August 9, 2017
More than 80 percent of military health care facilities offer some form of complementary and alternative medicine—in addition to conventional medicine—mainly for pain management and psychological disorders, according to a new study from the RAND Corporation.
Complementary and alternative medicine includes such practices as acupuncture, chiropractic, stress management/relaxation therapy, progressive muscle relaxation, yoga, biofeedback and massage.
About a third of the general population reports using these therapies, but the RAND study is the first to gather system-wide data for military health facilities.
“Health professionals at military health facilities report they are using these treatments because they've found that they work for specific conditions,” said Patricia M. Herman, lead author of the study and a senior behavioral scientist at RAND, a nonprofit research organization.
For the military, these treatments are “one more tool in the tool kit for dealing with issues like chronic pain, and they can offer an alternative to opioid drugs,” Herman said. “In addition, some of the mind/body practices can be effective for the reduction of post-traumatic stress disorder symptoms. A patient might not want to admit they have PTSD, but they may be persuaded to take a yoga class.”
Health professionals at military health facilities reported that complementary and alternative medicine services are most often used to treat chronic pain, stress, anxiety, back pain and sleep disturbance. The services used most often for these conditions are acupuncture, combinations of mind-body medicine therapies, stress management/relaxation therapies, progressive muscle relaxation and chiropractic.
The RAND study found that the number of complementary and alternative medicine therapies vary according to service branch and size of facility. Larger facilities and the U.S. Army offer a larger number of such services.
Respondents at the facilities said they offered these services as adjunctive therapy to chronic disease management (80 percent), to fulfill patient preference (74 percent), to promote wellness (72 percent) and because of proven clinical effectiveness (66 percent). Half said they offered these services because they promote cost savings.
Lack of provider availability for these services and lack of conventional provider awareness/interest were the most common reasons cited by respondents for not offering them. Rarely did they report a lack of patient interest in these therapies or worries about their safety or efficacy as barriers to offering these kinds of care.
The RAND study recommends that the military health care system standardize the codings for complementary and alternative medicine services. This would better allow it to track the types of services being offered, their provider types and the conditions for which they are being used. The system should make sure providers have credentials to offer these services and are properly and consistently trained.
More than half of military treatment facilities cited scientific evidence as a reason to offer such therapies. Addressing complementary and alternative medicine in clinical guidelines for conditions for which these services are frequently used would help providers have access to the scientific evidence on the safety, efficacy and effectiveness of these therapies for specific conditions and support better informed clinical decisions.
The study recommends that future research be targeted toward the complementary and alternative medicine service/condition combinations associated with reports of symptom improvement and/or medication reduction.
Other authors of the study, “Complementary and Alternative Medicine in the Military Health System,” include Melony E. Sorbero and Ann C. Sims-Columbia.
The research was sponsored by the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies and the defense intelligence community.