Veterans seeking care at the Providence VA can now sign up for acupuncture treatments. It’s just one of several new alternative medical therapies offered at the VA to try to address pain and mental health.
That’s significant at a time when questions are being raised about the VA’s heavy reliance on addictive prescription painkillers. For this week’s The Pulse, we learn more about an alternative therapy that’s helping one vet cut down on medication.
We’re in the Providence VA’s primary care clinic. It’s a warren of exam rooms and in one of them, a physician gets ready to provide a special treatment to alleviate a patient’s back and ankle pain.
“I’m Paul Pirraglia , I’m the chief of primary care here at the Providence VA. A number of providers, myself included, learned how to do this particular technique, which is called battlefield acupuncture.
That’s right. Battlefield acupuncture. You may have heard of the second part: acupuncture, which is part of traditional Chinese medicine. It’s mainly used for pain relief. And it involves sticking slim needles into the skin at specific points on the body. The traditional Chinese explanation is that it manipulates a patient’s qi (chee), or life force, and gets everything back in balance. You can do it in a doctor’s office. But…on the battlefield? Pirraglia says, why not?
"Battlefield acupuncture was developed by an air force physician. And the idea is to harness the fact that there are qi points available on a soldier in the field, at least on their ears which are often exposed. The idea was that this could be a battlefield application for pain management.”
It might be startling to hear a VA physician talking about qi. Pirraglia says he’s no expert, but he’s totally on board with the technique because he’s seen it work. He’s been offering it to his patients for about six months now. Many of them are like Harry Garcia, an Army veteran who’s been living with chronic ankle and back pain. He’s here for his twice monthly treatment.
“I’ve been on pain management medication now going as far back as January of ‘05," says Garcia. "I was getting ready for deployment overseas when I got hurt which unfortunately required me to have numerous surgeries.”
Garcia hops up onto the exam room table as Pirraglia gets the acupuncture needles ready. Garcia says all the ankle and back surgeries – stemming from what started as a simple injury – left him with debilitating pain. Right now, on a scale of one to 10, it’s at a seven.
“I’ve been on pain medication, all kind of pain medication, for a very long time now," Garcia says. "And it’s to the point where you’re just tired of taking pills. Pills and pills.”
Garcia is not unusual. Opioid prescribing is high in the VA. The Center for Investigative Reporting found that prescriptions for painkillers like Oxycodone and Hydrocodone had actually climbed in 2012. That’s problematic for some patients who could become addicted. Indeed, the National Institute on Drug Abuse reports that prescription drug abuse is higher among veterans than the civilian population.
Patient Harry Garcia says the high doses of opioid painkillers he’s been on have made him feel like a zombie. Now, he wants to step it down. And his doctor thinks he can help do more than just wean him off.
“When Dr. Pirraglia suggested battlefield acupuncture , what went through your mind?" I ask.
“Let’s do it. Just like that," says Garcia.
“Alright, so we’ll get started," says Dr. Paul Pirraglia. He swipes Garcia’s ear with alcohol. Then he shoots a short, gold-plated acupuncture needle about the size of a small earring stud into the top of Garcia’s ear. Unlike some kinds of acupuncture needles, these are meant to stay in for a few days.
“OK. Let’s walk," Pirraglia tells Garcia. Then he explains to me: “Part of the process is after each needle the patient walks. The idea is that it stimulates the qi.”
Pirraglia says that was part of the training, and he believes it’s effective. Not just for stimulating qi, but watching a patient’s gait change as the pain subsides. Garcia comes back around the corner from his walk, and Pirraglia asks about his pain now.
“So where are you at now?"
“Six and a half. So usually it starts to work right away. It’s awesome.”
So remember, Garcia started at a seven out of 10. After one needle in the ear, it’s at a six and a half. This is no scientific measure of course, but Garcia’s own assessment of how he feels. And with each of the 10 needles total that Pirraglia puts in, Garcia’s pain score drops another half point.
“Where are you at?”
BY the time the 10th and final needle is in - “Good, that’s the last one. Alright, let’s walk" - this one in the center of the ear, Garcia’s feeling good.
“Where are we at?”
“Two and a half.”
So are alternative therapies like meditation or battlefield acupuncture the answer to getting thousands of vets off of some very high doses of prescription painkillers? Not necessarily. Reporter and editor Katie Drummond covered the military and alternative medicine for Wired Magazine. She says they’re nice supplements, but the VA system has some bigger problems to solve.
“There are wait lists for soldiers waiting to see psychiatrists and psychologists at VA clinics who can’t get in for a year in a half. Is it really going to make a difference that they can take a yoga class once a week?" Drummond says. "I mean some of these people are tremendously injured. They’re depressed, anxious, they are addicted to very serious medication.”
The Providence VA says wait lists for substance abuse appointments are 30 days or less for most veterans. But it’s been slow to embrace some of the alternative medical therapies, like acupuncture, that have been around the VA for years. Why? Drummond suspects a lack of resources and red tape.
“So I would chalk a lot of it up to not to a lack of desire among people who work at the VA, many of whom care deeply about what they do and care deeply about the veterans," Drummond says, "but just that they are bogged down by this massive institutional bureaucracy that is slow to adapt in certain circumstances.”
Doctor Paul Pirraglia says a lack of time and people definitely hinder his ability to implement new programs faster. But he says the VA in Providence is trying to offer more alternative therapies, like mindfulness meditation. And the center has tried to beef up addiction and mental health services. What’s more, Pirraglia says, the VA is working across the system to curb an over-reliance on prescription painkillers. For Pirraglia though, it’s one patient at a time. He’s helped Harry Garcia taper his medications down by about half, and the goal is to keep going.
Harry Garcia is getting ready to leave the exam room. Five acupuncture needles are firmly placed in each ear. They’re tiny gold balls, about the size of a grain of rice. The pain relief is not permanent, but it’s not fleeting either.
“And it lasts about five to seven or eight days," says Garcia. "They stay there. They usually fall out on their own.”
Garcia says that between treatments, he still relies on pain medications, but much less than before he started. He hopes to get down to zero pills someday soon.