Healing Combat Trauma

Combat Veterans, PTSD and Acupuncture

We've written about acupuncture before on this blog, in posts linked here. And an article in the current issue of "Acupuncture Today" magazine (May, 2009) discusses -- tangentially -- the use of acupuncture for PTSD.  It especially emphasizes the costs savings, particularly when used as a form of pain control (a typical use of traditional acupuncture, known as TCM). Here's a story, though, that shows the human side of acupuncture's worth for a combat veteran.

Recently I met a Marine who was part of a wounded warriors unit.  I won't say who he was or where he was located, to protect his privacy, but he had completed several hazardous deployments in Iraq and had come back to the Marine base to continue his service. I happened to learn that he sampled a few modalities from the "complementary and alternative medicine" spectrum we've discussed on this blog before, and one of the therapies he'd tried was acupuncture.  I happened to catch him in an unguarded moment, when he had his mind on other things (what amount to pain control, at the time) and I asked him to describe his experience, because I wasn't sure who he'd seen or what type of acupuncture it had been.  He described that he'd been interested in checking it out, but that the commanding officer  had considered it to be some form of "voodoo," so was pretty much against it.  But there was one acupuncturist from the town near the base who was willing to come on base and offer it, and do that for free.  So that removed some of the initial barriers to trying it, and the commander okayed it.  With those circumstances in mind, I asked him what his experience was like.  This is what he said:

"After she stuck me (needled me), I went back out to my truck, and I just sat there, for about an hour and a half, just GLOWING (his words.)."  His eyes moistened briefly as he said, "I realized it was the first time I had felt happy in two and a half years," he volunteered, continuing, "I had forgotten what it was it like to feel real joy."

I couldn't leave well enough alone -- I had to track down the acupuncturist he'd seen.  I figured out who she was, called her up, she answered the phone, we identified him as the patient in question, and then had a brief conversation about what he'd shared.  She told me she had goosebumps from hearing the story, which she hadn't known before, and added, "this is why we do what we do."

With all the lip service -- and, one hopes, quite a bit more than that -- these days being paid to treating combat veterans in more comprehensive ways that meet their needs better, I hope ancient methods will merit due consideration.  When I remember this short conversation with the very much moved Marine, it's hard not to appreciate its merits. Neatly, there are several types of acupuncture -- one which specializes in addiction treatment, one which focuses on treating body, mind and spirit, and a general, all-pupose form (along with many others).  With many offerings to choose from, and increasingly more research to support its efficacy, acupuncture truly deserves a place at the table in treating the hidden wounds of combat veterans.  I have only to remember the glow in this Marine's retelling of his experience to remember why.

Vietnam Veteran Turns to Acupuncture, Qi Gong and Yoga for Relief from PTSD

We've been discussing various forms of Complementary and Alternative Medicine, or "CAM" for short, which seem to have potential therapeutic usefulnessness for treating PTSD.  Here's a mention in a recent article in the Salt Lake Tribune of March 14, 2008, of other Eastern methods, including the energetic medicine, "Qi Gong," which appear to have brought some relief to one Vietnam war-era nurse.  From an article by Matthew D. LaPlante:

Mary Jane Shipley is a 62-year-old former trauma nurse who was stationed at a mobile Army hospital in Vung Tau, Vietnam. 

Shipley's "eyes well with tears," LaPlante writes, at the recollection of the young men she watched die there, burnt and broken and missing pieces of their bodies as they faded away." 

He continues, "Shipley says she knew almost immediately after returning home there was something wrong with her. In part, it was the helicopters. She could hear them, even smell them, ferrying patients to the Salt Lake City hospital where she worked - sometimes minutes before any of her associates could."

Her other symptoms are hallmarks of PTSD: "She had trouble relating to other people. She was restless. She was constantly afraid. Perhaps to the eyes of today's doctors and nurses, Shipley's illness would have been obvious. But back then, no one reached out."

In Shipley's case, according to LaPlante, "It took her 30 years to realize she wasn't alone. Now in treatment for post-traumatic stress disorder, the Western-trained nurse has found Eastern therapies to be most helpful. She practices yoga and qigong. And at least twice a week, she undergoes acupuncture. "It took me so long to figure out what works for me," Shipley laments, "and I still have so much trouble."

In Honor of Veterans Day: Community Acupuncture Clinics for Veterans

In honor of Veterans Day, Acupuncture without Borders is holding community acupuncture clinics for veterans in the following cities:

Newark, CA;

West Los Angeles, CA;

Stamford, CT;

Ft. Lauderdale, FL;

St. Augustine, FL;

St. Petersburg, FL;

Tamarac, FL;

Boston, MA;

Cambridge, MA;

Albuquerque, NM;

Santa Fe, NM;

Carson City, NV;

New York, NY;

Glenside, PA;

McLean, VA;

Longview, WA;

Seattle, WA; and

Racine, WI.

