Use of Integrative Medicine in the United States Military Health System

Abstract

Integrative medicine (IM) is a model of care which uses both conventional and nonconventional therapies in a “whole person” approach to achieve optimum mental, physical, emotional, spiritual, and environmental health, and is increasingly popular among patients and providers seeking to relieve chronic or multifactorial conditions. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature “polytrauma triad” of chronic pain, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture, chiropractic, and mind-body techniques. These are of particular interest for their potential to relieve symptoms without relying on opiates, which impair performance and show high potential for abuse while often failing to provide full relief. This review describes the use of IM in the MHS, including definitions of the model, common therapies and potential for use, and controversy surrounding the practice. More research is needed to build a comprehensive usage analysis, which in turn will inform sound clinical and financial practice for the MHS and its beneficiaries.

<p>The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain?</p>

“…41 Integrative medicine, a holistic model of care which aims to selectively combine the exclusively evidence-based complementary and alternative therapies into conventional medicine, 42 has risen in popularity in recent years among patients and medical providers for the relief of chronic or multifactorial conditions such as CNCP. 43 It is a combination of medical treatments such as acupuncture, massage relaxation techniques, healing touch, etc. 44,45 Clinical studies have shown that acupuncture is a reasonable effective option for multiple chronic pain conditions.…”

“…46 There is a rising interest in using acupuncture for CNCP instead of reliance on opioid analgesics. 43 The substantial basic knowledge development on pain and its therapies has led to the CNCP guidelines being updated, 14,[18][19][20][21]47 while the WHO three-step analgesic ladder has remained unchanged.…”

A nature-based health intervention at a military healthcare center: a randomized, controlled, cross-over study

“…Complementary and ancillary interventions may enhance the success of efforts to promote better physical and mental health, and quality of life for military service members (Madsen, Vaughan & Koehlmoos, 2017). Among ancillary programs, many involve outdoor activities (Stigsdotter et al, 2011) such as sports (Caddick, Smith & Phoenix, 2014;Caddick, Smith & Phoenix, 2015;Marchand et al, 2018), horticulture (Gorman & Cacciatore, 2017;Lehmann, Detweiler & Detweiler, 2018), nature adventure (Gelkopf et al, 2013;Hyer et al, 1996), equine and other animal therapies (Fine & Beck, 2015), and spending time in nature (Poulsen, Stigsdotter & Davidsen, 2018;Poulsen, Stigsdotter & Refshage, 2015;Wagenfeld, Roy-Fisher & Mitchell, 2013).…”

Acupuncture: Bridging the Gap Between the Military and Veterans' Health Systems

“…A total of 23 integrative therapies across 15 modalities are reported in use across the MHS, ranging from clinical standards such as cognitive-behavioral therapy, to body-based techniques such as chiropractic and yoga, to various mindfulness and meditative exercises. 18 Similarly, like the situation in the VHA, these therapies are not standardized across treatment facilities, and efforts to increase access are frequently patient-driven. 18,19 Taken together, this comparison of the VHA and the MHS shows multiple opportunities for acupuncture to serve as a point of crossagency capacity building, knowledge sharing, and care standardization.…”

“…18 Similarly, like the situation in the VHA, these therapies are not standardized across treatment facilities, and efforts to increase access are frequently patient-driven. 18,19 Taken together, this comparison of the VHA and the MHS shows multiple opportunities for acupuncture to serve as a point of crossagency capacity building, knowledge sharing, and care standardization. While the DoD has provided leadership for several bridging efforts, including the DVCIPM, DVBIC, the ATACS program, and the Pain Management Task Force, the VHA holds significant resources in the Integrative Health Coordinating Center.…”