Research in Chronic Pain health care: The Movement toward Integrative Medicine as Non-Drug treatment approaches and Teaching Self-Care therapy

Why are we looking for non-drug approaches to chronic pain?  Dr. Schoomaker explains in this March 2015 interview.  Opioid dependence and death from accidental overdose is higher than death from motor vehicle accidents.  He also discusses how complementary medicine (which includes TAM/TCM) can be stand-alone treatment for chronic pain or used as a complement to conventional treatment.

Movement toward more non-drug pain management options, especially for chronic pain in military and veteran population.  "ancient approaches . . . are actually quite effective"--Schoomaker. 
New research and study collaborations in non-drug (non-pharmacological) pain management treatment options started in 2014.  These studies include collaborations between VA and NCCIH and some DoD sites.  The grant funders are looking to support projects that look at non-drug pain management options that include teaching patients self-care as well as hands-on treatment and interventions.  This includes looking at movement therapy, including tai chi and yoga, for self-care pain management.  Guided imagery and music therapy are also on the list.  Related therapies that are regularly used as part of Traditional Asian Medicine treatment include:  movement therapy (tai chi and qi gong), guided imagery (qi gong), acupuncture, and medical massage therapy (tuina).

For more information, see this youtube video of Dr. Eric Schoomaker discussing collaboration of National Institute of Health (NIH) and the Department of Veterans Affairs (VA).

Reference:  The February 2015 related press release by the National Advisory Council on Complementary and Integrative Health (NCCIH) discusses the research initiatives.

Related blogposts:
Pain Management:  What is the Army Pain Management Task Force?
November 2014 Pain medicine article review
Music and Healing
Resource:  HeartMath to MBSR
NBC news clip on review of acupuncture studies:  "acupuncture works"
2012 research review:  Opioid use in Veterans of Afghanistan and Iraq

Pain Medicine Article Review. Life is Movement, Pain is Stagnation.

Pain Medicine article Review
U.S. Medicine published an article November 2014 with the most recent news in military pain management, "Pain is a Growing Issue for Troops and Veterans; Safer Remedies Sought" by Sandra Basu.  It discusses some innovative strategies of non-drug pain management modalities and how the VA and DoD are working toward making them more available to service members.  While there may still be a long road ahead, it appears they may be through the woods and into the open fields with all the plans this article lays out.  I am happy our military leaders in pain management are continuing with their forward-thinking on integrative medicine and non-drug pain management options for service members, dependents, retirees, and veterans. 

In health care, BE YOUR OWN ADVOCATE
Getting access to the health care a person needs can be challenging.  The Affordable Health Care Act was set up to make this easier.  Any system is not perfect.  All systems could be better.  I encourage my friends, family, and patients to be advocates for themselves and their children when it comes to health care.  It is often not easy advocating for yourself, but it is the ethical and just thing to do.  We must be pro-active in our health.  Life is about movement.  "a rolling stone gathers no moss".  One of the laws of inertia:  "an object in motion stays in motion".  In Traditional Chinese Medicine, life is about movement, flow, transitions, change.  When we stop the movement, stagnation arises.  Out of stagnation comes disharmony and, eventually, disease.

Life is Movement
So, be pro-active about your health and the health of your community.  Support your community leaders and let them know how they can support and represent you.  (Leaders love constructive feedback--it helps them do their job).  Be active in your mind, body, and spirit.  Life is movement.  Let it flow.

-Megan

TBI update: DoD numbers for 2012

This is an updated link for DoD (Department of Defense) TBI numbers for 2012.  March is TBI Awareness Month.  Please see a related post from last March for more information and links.

In these new graphs,
Notice the total number by branch:
Navy
Marines (part of Navy)
Army
Air Force

Reserves
National Guard

Other posts:
Traumatic Brain Injury Awareness month

September is Suicide Prevention Awareness Month

September is Suicide Prevention Awareness Month.

I attended a Suicide Prevention Stand Down event in September.  I wanted to share some resources I came across through the training.

Www.preventsuicide.army.mil
If you want to have more training in suicide prevention, ASIST is a program available to train laypersons in resources for suicide prevention.

Free online and phone counseling:
Veterans Suicide Prevention Hotline 1-800-273-8255

Military OneSource or 1-800-342-9647 or online counseling site
The D-STRESS LINE or 1-877-476-7734

related blog post, "DSTRESS LINE for Marines (and Sailors)"

TriWest Online Free Counseling--see video
National Hotline 1-800-273-TALK
The Safe Hotline, Sexual Assault Support for the DoD community 1-877-995-5247 or 911



   

Wounded Warrior care at Camp Pendleton is team effort

Wounded Warrior care at Camp Pendleton is team effort

This is from an article by LT Marc Calestini at Naval Hospital, Camp Pendleton, "Wounded Warrior care at Camp Pendleton is Team Effort".  Posted in the Navy Medicine Live blog April 12th, 2012. 

