals, encouraging integration and utilization where indicated. We found acupuncture to be highly cost-effective...considerably less that the current threshold at the National Institute for Health and Clinical Excellence."
The NICE, according to the article, has a set threshold of cost. Treatment costing below this threshold is considered worth paying for. The determined incremental cost of acupuncture is just a fifth of that threshold amount, well under it. In conclusion, the article read, "A short course of traditional acupuncture for the treatment of lower back pain in primary care confers a modest health benefit. The use of acupuncture care for the treatment of lower back pain therefore appears highly cost-effective."
Until a bill is passed, patients should not expect to see insurance coverage of acupuncture, but those most in need are receiving consideration for care at some Army health clinics.
"A lot of it is a time constraint, if you have a really busy provider," Whitman said. "It's really hard to fit it in the treatment plan."
Multiple doctors at the Landstuhl Regional Medical center are qualified to perform acupuncture and are doing so through the Anesthesia Interventional Pain Management department there. Several other Army mTBI clinics have begun utilizing acupuncture or hope to do so in the near future.