For more information on these clinics, click here.  NOTE: Do not assume that they are each being held on Veterans Day itself.  Most are held on a day either before or after, so check the schedule first several days in advance by clicking the aforementioned link.

Editor's note: For more on why acupuncture might be a suitable or interesting treatment modality for combat trauma and/or PTSD, click here.

Acupuncture Without Borders: Treating Veterans, Addressing Trauma

An organization called "Acupuncturists without Borders," (after the organization of doctors called Medicins Sans Frontiers) has been treating veterans and their particular concerns regarding combat trauma and PTSD.  Says one veteran:

“I served two tours of combat in Vietnam. I’m 100% disabled because of PTSD. When I first started coming to the AWB clinic in Albuquerque, I had spent years suffering from high anxiety. I believe that because of the acupuncture I have become calmer and my anxiety has drastically come down. I don’t want the new vets to suffer for years like I did. Acupuncture is helping me get my life back.” -- Raul Rojas

Richard H. Thompson, a four star general (retired), adds, "I have participated and believe it can help. I fully support the efforts of this organization."

According to Acupuncture without Borders, veterans acupuncture clinics are currently open in the following cities: Fort Myers, Florida; Warm Mineral Springs, Florida; Chicago, Illinois; Portland, Maine; Framingham, Massachusetts; Grants Pass, Oregon; Portland, Oregon; Madison, Wisconsin; Portland, Maine; Portland, Oregon; Rochester, New York; Rockland, Maine; Albuquerque, New Mexico; Pojoaque (Santa Fe area), New Mexico; Times Square, New York City, New York; and Stevens Point, Wisconsin; with future acupuncture clinics for veterans pending in Arlington, Massachusetts; Ann Arbor, Michigan; Ithaca, New York; New York City, New York; Charlotte, North Carolina; Philadelphia, Pennsylvania; and others.

For a list of the currently operating veterans acupuncture clinics, click here.

If you're an acupuncturist who wants to become involved, there are future trainings scheduled in Albuquerque, Los Angeles and Orlando, Florida, in the coming months.  Click here for a list of the trainings.

For a link to the organization itself, click here.

Getting Stuck to Get Unstuck: Army Studies Acupuncture for PTSD

An article from March 6, 2008 talks about the "Army PTSD Study on Track to Present Findings This Year."

Findings from a study on the effectiveness of acupuncture as a treatment for PTSD among military personnel may be reported later this year, according to research officials at the US Army’s prestigious Walter Reed Medical Center in Washington, DC.

According to the government web site www.clinicaltrials.gov initial report on the study, untreated PTSD “leads to decreased force readiness and increased health care utilization. Yet, service members with the disorder may be resistant to traditional treatments or find them undesirable because of side-effects, stigma, and long-term commitment.

“Acupuncture, which has few known side effects, holds promise as an effective treatment option for PTSD. Acupuncture has been shown to improve well-being and has been successfully used to treat stress, anxiety and pain conditions.”

Col. Charles C. Engel , principal investigator of the project, reports that data collection and primary statistical analysis have been completed and secondary analysis is currently underway. He says that the project intends to report data at upcoming professional conferences. These include the Force Health Protection conference in Albuquerque and the International Society for Trauma Stress Studies (ISTSS) in Chicago.

According to the web site, the project was intended to enroll up to 75 subjects, all active duty personnel. Researchers were to gauge the subjects’ PTSD status and response to treatment with the PTSD Checklist during a 12-week, randomized, waitlist-controlled trial. Participants were to receive an eight-session course of acupuncture treatment, and were to be evaluated throughout the study by way of clinical assessments and an independent assessing acupuncturist.

According to the study staff, all subjects were to receive a standardized protocol, based on Chinese medicine principles, for “clearing and calming” during the first four treatment sessions. During the fifth through eighth sessions, individualized treatments were to be given according to Chinese medicine diagnosis. All acupuncture services were to be performed by licensed acupuncturists who were graduates of the TAI Sophia Institute located in nearby Laurel, Maryland.

Marjorie Shovlin, a licensed acupuncturist in Washington, DC, was one of the acupuncturists providing treatment during the 18-month study period. She gave a presentation on the study methods and goals at the 18th annual NADA conference in May of last year.