Naval Hospital Pendleton's new "Hope and Care Center", their Holistic Health Program, has several CAM health team members such as massage therapists, recreational therapists, and an acupuncturist.  The article is written from the perspective of one of the medical officers in the clinic. 

Source
Navy Medicine Live blog.  "Wounded Warrior Care at Camp Pendleton is Team Effort".  posted 2012/04/12.  Calestini, Marc.

Insomnia part 5: Insomnia and Combat Stress, a course for those who treat Servicemembers

May is National Better Sleep Month

Related Insomnia blog posts in this series:

Traditional Chinese Medicine and Insomnia or "What is Insomnia?"

How is your Sleep Hygiene?

Sleep Medications
More Sleep Resources
Short Courses: Learn Acu-tack to Treat Insomnia in Servicemembers

Short Courses: Learn Acu-tack to Treat Insomnia in Servicemembers

The protocol and techniques taught in the Acu-tack Courses treat insomnia by breaking the cycle of stress, pain, and insomnia. This protocol helps the body remember how to balance its ability to reset from fight or flight mode (sympathetic nervous system state) to rest and digest mode (parasympathetic state).

If you are a medic or corpsmen or other deploy-able medical personnel and interested in taking a course from De-Stress Vets, check out the website for information on "Acu-tack for Stress Relief©"and "Acu-tack for Pain Relief©" or contact me via the Hospital Practice Handbook Project website with "requesting info on Acutack courses" in the subject line.  [update March 2018]

How does Poor Sleep affect your Health?
If you are a servicemember on active duty, you know well the costs and benefits of sleep deprivation.  A certain amount is neccessary as a regular part of your duties.  However, it is not safe nor healthy if your sleep deprivation is chronic and interferes with your ability to do your job well and safely.  Poor sleep can lead to chronic sleep deprivation which may increase your risk of other physical and mental health such as:  pain, depression, anxiety, frustration, excess anger, and fatigue.

Chronic poor sleep decreases your resilience (resilience is your "bounce-back" factor). According to the Mayo Clinic (mayoclinic.com), chronic sleep deprivation:

• is linked to a number of physical and mental health disorders and substance abuse
• Ongoing lack of sleep increases your risk of
• illness
• infection
• high blood pressure
• heart disease
• diabetes
• chronic pain. (www.mayoclinic.com)

What Are the Benefits of Good Quality Sleep?
Wake feeling rested and energized for whatever may lie ahead in your day.
Body is strengthened in its own ability to heal and restore itself.
Lower blood pressure; reduced stress.
Increased Resilience.
Able to better absorb and understand information throughout your day (vs. being sleep-deprived).
You are better able to react and respond appropriately to various factors throughout your day.
According to Mayo's website, good quality sleep:

• improves performance [through]
• quicker reaction time
• better memory
• less confusion
• fewer accidents and mistakes (www.mayoclinic.com).

The Navy’s “10 Top Tips for Tip Top Sleep”
Cognitive Behavioral Therapy for Improving Sleep, a successful alternative to prescription
medications for insomnia.

Harvard's Sleep, Learning, and Memory website

Acupuncture and Combat Stress, TBI, and Traumatic Stress
What is the Training Level of My Acupuncturist?
Acupuncturist talks about TCM diagnostic patterns of Insomnia

Navy’s Center for Combat and Operational Stress Control (COSC)
The Navy’s Stress Continuum

      related Stress Continuum blog post

The Navy’s Tips on Building Resilience

Resilience and Spirituality, a Navy article

The OASIS program--Overcoming Adversity and Stress Injury Support

The STRESS CONTINUUM by Navy Marine Corps Combat Operational Stress Control Program

Free Online and Phone Counseling for Stress

Online and phone counseling—free services through
Military OneSource or 1-800-342-9647 or online counseling site
The D-STRESS LINE or 1-877-476-7734

TriWest Online Free Counseling--see video
Veterans Suicide Prevention Hotline 1-800-273-8255
National Hotline 1-800-273-TALK
The Safe Hotline, Sexual Assault Support for the DoD community 1-877-995-5247 or 911

Acupuncture used to treat TBI at Military Concussion Care Center, part of the "Operation Stress Control and Readiness Program (OSCAR)" through the Navy and Marine Corps

Acupuncture Makes Strides in Treatment of Brain Injuries, PTSD (VIDEO)
similar to Kandahar video.  Also an article from the DoD Live "Armed with Science" blog, written by C. Voorhees, June 2011.

