Helping The Traumatic
Amputee Military Member:
Ear And Scalp Acupuncture
Amputee patients represent a small population of our military service men and women who suffer severe traumatic injury, but are a unique challenge for the control of phantom pain, postoperative complications, and posttraumatic stress. For the past year, there has been an effort at Walter Reed Army Medical Center (WRAMC), Washington, DC, to integrate acupuncture therapy at the bedside of these brave soldiers who have sacrificed for our freedom in the current war theaters of Iraq and Afghanistan. Because of wounds on the extremities of these patients, auriculotherapy, utilizing the "Battlefield Acupuncture" points (omega 2, thalamic, cingulate gyrus, Shen Men, and zero point) described by Niemtzow, have demonstrated approximately a 50% success rate when either integrated or used when traditional Western drug therapy has been inadequate. This is a much lower rate than what is observed in our normal everyday non-combat patients. Auriculotherapy practiced at the bedside of the amputee patients is very easy and convenient to administer whether using electronic or needle stimulation. Interestingly enough, these patients are very reluctant to have acupuncture for fear of pain. Previously, these soldiers would have marched 20 miles on an injured ankle. Now, having had the dreaded experience of losing a limb, any pain-generating procedure, no matter how minor, is strictly avoided by them. In fact, if the auriculotherapy/scalp acupuncture does not work the 1st time, the majority of the patients refuse a 2nd attempt.
In the search to improve the 50% success rate, Dr Joe Helms suggested combining cranial acupuncture with the auriculotherapy. In a preliminary effort to demonstrate the technique, Dr Helms visited WRAMC to better understand the clinical challenges of treating the amputee patient. The military acupuncturists were introduced to cranial acupuncture, and we felt encouraged enough after "field testing" to schedule a 3-day course of auriculotherapy and cranial acupuncture for military acupuncture physicians responsible for the care of amputee patients.
On February 10, 11, and 12 this year, WRAMC hosted an Ear and Scalp Acupuncture course. Colonel Jeff M. Gambel, MD, MPH, Director of Physical Medicine and Rehabilitation, was gracious enough to organize the event. Colonel Richard C. Niemtzow, MD, PhD, MPH, USAF, MC, FS, and Colonel Stephen M. Burns, MD, USAF, MC, FS, taught the Auriculotherapy course, and Dr Helms and Jason Jishun Hao, DOM, taught the Scalp Acupuncture course. The sessions permitted ample time for hands-on training. This was a unique opportunity for military medical acupuncture physicians to gain new skills in this domain. It is hoped that after a period of observations and a better appreciation of combining 2 acupuncture modalities that a clinical trial can be initiated to properly research this endeavor at WRAMC.
Interestingly enough, this conjures up the discussion of treating a patient with multimodality acupuncture techniques in 1 session. At Malcolm Grow Medical Center (MGMC), Andrews Air Force Base, Maryland, the multimodality concept has been practiced since 2002. I realized this concept in my early military and private practices in the mid-1990s. At MGMC, physicians are urged and taught to employ multimodality acupuncture techniques to reduce pain down to 0-1/10. Normally, success is achieved rapidly with the "Battlefield Acupuncture" technique, and residual low-level pain may be further reduced with a piezo electrical stimulator or a modified Craig Technique. Sandwiching in different acupuncture modalities during a single patient visit is a great force multiplier. Once we know the combination that works best for the patient, it becomes a relatively easy task to treat the patient at subsequent visits. For example, lower back pain may be initially treated with auriculotherapy (Battlefield Acupuncture), Craig Technique, and scalp acupuncture. Sure, it takes time, but we are interested in an immediate result. For the most part, we find the ear acupuncture to be very efficient. We also observed that some patients who initially do not respond to auriculotherapy, and are then treated with Korean Hand Acupuncture, experience a "renewed success" with auriculotherapy. For some reason the neuron-physiological pathway "opens up." To further substantiate our clinical concept, we have recently completed an Air Force acupuncture clinical trial of over 100 patients to determine clinical benefits and cost outcomes. We hope this information will be published in the next several months. The importance of clinical data outcomes cannot be overemphasized.
Acupuncture has been a wonderful investment in my medical career. I trust that you, too, are enjoying your medical acupuncture practices and the benefits of being part of the American Academy of Medical Acupuncture. This is a very special organization that is worthy of your time and consideration. The Academy has enhanced my career through education and personal contacts. We also hope that our journal, Medical Acupuncture, has been an asset to your development. There is a tremendous behind-the-scenes effort to always make it happen on time. I thank the entire editorial staff and publisher for their assistance.
-- Richard C. Niemtzow, MD, PhD, MPH
Dr Richard Niemtzow is a Radiation Oncologist and a Colonel on active duty in the U.S. Air Force. He is Chief Medical Consultant for Alternative and Complementary Medicine for the U. S. Air Force Surgeon General. Dr Niemtzow practices Medical Acupuncture full-time at Andrews Air Force Base in Maryland, Pentagon, and Walter Reed Army Medical Center. He is the Chairperson of the American Academy of Medical Acupuncture (AAMA) Research Committee, Senior Editor of the Journal of Alternative and Complementary Medicine, and President of the Maryland Medical Acupuncture Society. Dr Niemtzow is the Ex Officio for the Department of Defense for the NIH CAM Advisory Council.
Richard C. Niemtzow, MD, PhD, MPH
9800 Cherry Hill Rd
College Park, MD 20740
Phone: 301-937-7424 • Cell: 619-647-7274
Fax: 301-595-8382 • E-mail: firstname.lastname@example.org
Colonel (Dr) Richard C. Niemtzow
Medical Group (AMC),
Malcolm Grow Medical Center
Andrews AFB, MD 20762