Jagged Little Pill: Pain, Chronic Pain, Pain Control, Pain Management and PTSD

I feel like I'm a little late to the party on this one, because I'm not clear yet why chronic and/or excruciating chronic pain would be a hallmark of PTSD, but according to the veterans I know, it's one of the most difficult conditions they face.  So, obviously, one worth discussing and learning more about.

The VA's site has some information about chronic pain and PTSD linked here, but it seems like fairly generic information, and not much of it is related to combat trauma specifically.  So I guess we need to "tie a string" around this topic and come back to it, when we learn more.  My guess is there's something about "adrenaline gone wild" in combat that sears these graphic memories into the body as a form of pain, and then the pain gets "refreshed" whenever the adrenaline gets refreshed.  Obviously, this is pretty rudimentary (and possibly even, completely wrong...) but, stranger things have happened; and I've personally heard odder things from medical specialists who later just threw in the towel on things that weren't as obvious as they seemed at first.

Certainly there are landmark books in the Mind-Body Medicine spectrum of approaches, such as the "The MindBody Prescription: Healing the Body, Healing the Pain," by John Sarno, M.D., (recommended by Andrew Weil, M.D.); and "Wherever You Go, There You Are: Mindfulness Meditations in Everyday Life," and other books written by Jon Kabat-Zinn, Ph.D., that address mindfulness meditation as a coping strategy for chronic pain (whether physiological or psychological in origin.) (Patience Mason's husband, Vietnam veteran Robert Mason, the author of Chickenhawk, apparently thinks Zinn's work is great.)  And there are other forms of "energetic medicine" (e.g., acupuncture, in particular) are good at lessening the experience of pain so that it can be managed, sometimes also reducing the source. 

And on the topic of is pain really the enemy, or is it more likely actually part of us -- there's almost nothing better than the Claude Anshin Thomas quote, excerpted from his book, At Hell's Gate: A Soldier's Journey from War to Peace, that we blogged about back in March of 2006.  If you're not familiar with what he said, go here and read that entry.  His perspective is sensational, and as often-wounded Vietnam veteran, his experience counts on this matter.

So it will be interesting, over time, to see where this goes, and take a look at "different strategies that might work" for pain control and pain management.  All I know for sure, from the veterans I've talked to, is that it's a MUST to cover, because it's a crucial, nonstop, searing reality of their lives.  And that's nothing to take lightly.

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

We're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

Army Broadens View of Possible PTSD Therapies, Includes Complementary and Alternative Medicine

A Military.com article published on May 29th reports on the U.S. Army's increasing openness to non-traditional therapies to treat PTSD.  The article by Bryant Jordan is called, "East Meets West in Army Mental Therapy," and it quotes Col. Elspeth Ritchie on the Army's increasing openness to options beyond traditional counseling and medication, to include items like yoga, acupuncture, meditation, and of course, virtual reality. The headline is positive, but in truth, the Army may be taking only baby steps towards including nontraditional therapies, often known as Complementary and Alternative Medicine (CAM).

(Some "definition of terms" is in order.  "Alternative medicine" means treatment choices other than conventional medicine, to be used instead of conventional medicine; "complementary medicine" means treatment choices to be used in addition to conventional medicine -- so the term "CAM," or "Complementary AND Alternative Medicine" is meant to be inclusive of both approaches.  This ends up being an important distinction, because responsible M.D.s are often more in favor of patients adding complementary therapies in to their treatment protocol, rather than replacing a conventional treatment protocol with fully alternative therapies. "Complementary" is misspelled in the Military.com article as "complimentary," which further confuses the terminology.) 

The article states that "Therapies that are "kind of tried and true" remain at the forefront of treating Soldiers with behavioral problems, [Col.] Ritchie said. These include behavioral therapy and exposure therapy -- where patients are "exposed" by degrees to scenarios that may be at the core of the problem -- and medication."  And it further quotes Col. Ritchie as saying that although CAM therapies "are interesting, we don't have the hard data to show which therapies are useful for what population. So we're really in the research phase of this for yoga, acupuncture and some other therapies."

The Military.com article is linked here.  A previous article by Noah Shactman in Wired magazine on March 25 discussed similar material, and mentions a Department of Defense grant opportunity with a closing date of May 15, providing $4 million in funds to study therapies with possible benefits for PTSD and/or TBI, including but not limited to "music, animal-facilitated therapy, art, dance/movement, massage therapy, EMDR program evaluation, virtual reality, acupuncture, spiritual ministry, transcendental meditation, yoga and other novel approaches."  (The grant opportunity announcement is linked here.)  According to the Wired article, reading from the grant application, the Army is willing to contemplate as well the potential effectiveness of "biologically-based treatments, botanicals, and nutritional supplements for enhancing cognitive function and mood in patients with trauma spectrum disorders, including TBI and/or PTSD, depression, anxiety, and/or substance dependence/abuse," and adds, "Even proposals for wild-sounding "therapies using bioenergies such as Qi gong, Reiki, distant healing and acupuncture" would be accepted."  The Wired article is linked here.