Military field physicians are using the practice of acupuncture to treat cases of mild traumatic brain injuries (mild TBI), including concussions, and cases of post-traumatic stress disorder (PTSD).

Acupuncture is a simple, non-medication way to treat insomnia, headaches, nightmares, and anxiety.

What is "Operation Stress Control and Readiness Program (OSCAR)"?
"Operation Stress Control and Readiness Program, a joint Navy-Marine Corps effort, embeds psychiatrists and psychologists within combat teams to provide mental health care to troops in Afghanistan. The program trains medical officers, corpsmen, chaplains, religious personnel and key leaders at the sergeant and first sergeant level to deliver basic mental health services. Troops also have the option to see physical therapists, occupational therapists, and acupuncturists at an outpatient concussion center to address physical and emotional impacts of combat-related injuries.
Having psychiatrists and psychologists embedded in regiments and battalions gives troops who might not naturally turn to a mental health provider a range of ways to seek help." [Armed with Science article.]


Navy Cmdr. (Dr.) Keith Stuessi, former director of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan, believes acupuncture is useful for treatment of mild TBI.
Stuessi describes the Concussion Restoration Care Center as a success – treating more than 320 concussion patients thus far. Of the more than 20 troops he personally treated, almost all saw marked improvements in their sleep, anxiety levels and frequency of headaches. Cmdr. Earl Frantz, who replaced Steussi at Camp Leatherneck in March, continued the practice of using acupuncture on troops with symptoms of mild TBI [Armed with Science article].

Related articles: July 2011 Medical Monday:  Breaking Ground on Identifying and Understanding TBI.
Related posts:  the DSTRESS LINE for Marines and Sailors
                          Traumatic Brain Injury Awareness Month (March)
                          What is the Training/Education Level of your Acupuncturist?
                          Military Chaplains and Combat Stress
For a Military Stress Recovery Project Clinic near You:
                    This is the link to the list (by state) of Military Stress Recovery Project clinics.  These are civilian clinics available through a larger non-profit group, Acupuncturists without Borders.  They recently opened a Women Veterans only clinic in Albuquerque, New Mexico, due to patient demand.  The Military Stress Recovery Project clinics are open to all veterans, active duty servicemembers, reservists, Guard, their families, and their care providers.

--Megan

Military Chaplains and Combat Stress--5 minute video

Military Chaplains get combat stress, too.  This is a great video of  Navy Chaplain LCDR Dundas deals with his own post traumatic stress disorder symptoms and through his journey is an even greater counselor to his Sailors and Marines.  Click here for the 5 minute YouTube video.

The DSTRESS LINE for Marines--free anonymous counseling by phone or online chat and Related Resources

ClipArt

The DSTRESS Line provides professional, anonymous counseling for Marines, their corpsmen, and their families.  It is a free call or free online chat. 

"Marines want to talk with someone who understands them as a Marine. The DSTRESS Line provides Marines, attached Sailors, and family members with a place to call and speak with 'one of their own.' It is a place to call and talk about problems before they turn into a crisis.

The DSTRESS Line helps callers increase resilience and develop the necessary skills required to cope with the widely varying challenges of life in the Corps and the inevitable stress of combat operations."

See their website for more details.
1-877-476-7734.

More Resources for Readjustment to Living State-side and More Counseling Services
There is also free online and phone counseling through:
Military OneSource

ClipArt

TriWest Online Free Counseling--see video
your CHAPLAIN

TRICARE
TRICARE Region North
TRICARE Region South
Defense Centers of Excellence Outreach Center
National Suicide Prevention Lifeline and Veterans Suicide Prevention Hotline 1-800-273-8255
Military Stress Recovery Project Clinics--free or low-cost acupuncture for veterans and their families.  Find a clinic near you on the Acupuncturists without Borders (AWB) website (listed by state).
Take the Post-Traumatic Growth Inventory anonymously.  [Inventory created by the American Psychological Association (APA)]
Information via online Short Video/Movie
video:  Dr. Mike Colson of the VA and re-adjustments issues for returning warriors, some resources through TriWest.
video:  GWOT = "Global War on Terrorism Veteran" with Dr. Mike Colson of the VA and some resources through TriWest.  He talks about some readjustment issues that are common to be aware of when you are just returning State-side.
video:  Symptoms of Combat Stress with Dr. Maguire of the VA. 
video:  Common Questions with Dr. Mike Colson.

