CHICAGO — Brief exposure to acupuncture significantly improved the symptoms of posttraumatic stress disorder when this treatment was compared with usual care, in a randomized controlled trial in 55 veterans.
Traditional Chinese medicine (TCM) acupuncture was evaluated for posttraumatic stress disorder (PTSD) because current treatments are only modestly effective, and some evidence exists for the efficacy of acupuncture in depression, anxiety, insomnia, and chronic pain syndrome, said Col. Charles C. Engel, MC, USA, who is director of the Department of Defense deployment health clinical center at Walter Reed Army Medical Center, Washington.
In addition, roughly 10%–17% of soldiers returning from the Iraq War experience PTSD in the year after deployment. The median time to care for most veterans is 12 years.
“I've done drug trials [and] psychotherapy trials, and this is the easiest trial in terms of recruitment,” Dr. Engel said at the annual meeting of the International Society for Traumatic Stress Studies. “Patients were excited about this as a modality.”
Dr. Engel and his associates randomized 55 active-duty personnel with PTSD to usual care (medication or psychosocial therapy) or eight 90-minute TCM acupuncture sessions delivered twice weekly for 4 weeks, plus usual care. The acupuncture sessions, which included needling and patient-practitioner interaction, were standardized for the first four sessions and individualized for the second four sessions. All practitioners held a master's degree in TCM acupuncture.
The mean Clinician-Administered PTSD Scale (CAPS) score at baseline was 76.2 in the acupuncture group and 70.0 in the usual care group, while the mean PTSD Checklist-Civilian Version (PCL-C) scores were 58.1 and 55.4. The civilian version was deliberately chosen because people in the military may have PTSD from multiple causes, only one of which is combat, Dr. Engel explained at the meeting cosponsored by Boston University.
Most of the patients were male (64.3% in the acupuncture group and 74% in the usual care group), the mean age of the two groups was 37 and 33 years, and 68% of all patients were recruited from primary care providers.
Patients with moderate to severe brain injury were excluded, as were those who had had a psychological trauma during the 30 days prior to randomization.
The analysis was based on 19 of 28 (68%) acupuncture patients and 24 of 27 (89%) usual care patients.
Compared with usual care, acupuncture was associated with significantly greater decreases in PTSD symptoms on CAPS and PCL-C, and these improvements were maintained through the 12-week follow-up, said Dr. Engel, who is also with the department of psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. The mean PCL-C decreases were 19.4 at the end of treatment and 19.8 at the 12-week follow-up in the acupuncture group, compared with 4.0 and 9.7 in the usual care group. Cohen's d measures of effect sizes both before and after treatment and between groups were large (all greater than 1.0), he noted.
Symptoms of depression and pain also significantly improved in the acupuncture group, compared with the usual care group. The 36-Item Short Form Health Survey (SF-36) scores for mental functioning improved significantly with acupuncture. There was a trend toward improvement in physical functioning on the SF-36, but it likely didn't reach significance because the sample was fairly healthy physically and didn't have much room to improve, Dr. Engel said in an interview.
The investigators are interested in conducting a large multicenter trial that would involve a sham acupuncture arm in addition to the usual care and regular acupuncture arms examined in the current study.
VET-HEAL, a research program of the Samueli Institute for Information Biology, in Alexandria, Va., provided funding for the study. Dr. Engel reported no relevant conflicts of interest.
'This is the easiest trial in terms of recruitment. Patients were excited about this as a modality.' DR. ENGEL