CDMRP 2012 Investigator Vignette

Title: Effectiveness of Acupuncture in the Treatment of Gulf War Illness

Lisa Conboy, MA, MS, ScD and Meredith St. John, MAc; New England School of Acupuncture, Inc.

Conboy: I applied for a grant application to look at acupuncture in the treatment of Gulf War Illness. We want to know if acupuncture as it's practiced in the real world can help Veterans with Gulf War Illness symptoms.

Gulf War Illness presents in a very complex way. So one Veteran with Gulf War Illness can have one set of symptoms and a different Veteran can present in a different way. It's a very complex set of symptoms.

And one of the challenges of studying this is that we're not really sure for any particular Veteran what caused their symptoms. And so acupuncture because it can individualize treatments to the particular person, whatever they're presenting with on that particular day, it would have the flexibility to offer effective treatments to all different Veterans with Gulf War Illness.

St. John: The type of acupuncture we provided is based on Principles of Traditional Chinese Medicine. The language of Traditional Chinese Medicine is not biomedical language. But part of what we want to be able to do when we work with the DoD is to build a bridge between the acupuncture world and the biomedical world so we can coordinate more effectively in taking care of patients.

Conboy: Acupuncture is still an alternative medicine. It's not covered by most insurance companies and even though the Army has put out a white paper that recommends acupuncture as a way to treat and manage pain, the National Institutes of Health have recommended acupuncture for the treatment of pain, but acupuncture is still fringe. It's still not the first thing that people think of.

Many acupuncture studies are focused more on mechanisms, how things work, so they have to be very controlled. Many studies have a placebo control trying to see what aspects of the acupuncture are most effective. This is a pragmatic trial. We want to know if acupuncture as it's practiced in the real world can help Veterans with the Gulf War Illness symptoms.

So I designed the study so that there were still two arms. One group is randomized to receive acupuncture twice a week for 6 months, and the other arm waits for 2 months but then that waitlist group gets 4 months of weekly treatment.

So not only does everybody get treatment, but because one group gets treatment once a week and one group gets treatment twice a week, I can start looking at dose. I can start looking at how much acupuncture do these Veterans really need to start to see results?

St. John: We recruited a network of acupuncturists all around the State because that's where the Vets are. It wouldn't have been very convenient for the Vets to have to travel the distance for acupuncture care twice a week, so it was important for us to be able to provide care to them close to home. Each patient gets an individualized diagnosis, and they get the treatment that's best for their condition that day. And at the end of the whole course of treatment, we receive the subject's full medical records so we can do an analysis and determine what the most effective treatments were.

Conboy: We have one questionnaire that asks what is the main symptom that you would like acupuncture to treat. What is the second most important symptom. And for safety reasons I have been looking at changes in how that has been improving. And overall the once a week and the twice a week people have been statistically significantly improving and clinically significantly improving. So that was wonderful to see the first time we had enough numbers to see that kind of change.

St. John: It made sense to us that acupuncture would be helpful for something like a multisymptom illness because it's helpful for other multisymptom illnesses like chronic fatigue and fibromyalgia, irritable bowel syndrome, certain kinds of headache. So we were very eager to see whether acupuncture could be helpful for Gulf War Illness. They were an undertreated group. They were somebody that really needed help.

Conboy: This is the first grant that I've had with the Veteran population. And I thought that the challenges of doing research using a very different model of health and illness would be a lot of fun and also extremely rewarding because I have the potential to maybe some help somebody today. There's such a need to help these Veterans. And I wanted to design a study that would look as much like what acupuncture treatment in the real world would be. So when I get my results I can tell the Army, look this is very similar to what's out there already and if the results are significant we're very close to being able to recommend it.