Megan's Notes on Symptoms of Combat Stress vs. PTSD

Combat Stress or operational theater stress or deployment stress is not PTSD.  Combat Stress is a normal body and mind reaction to shock and stressful situations and human experiences that are common in war zones.  PTSD is a diagnosis given by a psychologist or psychiatrist when symptoms of combat stress have not improved over a long period of time (more than 1 year).  Proper and early treatment of combat stress prevents the development of PTSD (post traumatic stress disorder) in most cases.

ClipArt

Symptoms of combat stress include (not all possible symptoms listed):  insomnia (poor sleep, waking feeling not rested, waking throughout night, waking at the same time every night, etc), unexplained anger and/or frustration, anxiety, mild depression, racing thoughts, reliving dreams or stressful memories (also called flashbacks), headaches, and/or body pain.  Some people have more than one symptom and some have just one symptom.  It is a problem if your symptoms impact your daily life and routine.  Check out the post-traumatic experience growth inventory by the APA.

Copyright Megan Kingsley Gale

Stress-Relief Acupuncture as practiced through De-Stress Vets and other Military Stress Recovery Project Clinics helps relieve these symptoms through the use of tiny needles (as thin or thinner than a strand of hair) in special points in the ear (called auricular acupuncture).  So, acupuncture is a good complement to your conventional treatment and/or counseling (with mental health therapist or chaplain).  When someone is experiencing traumatic stress or combat stress, their body-mind is stuck in state called "sympathetic nervous system overload".  It is the autonomic nervous system's job to fluctuate from "fight or flight" (sympathetic response) to "rest and digest" (parasympathetic mode) in a balanced, healthy way.  Stress-Relief Acupuncture works by reminding the body's autonomic nervous system how to reset from "fight or flight" to "rest and digest".  Our bodies have their own wisdom to heal; modalities/medicines such as acupuncture and Traditional Chinese Medicine help our bodies remember how to be in balance and not in "dis-stress" or "dis-ease" states.

If you are a medic or corpsmen or other deploy-able medical personnel and interested in taking a course from De-Stress Vets, check out the website for information on "Acu-tack for Stress Relief©" and "Acu-tack for Pain Relief©" or send an email with "requesting info on Acutack courses" in the subject line to info@destressvets.com. 

See related posts in this blog such as Managing Traumatic Stress, Resilience in a Time of War,  The Yellow Ribbon Reintegration Program, the FOCUS and FOCUS for Couples programs, Female Soldiers and their Wounds of War, and "What is the Training Level of My Acupuncturist?".

©Acutack courses copyright held by Megan Kingsley Gale, 2011.

Traumatic Brain Injury (TBI) Awareness Month

Source:  ClipArt

March is BRAIN INJURY AWARENESS Month
For more resources on TBI, scroll to the end of this post.


March is "Brain Injury Awareness Month".  [Short YouTube video here.]  A recent DoDLive blog post, "TBI:  To Be Improved" is by Army Staff SGT Victor Medina.  He authors the "TBI Warrior blog" and shares his story of recovery from a warzone TBI.  For the whole article, see:  TBI: To Be Improved on the DoDLive blog.  Here's the intro:
From Elaine Wilson, Family Matters Blog Editor: I’d like to introduce guest blogger Army Staff Sgt. Victor Medina, who sustained a moderate traumatic brain injury during his third deployment in Iraq in 2009. Several months later, Medina started a blog titled “TBI Warrior” to help educate other survivors and caregivers affected by a brain injury through his own experiences — before and after TBI. He shared his story in a Defense Centers of Excellence Blog on March 2.

The mission of Medina's blog "TBI Warrior:  Traumatic Brain Injury is a New Beginning.  IT WILL GET BETTER" is to:  "provide insight on Traumatic Brain Injuries from the perspective of a survivor and a caregiver.  Empower survivors and caregivers through education, providing resources to heal with hope.  We stand for early identification and appropriate intervention with compassion.  The survivor's knowledge and motivation are key to successful rehabilitation."

In Medina's blog, he makes a good point with referenced arguments that the diagnoses of PTSD and TBI, while often diagnosed together, are separate conditions and diagnoses.  He makes the point that if you have a TBI you may or may not also have PTSD.  It is okay to have one and not the other; the conditions are not "comorbid".  See his blog for the entire thoughtful argument.

