Military tries acupuncture to treat troops for PTSD
New approach making inroads in Western medicine.
Tony Bailes of Austin was in the Army in 2003 when he injured his back in Iraq and tried everything his doctor recommended. Nothing helped. Then, the pain specialist prescribed acupuncture, and two weeks later, "my back pain was gone," he said.
A combat medic, Bailes returned to Iraq for a second tour in 2005 and came home in 2006 with a different kind of pain: emotional anguish, nightmares and insomnia. He was diagnosed with post-traumatic stress disorder, but antidepressants made him feel worse, he said. Again, he turned to acupuncture and recovered, he said. Now he's studying the more than 2,000-year-old Chinese practice of using hair-thin needles for healing and planning to make it his life's work.
Acupuncture is endorsed by many Western medicine practitioners as a treatment for physical pain, and now the therapy along with other Eastern practices, including yoga, meditation and tai chi is slowly making inroads in Western medicine as a treatment for mental pain. The military is leading the pack.
"The military, in many respects, is kind of a front-runner" in using alternative treatments, said Alexandra York, a research associate in military medical research at the Samueli Institute in Alexandria, Va., which studies alternative therapies. "I think it's because of the complexity of the conditions they see. It almost demands that other options be examined."
About 30 to 45 percent of soldiers come home with some mental health problems, said Dr. Marcia Valenstein, an associate professor in the University of Michigan Department of Psychiatry and a staff psychiatrist at the Department of Veterans Affairs Center of Excellence in Ann Arbor. PTSD is one of the most common. A study in this month's Archives of General Psychiatry estimated that as many as 17 percent of U.S. veterans who served in Iraq and Afghanistan have PTSD, which can cause symptoms such as depression and anger.
So far, about 16 programs across the various branches of the military for active-duty troops with PTSD exist or are in the works, offering acupuncture and other alternative treatments along with counseling, said Jerry Wesch, a clinical psychologist at one of the nation's biggest programs, at Fort Hood in Killeen. Since the Fort Hood program started in August 2008, 250 soldiers have gone through it, Wesch said. It was modeled after a program that began at Fort Bliss in El Paso in July 2007, becoming what is believed to be the first comprehensive effort of its kind in the military combining alternative and traditional therapies for troops with PTSD.
After visiting the Fort Bliss program in July 2008, Gen. George Casey, the Army chief of staff, called it "the most innovative program that I've seen," according to published reports.
"We are working on a comprehensive mental health care program for the Army, and I think this … clearly could be a part of that," he added.
On the VA website, a section on PTSD treatments calls cognitive behavioral therapy and medication the most successful treatments. But they don't work for everyone, experts said, and the VA says it is studying Chinese medicine treatments that enable soldiers to stay in the service and return to duty.
The military also saw suicides spiking and knew it needed to do more to help soldiers recover, said Dr. Brian Earthman of Cedar Park, a psychiatrist who also is an Army Reserve major.
"The military acknowledged we were not adequately meeting the needs of the soldiers in terms of PTSD treatment, and we started exploring different treatment options that weren't our previous first-line treatments," Earthman said. "They have ramped up their efforts to better treat PTSD."
In his private practice, Earthman refers some of his PTSD patients to acupuncture but says he knows that he is not the typical among civilian psychiatrists.
"One thing about the military is they are very practical and very pragmatic," Wesch said. "If something looks like it's going to work, if you can demonstrate something works, it's going to be approved."
Even so, the civilian creator of the program at Fort Bliss, John Fortunato, said the approach has plenty of skeptics within the ranks, including military psychiatrists.
"I would have to put up with comments like 'How's the spa?' and 'They do aromatherapy and crystals at Fort Bliss,'u2009" said Fortunato, a Vietnam veteran, psychologist and Benedictine monk. "We don't use aromatherapy or crystals at Fort Bliss."
In the civilian world, there is less openness to using acupuncture for PTSD and other mental health disorders, experts said, because the trend is so new. In traditional medicine, just like in the military, mental health patients are generally given talk therapy and medication, but not all respond.
"Joe Six-Pack psychiatrist is not writing prescriptions for acupuncture," said Valenstein, who researches mental health problems and veterans.
A key reason for that: There is no definitive research that says acupuncture is an effective treatment for PTSD. A preliminary study of 61 adults in 2007 by the University of Louisville School of Medicine showed that acupuncture's effect on PTSD was similar to behavioral therapy, suggesting it could be an effective treatment. At the same time, a growing body of research is supporting the positive effects of acupuncture on depression. But many civilian and military doctors want to see more studies before they support acupuncture, experts said.
In February, University of Texas researcher Rosa Schnyer, an acupuncturist and clinical assistant professor in the College of Pharmacy, published a study with Stanford University involving 150 pregnant women diagnosed with major depression. The study found that those who received acupuncture had their symptoms reduced by half based on a scale the researchers used to score the women's depression.
