By Vivian Ly, DC
As a part of my chiropractic residency, I have been exposed to different treatment options for veterans with acute and chronic pain. These include, but are not limited to, cognitive behavioral therapy, pharmaceutical drugs, interventional pain procedures, and battlefield acupuncture (BFA). In this blog post, I will focus on BFA. During my student clerkship, I was briefly introduced to BFA but since the start of my residency, I have learned much more about BFA as a non-pharmaceutical pain-reduction option for veterans with acute and chronic diagnosed pain.
In 2001, Air Force Colonel Richard Niemtzow introduced the BFA protocol as a subset of auricular acupuncture. 1 In 2013, $5.4 million was awarded to the Departments of Defense (DoD) and Veterans Affairs (VA) to teach BFA to healthcare providers in both the military and department of Veterans Affairs and assess it. BFA is easily learned and has been proposed to treat a variety of conditions that cause pain in active military members and veterans.2
In 2001, Air Force Colonel Richard Niemtzow introduced the BFA protocol as a subset of auricular acupuncture. In 2013, $5.4 million was awarded to the Departments of Defense and Veterans Affairs to teach BFA to healthcare providers in both the military and department of Veterans Affairs and assess it. BFA is easily learned and has been proposed to treat a variety of conditions that cause pain in active military members and veterans.
The BFA protocol uses a sequential series of five specific acupoints in each ear–cingulate gyrus, thalamus, omega-2, point zero and shen men. Rather than traditional acupuncture needles, Aiguille Semi-Permanent (ASP) needles are used at each of the listed points. ASP needles are short gold-plated studs that are shaped like a dart and are designed to stay in the ear for several days.3 After an ASP needle is inserted in each point, the patient is asked to ambulate and his or her pain is reassessed. All five points on each ear are completed unless the patient experiences resolution of pain or requests cessation for other reasons. The small gold-plated ASP needles are left in the ear and fall out by themselves, generally between two and seven days. The materials costs roughly $5.2 BFA is indicated in adults with diagnosed acute or chronic pain and is contraindicated in patients who are or might be pregnant, have an aversion to needles, or have an active infection in an each which is being treated. Common adverse events include transient euphoria, local discomfort, transient lightheadedness. Rare adverse events include infection.
Few studies have investigated the auricular acupuncture physiologic mechanism of action and further research is needed to gain a greater understanding of the effects.3 Evidence for the efficacy of BFA is limited, though a recent pilot study was published concluding the short-and intermediate-term beneficial effects of BFA on chronic pain is clinically meaningful. In this pilot study, 112 veterans received BFA during a shared medical appointment within a VA primary care practice. Each patient’s baseline pretreatment self-reported pain level was recorded using the Defense and Veterans Pain rating scale, with a pain score of 1 to 10 and post-treatment pain scores were taken days 0, 1, 7, and 30. At posttreatment day 1, 80.7% of the patients continued experiencing decreased pain, whereas 52.4% and 51% reported a sustained decrease in pain at days 7 and 30. Additionally, although a majority of patients benefited from pain decrease immediately after treatment, the decrease was more sustained in patient with higher baseline scores. The results show that BFA is highly effective for short- and intermediate-term pain reduction and may continue to provide relief over the longer term in a smaller subset of patients. Limitations of this study include: patients were not randomized to the intervention and it is likely that those who received the treatment were favorably disposed toward acupuncture and therefore more likely to experience a positive result. 1 Still, more rigorous investigation is needed before widespread dissemination occurs.2
Though further investigation needs to be done, BFA is a relatively new and lesser known treatment option for acute and chronic pain that is being utilized in the DoD and VA.
Dr. Ly is the 2018-2019 Connecticut VA chiropractic resident. She graduated from Palmer West College of Chiropractic in March 2018 as valedictorian and earned the Clinical Excellence Award. Dr. Ly grew up in San Diego and went to University of California, Irvine, for her undergraduate education.
1. Federman DG, Radhakrishnan K, Gabriel L, Poulin L, Kravetz J. Group battlefield acupuncture in primary care for veterans with pain. South Med J 2018;111:619.
2. Federman DG, Gunderson CG. Battlefield acupuncture: is it ready for widespread dissemination? South Med J 2017;110:55–57.
3. Heather C. King, Anita H. Hickey, Cynthia Connelly; Auricular Acupuncture: A Brief Introduction for Military Providers, Military Medicine, Volume 178, Issue 8, 1 August 2013, Pages 867–874.