Design and Rationale of a Comparative Effectiveness Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury

Abstract

Background: Exposure to deployment and battle can induce a constellation of physical, cognitive, psychological, and behavioral symptoms, also referred to as war-related Trauma Spectrum Response (wrTSR). One prevalent cause of this response is traumatic brain injury (TBI) and its ensuing sequelae, such as pain and suffering caused by post-traumatic headache. Current pharmacologic treatment of these headaches is often inadequate and complicated by the multi-component nature of wrTSR. Acupuncture has been found to reduce pain, improve health-related quality of life, prevent migraine headaches, and reduce tension-type and chronic daily headaches. Objective: An ongoing study is endeavoring to advance understanding of the speed and depth of healing induced by two acupuncture approaches, compared to current standard practice and with the aim of providing insights to guide future implementation of acupuncture treatment in the military. Design: A comparative effectiveness study protocol will be used to determine if auricular acupuncture (AA) or semi-standardized traditional Chinese acupuncture (TCA) alleviates headaches and reduces associated comorbidities more effectively than usual care alone in a cohort of active duty military personnel with mild-tomoderate TBI. Summary: Given that the study is currently underway, no results or conclusions can be reported at present. While current evidence from acupuncture research demonstrates its promising healing impact across the wrTSR, a number of unanswered questions and information gaps remain. It is hoped that the proposed study will address some of these questions and gaps.

Use of Integrative Medicine in the United States Military Health System

“…Evidence is mixed but overall positive for treatment of PTSD and currently insufficient for treatment of TBI [ 28 , 56 , 73 ]. Techniques known in use within the MHS include dry needling, modified Chinese acupuncture, meridian-based French technique, scalp acupuncture, tendinomuscular acupuncture, moxibustion, and electrical stimulation [ 74 – 76 ]. Of particular interest in the MHS is an auricular technique known as “battlefield acupuncture,” in which small pins are placed into the ear, frequently to control pain [ 77 , 78 ].…”

Acupuncture in Military Medicine

“…Finally the review mentioned an exploratory, randomized study to examine the effectiveness of acupuncture for TBI related headache in an active duty population at Walter Reed National Naval Medical Center that began in 2011 [56]. Of particular interest is the design of this study which will compare a standardized ear acupuncture technique (developed by a medical acupuncturist) to an individualized, semi-standard acupuncture protocol (developed by a licensed acupuncturist and psychiatrist) [57]. While headache is the primary outcome of this study additional secondary measures examining sleep, stress, depression, and anxiety will be collected.…”

Acupuncture and Meditation for Military Veterans: First Steps of Quality Management and Future Program Development

“…Acupuncture originated in China more than 2500 years ago and is one of the oldest, most frequently used medical procedures in the world. 9 It is defined as a Chinese medical procedure that treats illnesses and provides symptom relief by inserting needles at specified sites on the body. 9 The WRIISC-DC acupuncture clinic includes individual and group auricular acupuncture.…”

“… 9 It is defined as a Chinese medical procedure that treats illnesses and provides symptom relief by inserting needles at specified sites on the body. 9 The WRIISC-DC acupuncture clinic includes individual and group auricular acupuncture. Individual acupuncture involves an individual session with a licensed acupuncturist trained in the Worsley 5-element model.…”