I'm unclear whether the Army is leading the way of all the military branches in considering the potential of CAM for PTSD; but whether it is or isn't, kudos to it for being reasonably open-minded.  One of the problems that seems to keep coming up with PTSD is that no one obvious choice comes up in treating it, that works every time.  There are a variety of pharmaceutical drugs that are prescribed, but no one remedy in particular appears to be the wonder drug, or cure-all.  (You hear the frustration about this when you listen to the stories of combat veterans who are taking a handful of pills to combat PTSD, sometimes as many as 20 or 30 separate medications - a scary cocktail, indeed.)  Other approaches for PTSD, such as talk therapy, cognitive therapy, EMDR, etc., all have their place in the pantheon of treatments, and each has their adherents/proponents, but again, there doesn't seem to be a one-size-fits-all, cure-all for PTSD.  In the absence of the medicinal "silver bullet" that cures all PTSD, it's great that the Army is at least embracing the concept of possible adjunct therapies, while asking them to prove themselves clinically, as much as possible.

In the following weeks, we will report on complementary and alternative therapies that appear to have some benefit in treating PTSD; in addition to the more mainstream approaches that are already in use.  (Virtual reality is another type of treatment entirely: dependent on technology, it doesn't fit the typical rubric of CAM, nor should it.)

Acupuncture May Help PTSD Sufferers

Acupuncture May Help Symptoms of Posttraumatic Stress Disorder

A pilot study by researchers at the University of Arizona's Department of Psychiatry shows that acupuncture may help people with posttraumatic stress disorder. Posttraumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.

Michael Hollifield, M.D., and colleagues conducted a clinical trial examining the effect of acupuncture on the symptoms of PTSD. The researchers analyzed depression, anxiety, and impairment in 73 people with a diagnosis of PTSD. The participants were assigned to receive either acupuncture or group cognitive-behavioral therapy over 12 weeks, or were assigned to a wait-list as part of the control group. The people in the control group were offered treatment or referral for treatment at the end of their participation.

The researchers found that acupuncture provided treatment effects similar to group cognitive-behavioral therapy; both interventions were superior to the control group. Additionally, treatment effects of both the acupuncture and the group therapy were maintained for 3 months after the end of treatment.

The limitations of the study are consistent with preliminary research. For example, this study had a small group of participants that lacked diversity, and the results do not account for outside factors that may have affected the treatments' results.

Michael Hollifield, Nityamo Sinclair-Lian, Teddy D. Warner, and Richard Hammerschlag, "Acupuncture for Posttraumatic Stress Disorder: A Randomized Controlled Pilot Trial." The Journal of Nervous and Mental Disease, June 2007.

Acupuncture and Healing Trauma

The University of New Mexico is studying acupuncture and Post-Traumatic Stress Disorder (PTSD).  An article on the ongoing study is linked here.

An excerpt from the article follows:

Researchers at the University of New Mexico are continuing work on a $250,000 two-year study of the effects of acupuncture in treating PTSD. The study, which began in May, was made possible with a grant from the National Institutes of Health. If successful, it could lay the path for larger trials that incorporate Eastern and Western approaches to treating the condition.

"This is the first study I'm aware of to look at acupuncture as a modality for PTSD," said Dr. Michael Hollifield, an associate professor of psychiatry and family medicine at the university's department of psychiatry and the study's principal investigator. "To date, our research supports using acupuncture for treating PTSD symptoms, including insomnia, anxiety and depression, in addition to some pain disorders. It may do so by stimulating the body's internal opiate system, though much more research on this issue is needed."

Aiding Dr. Hollifield in his research are Nityamo Sinclair-Lian, DOM, and Teddy Warner, Ph.D., who will serve as co-investigators. Drs. Hollifield and Sinclair-Lian collaborated previously on a study on the effects of trauma in Vietnamese and Kurdish refugees. Dr. Sinclair-Lian also runs a public health pain clinic for Vietnamese refugees, and provides acupuncture detoxification for substance users at a local outreach shelter for the homeless.

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Anecdotally, as they say in the medical biz, acupuncture and other traditional healing modalities, are known to offer comfort and relief to numerous health conditions.  We'll list individual acupuncturists here on this blog as we come to learn about ones who are interested in the topic; and in general, check out a comprehensive directory of specialized acupuncturists here, of a type that treats conditions affecting the body, mind and spirit.