Pathways to Healing

by Elaine Zablocki

US Troops Benefit from Acupuncture, Yoga, Guided Imagery

During the wars in Iraq and Afghanistan, more than 2.2 million troops have gone into battle, and more than 48,000 have returned home with visible and invisible injuries. Since 2001 Samueli Institute has conducted and funded research on ways to rebuild the health of these returning veterans – and its research has important lessons for all of us.

The Samueli Institute is a nonprofit research organization supporting scientific exploration of healing processes and their role in medicine. Its founder and CEO, Wayne B. Jonas, MD, was the director of the Office of Alternative Medicine at the National Institute of Health from 1995 to 1998. Before that, he served as director of the Medical Research Fellowship at the Walter Reed Army Institute of Research, training a generation of military physicians in rigorous research methodology.

“In more than 10 years of armed conflicts, a large number of the nation’s veterans are exhibiting what I term the trauma spectrum response – an array of symptoms, including pain, anxiety, depression, sleeplessness, excessive drug use and social isolation, resulting from multiple deployments or a battlefield insult, like an explosion or other trauma,” Jonas says. “These symptoms often progress to chronic conditions, like posttraumatic stress and chronic pain.”

Samueli Institute is conducting research on the effectiveness of drugless, self-care, and integrative practices for treatment and healing of these conditions. “Our research on acupuncture, mind-body, nutrition and self-care approaches with military and veterans has demonstrated that these practices can help heal and reset veterans to optimal well-being and function,” Jonas says. “Most of these people and families are young, with a long battle for recovery in front of them. Samueli Institute believes that by providing unbiased evaluations of the science of healing and building coalitions with partners like the US military to convert science into action, we can help create a flourishing society.”

Acupuncture is one modality that has been used informally in the military for a considerable time by physicians with appropriate training. Considerable research shows its effectiveness. Battlefield Acupuncture, developed by Richard C. Niemtzow, MD, PHD, MPH, in 2001, is a simplified five-point ear acupuncture technique; one study found that it reduced pain by 23%. “The advantage is that you can use this method in a situation where you don’t have much time and don’t have access to the full body. You can provide non-narcotic pain relief very, very rapidly,” says Kevin Berry, MD, Samueli Institute vice president of military medical research.

Recently the Department of Defense/Veterans Administration Joint Incentive Fund approved $5.4 million in funding to the military to teach and evaluate Battlefield Acupuncture over a two-year period. “The technique is now being implemented throughout the Army, Air Force, Navy, and VA through a ‘train the trainer’ program,” Berry says. “The funds will cover all the logistical and training requirements for military medical providers.”

Yoga and Guided Imagery Effective for Veterans

It’s estimated that 1 in 5 veterans of the Iraq and Afghanistan wars returns home with post traumatic stress disorder (PTSD). A recent New Yorker article on returning veterans and the challenges that they face clarifies just what posttraumatic stress means in this context. It is the recurrent, intrusive memory of extreme physical events and also extreme emotional and moral events. Seeing people die suddenly, their bodies torn apart. Split-second decisions wherein your actions may damage others for life. Killing people. Surviving when your buddies were killed.

In evaluating treatment options, we must always be aware of the complex nature of the injuries, Berry observes. “A pain scale is arbitrary; it doesn’t speak to function,” he says. “In many cases, pain has a cognitive or memory component, which is difficult for people to describe and differentiate. If you ask someone how much pain they’re in, they usually can’t analyze how much pain is due to physical injury and how much to spiritual trauma. Guided imagery is an excellent example of a modality that can help a person recover from stress and trauma, without requiring a detailed history first.”

One recent study, a collaboration between Samueli Institute and the Scripps Center for Integrative Medicine in San Diego, looked at guided imagery and healing touch in returning active duty marines with PTSD. Half of them received six sessions with a Scripps practitioner during a three-week period, while the control group received usual treatment. Those who received the complementary therapies reported a significant improvement. “Scores for PTSD symptoms decreased substantially, about 14 points, and below the clinical cutoffs for PTSD,” says Mimi Guarneri, MD, principal investigator. “This indicates that the intervention was not just statistically significant, but actually decreased symptoms below the threshold for PTSD diagnosis.”

In 2007, Samueli Institute supported a pilot study at the Walter Reed Army Medical Center to determine whether Yoga-nidra could reduce PTSD symptoms in military personnel. Yoga-nidra is a self-care practice that focuses on reducing physical, emotional, and mental tension through body scanning and deep breathing. It is practiced while lying on the back, so no yoga poses are required, making it especially suitable for soldiers with combat-related PTSD symptoms.

The study showed a decrease in symptoms, and garnered favorable anecdotal comments from study participants, such as “It is easier to get to sleep and I sleep longer,” and “I feel more accepting of situations in my life that I cannot control.”

Lessons Learned from the Military Experience

On first thought, it may seem surprising that the military is pioneering the use of complementary and alternative modalities in new settings. On second thought, it makes sense that organizations facing substantial needs under time and financial pressure are ready to explore new approaches.

“The overarching message here is that finding what works takes precedent over anything else,” Berry says. “The military today crosses racial lines, gender lines and cultural lines. We need to embody the best of diversity, and we need a diversity of options to help restore and heal. When a relatively short course of narcotics can knock out pain and allow the individual to heal, that’s great. But we know that isn’t true in all situations, so we need alternatives available, particularly when the stakes are high.”

Samueli Institute research has found that the practice of mindfulness is an effective healing support for a wide variety of conditions. “Being aware of themselves in the moment, taking time to be present and not overwrought with the future or past, seems to release an innate capacity to heal,” Berry says. “It improves cognitive function. It calms down sympathetic overtones. It modifies and mediates inflammation … it is quite a powerful tool.”

Berry reminds us that military medicine is held to an exceptional standard. “People who put on a uniform do so voluntarily, for the safety and preservation of our country,” he says. “When they are sick or injured, there really is a moral imperative that we provide what is helpful. If it comes from a ‘nonstandard’ perspective or philosophy, that doesn’t matter. What we are interested here at the institute is finding hardcore evidence on what really works.”

Resources

www.SamueliInstitute.org.

For a continuing survey of military and other research on the effectiveness of CAM therapies, see more than 300 peer-reviewed journal articles from Samueli Institute in a searchable database at: http://www.samueliinstitute.org/knowledge-center/publications/journal-publications.

Finkel D. The Return: the traumatized veterans of Iraq and Afghanistan. New Yorker. September 9, 2013. Available at http://www.newyorker.com/reporting/2013/09/09/130909fa_fact_finkel.

Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She writes regularly for many health-care publications.