Schnyer is now working with Massachusetts General Hospital on a study to see how depressed patients respond to acupuncture and antidepressants together. "Antidepressants work on a certain percentage of people, but 20 percent of them don't respond and 80 percent relapse, so there's a huge need for better treatment," she said.
Other research on acupuncture and depression has been inconclusive or inconsistent.
How acupuncture works is not well understood. Practitioners place needles along what they say are energy pathways in the body that are linked to the organs, muscular system and nervous system. Practitioners say that ill health or injury causes a break in the energy f
low. They say acupuncture needles unblock the flow, restoring balance or health to the person.
In the case of mental or emotional stress, the needles are believed to stimulate neurotransmitters along nerve pathways and cause responses in the central nervous system, said William Morris, president and CEO of the Academy of Oriental Medicine at Austin.
He said acupuncture is widely used as a treatment for addictions, which sometimes accompany PTSD when soldiers try to self-medicate.
The National Certification Commission for Acupuncture and Oriental Medicine estimated in 2003 that 20 million Americans had tried acupuncture, mostly for muscle, joint and nervous system conditions but also for treating pain from cancer and infertility. More Americans are seeking it, with 3.1 million people visiting acupuncturists in 2006, a 47 percent increase from 2002, according to national survey data cited by Morris.
"I've heard testimonials about (acupuncture) helping with anxiety and depression," said Dr. James Kreisle Jr., an Austin psychiatrist who has been practicing since 1979. But "mainstream doctors are not advocating that because we don't have controlled (scientific) data to support that kind of therapy."
Kreisle said he is open to his patients trying acupuncture but would not want to see it be used as a substitute for traditional treatment.
Elizabeth Peterson, a former combat medic and owner of Acupuncture for Soldiers, agrees that acupuncture works best for PTSD patients when used in conjunction with traditional therapy.
"I'd be very cautious about treating patients who aren't seeing a psychiatrist or a therapist," she said.
She moved her business, which was based in Austin until recently, to Salado to be closer to Fort Hood. Even so, she said, most of the veterans she treats are not from the Afghan or Iraq wars; they served in Vietnam, Korea and even World War II. Some patients are spouses.
"There are Vietnam veterans who are still suffering so much," she said.
Most acupuncturists don't just stick needles in people, she said.
"I think patients gravitate towards it (because) when you sit down and ask them questions, we'll discuss other things, and they'll talk about stress," Peterson said.
"Acupuncture can't fix everything, but it can definitely add to Western medicine."
The military programs at Fort Hood and Fort Bliss meld traditional Western therapies with Eastern approaches.
At Fort Bliss, Fortunato said he founded the Restoration and Resilience Center because he could not bear to see returning soldiers with PTSD beg for help and be discharged as unfit for duty.
"It ticked me off," he said. "The soldiers would say, 'I gave my life for this country. The Army's my life. Don't kick me out. Help me.' "
Fortunato said the program was hard to sell to base officials at first.
Last year, 900 soldiers were diagnosed with PTSD at Fort Bliss' William Beaumont Army Medical Center, where Fortunato is chief of behavioral health. Of those, 700 received regular treatment and were "doing fine," he said, but 200 with severe symptoms were to be medically discharged. About half of those chose the Restoration and Resilience program, Fortunato said.
It offers psychological therapy along with spiritual guidance from a chaplain and alternative treatments, such as acupuncture, meditation and yoga. It lasts six months, and two-thirds of the soldiers return to duty. Most of the other third don't because of physical reasons, such as chronic back pain, Fortunato said.
Casey was quoted during his visit two years ago as saying, "Unfortunately you can't package John Fortunato and move him around and it really takes someone with that passion to drive these kinds of operations, but there are some of the elements of this that are clearly exportable, and we will do that."
At Fort Hood, soldiers who enter the Warrior Combat Stress Reset Program for combat stress and PTSD participate every day for three weeks in alternative therapies aimed at calming the mind, body and spirit, including group therapy, biofeedback, education in coping skills, movement exercises and alternative therapies, including acupuncture, massage and yoga. That's followed by weekly group therapy for eight weeks.
Bailes, 39, is in his third year at the Academy of Oriental Medicine at Austin, pursuing a degree that will lead to a license to practice acupuncture.
Earlier this month, he treated Sharla Labadie, 53, of Austin for insomnia. Labadie, who has trouble falling asleep and has restless legs syndrome, said she was addicted to sleeping pills. "I was taking up to five a night, just to get to sleep."
After twice weekly acupuncture for the past two months, she says she still has trouble falling asleep but is sleeping more deeply, and "I'm not wiggling as much."
After he graduates next year, Bailes' dream is to open a clinic. He wants to treat soldiers and veterans with PTSD.
"I'm one of them," he said.