The Defense Centers for Excellence has a great resource page on Traumatic Brain Injuries.  It includes links to some videos and more links to finished studies or ongoing related research.  In honor of Brain Injury Awareness Month, there is a related DoD webpage for more resources that include Fact Sheets, ICD-9 coding guidance on TBI for providers, and mobile apps for health care providers.  This includes the fact sheets "Courage to Care--TBI:  What Military Families Need to Know," and a TBI statistics sheet.

Want to learn what the mechanics of a blast, such as an IED are?  Check out the "mechanics of a blast injury" video on the BrainLine Military website.

Here are those TBI resource pages again:
Department of Defense Traumatic Brain Injury resource page
Defense Centers of Excellence Brain Injury Awareness Month webpage (fact sheets, mobile aps)
Victor Medina's TBI Warrior blog
Courage to Care's fact sheet "TBI:  What Military Families Need to Know"
TBI Statistics/Numbers
Some nice graphs with data on TBI from the Department of Defense as recent as February 2012.
The National Instutite of Health's Research on TBI page.  This is a special branch called the "National Institute of Neurological Disorders and Stroke".
The Center for Disease Control and Prevention (CDC) Brain Injury page
There is a cool interactive website for learning about the brain and brain injury called BrainLine.
American Heros at Work is a U.S. Dept. of Labor project that addresses the employment challenges of returning Service Members and Veterans living with TBI and/or PTSD.
"Mechanics of a Blast Injury" video on BrainLine Military.
Traumatic Brain Injury:  The Journey Home

DVBIC = The Defense and Veterans Brain Injury Center, a DCoE component center, offers medical care, research initiatives and programs to active duty military, dependents and veterans.  Information on brain injury and associated research and treatment. Fort Campbell Makes Advances in TBI Evaluation Real Warriors Army Surgeon General on Brain Injury Awareness Month More reading lists on TBI, "Take Note program" Related Article from Fort Sam Huston on National Brain Injury Awareness Month Post-combat Driving program for servicemembers and their families.  Army Medicine TBI overview video for servicemembers and their families  2013 post on DoD numbers for 2012 update with more detail than image below.

--Megan

Wounded Warriors--2010 legislation for Daily Living special compensation

(Found this article on www.woundedwarriorregiment.org, the website for the U.S. Marines wounded warrior regiment.  This is directly quoted.)

Special Compensation for Assistance with Activities of Daily Living

By Capt. Jill Wolf

---

Some service members who are catastrophically wounded, ill or injured are now eligible for compensation designed to offset the economic burden primary caregivers incur when assisting them.
When a service member sustains a catastrophic injury or illness, a family member or close friend often takes on the role of caregiver, providing non-medical support for daily activities. These caregivers sometimes discontinue employment to care for their loved one, leading to a loss or reduction of income.
Authorized by the Fiscal Year 2010 National Defense Authorization Act, Special Compensation for Assistance with Activities of Daily Living (SCAADL) is designed to mitigate this financial hardship. Monthly payment amounts are based upon the U.S. Department of Labor’s Bureau of Labor Statistics wage rate for home health aides and are adjusted by the geographic area of residence or recovery and a three-tier system based on the complexity of care.
MARADMIN 501/11 describes the criteria for receiving SCAADL. The basic qualifications are as follows:

• Have a catastrophic injury or illness incurred or aggravated in the line of duty (combat or non-combat related);
• Have been certified by a DoD or Veteran Affairs physician to be in a need of assistance from another person to perform the personal functions required in daily living; and
• Would, in the absence of this provision, require some form of residential institutional care (i.e. hospitalization or nursing home care).
• Are not currently in inpatient status in a medical facility

According to DoD Instruction 1431.12, catastrophic is defined as, “a permanent severely disabling injury, disorder or illness incurred or aggravated in the line of duty that the Secretary of the Military Department concerned determines compromises the ability of the afflicted person to carry out activities of daily living to such a degree that the person requires personal or mechanical assistance to leave home or bed, or constant supervision to avoid physical harm to self or others.”
The United States Marine Corps Wounded Warrior Regiment has identified potentially eligible Marines within their command to begin the application and payment process. Applications for SCAADL require DD Form 2948 which must be completed by a licensed DoD or VA physician. SCAADL claims will be certified by the WWR Pay and Entitlements section. Marine Corps Base Quantico finance office will compute the payment amount and make the SCAADL payment. Service members who believe they are eligible for this compensation should contact a member of their recovery team, including their primary care manager, recovery care coordinator or unit leadership.
For more information on SCAADL, reference MARADMIN 501/11 and the WWR fact sheet.