New NIH Initiative To Study The Effectivness Of Alternative Treatments

Posted by Ellen Simon on 19th Apr 2016

(Originally published in The Washington Post - October 15, 2014. Written by Emily Wax-Thibodeaux.)

The acupuncturist in his glow-in-the-dark yellow Crocs gently leaned over the burly and bearded Army Special Operations officer, who was stretched across a bed in the “zen den” of the Hunter Holmes McGuire VA Medical Center.

The air was sweet with eucalyptus and peppermint aromatherapy. The lighting was warm, fluttering with the golden hue of battery-operated candles. A funky Indian elephant batik hung on the wall. The retired lieutenant colonel, who had been injured in a combat plane crash, inhaled and exhaled as the doctor pressed needles into his knees.

Like hundreds of veterans from across the country who have come to this VA hospital for treatment of chronic pain, panic attacks, traumatic injuries and other ailments, he said he was so fed up with taking heavy-duty painkillers that he was willing to try anything.

The alternative-therapy programs mark a dramatic departure in the treatment offered to troops who are returning from the wars in Iraq and Afghanistan and seeking relief from pain.

Among the options: Equine therapy. Alpha stimulation. Qigong. Guided imagery. Life coaching. Yoga and Pilates. Hypnosis. Aqua therapy. Botox.

Retired Army Staff Sgt. Cedric McAfee takes part in a tai chi class at the Polytrauma Transitional Rehabilitation Center at the Hunter Holmes McGuire VA Medical Center in Richmond. (Timothy C. Wright/For the Washington Post)

The Richmond hospital and three other pilot programs offering these therapies are part of an effort by the Veterans Health Administration to reduce the dependence of tens of thousands on opiate painkillers. While doctors say the highly addictive drugs can help in the short term, they also can be harmful and often require another round of prescription pills to counteract side effects that can include insomnia, constipation, bone pain, anxiety and depression.

“I used to take a half a dozen painkillers a day, maybe more, and wash ’em down with scotch,” moaned the lieutenant colonel, who worked in intelligence and asked not to be named. “If you told me I’d be doing this sort of ‘wives’ tale’ type stuff even a few years ago, I wouldn’t have believed it.”

The scientific basis for these alternative therapies is mixed, and much of the research is preliminary.

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Last month, the National Institutes of Health and the Department of Veterans Affairs announced the launch of a five-year, $21.7 million initiative to study the effectiveness of alternative treatments. The undertaking includes 13 separate research projects.

On a crisp fall morning, a group of veterans at the Richmond hospital met in the courtyard flower garden for a session of tai chi. Native American flute music hummed from a CD player.

Retired Staff Sgt. Cedric ­McAfee, 43, a 260-pound combat veteran of the wars in Iraq and Afghanistan, said he initially dreaded trying tai chi. He felt embarrassed. But he realized the “grocery bag full of pills were making it all worse.”

The turning point came when his teenage son invited him to his football game. McAfee couldn’t go, afraid he would have a panic attack because of the crowds. Along with post-traumatic stress disorder, McAfee suffers from a traumatic brain injury, hypervigilance — “I freak out if my kids don’t come back after 10 minutes” — and a shattered knee, which requires a brace.

Marine Corporal Parker Harbold wears a device on his ear that helps to generate alpha brain waves to aid chronic pain. (Timothy C. Wright/For the Washington Post)

So he spread his feet shoulder-width apart. He bent his knees slightly. He made his hand into an energy ball, shifted into a running back position and reached his arms in front of him.

“My mother always told us that pills aren’t the answer,” McAfee said after the class. “I take a pain pill and get drowsy, then they give you a pill to bring you up again, then you take another pill to come down because you can’t sleep.”

He said he was willing to try anything to end the pain.

“I sit at home and think I’m big and tough, but you know, I really wanted to give this stuff a try,” he said.

Doctors at the Pentagon and VA say that the use of painkillers such as hydrocodone and oxycodone contributes to job loss, family strife, homelessness and even suicide among veterans. By sedating those who take them, the pills can also lead to health problems such as weight gain, diabetes and heart disease. More than 600,000 veterans are taking opioid painkillers, VA officials said.

“Even in 2004, it was like ‘here’s your morphine,’ ‘here’s your oxy,’ ” said Ajit Pai, chief of physical medicine and rehabilitation at McGuire. “It was the choice treatment back then. The patients really didn’t like it. I think we really realize now that we decreased their pain, but we also decreased their function.”

The effectiveness of some alternative treatments, such as qigong — a traditional Chinese practice that combines meditation and martial arts to balance “life energy” — and the use of bright morning light to help manage chronic low-back pain, remains uncertain.

But medical experts say that some of the alternative treatments are proving effective. The Food and Drug Administration, for instance, in 2010 approved Botox to prevent headaches and treat neck pain in adults. Insurance companies are increasingly covering acupuncture for treating four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain.

“There’s always that question of stigma and what’s voodoo and what’s not,” Pai said. “But we’re seeing that they work and without the crushing side effects.”

Marine Cpl. Parker Harbold, 23, said he hopes the NIH researchers speak to him.

Before he began treatment in Richmond, Harbold said that he took 15 pills a day, “a giant sack of nasty freaking opioids, then an opioid patch, then antidepressants and then stool softeners,” all to treat traumatic brain injury and foot and knee pain he suffered after falling off a truck in Afghanistan. “Nothing was helping, the pills made me even more of a mess,” he said.

At Camp Lejeune, he started using an iPod-size alpha-stimulation device. Such devices, which are FDA-approved to treat anxiety, insomnia, depression and pain, emit small amounts of electricity and can be applied with small probes through ear clips. He uses the device at least once a day for an hour and often when he feels a panic attack coming on.

“It’s been so rough trying to get the right help, and I know so many guys who are just addicted to the painkillers and they are suicidal over it,” he said.

What he likes about alpha-stim, he said, is that he is alert afterward rather than “totally drugged and out of it and unable to function.”

When he came to McGuire, he also enrolled in guided imagery, which involves evoking images, and equine therapy, in which veterans spend time with horses on a nearby farm. Like many young veterans who suffer from traumatic brain injury, he speaks slowly, struggling to remember words, and often grows increasingly nervous because of his memory loss.

“I’m from Texas, so the smell of the horses really calmed me down,” he said.

The veterans and current service members here for treatment say that the new generation of leaders and doctors in the military and VA hospitals are far more open to these kinds of treatments.

Retired Air Force Tech. Sgt. Steve Hollis, who suffered multiple injuries during action in Desert Storm and the Balkans, said he was searching for a way to quit his cocktail of painkillers. Inside a treatment center that smelled like peppermint, he found himself receiving a treatment he never expected: Botox.

“I’m not really a mani-pedi-Botox-type guy,” he said. “But when they offered Botox for my horrible headaches, I said, ‘I’m willing to try anything.’ ”

He soon found that his 15 or so migraines a month were cut by half. “It’s really worked for me,” he said, as he clenched his fists while the needle entered his scalp.

Unlike with the narcotic painkillers, he loves the side effects.

“I have a nice, smooth, wrinkle-free forehead,” he said. “My wife is jealous. She wants to take my VA card.”