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FLOW Symposium


The Yin and Yang of BFA Research


Building Capacity for Complementary and Integrative Medicine Through a Large, Cross-Agency, Acupuncture Training Program: Lessons Learned from a Military Health System and Veterans Health Administration Joint Initiative Project

                                                                                                                                                                            Mil Med. 2018 Nov

Military Health System (MHS)

Veterans’ Health Administration (VHA)

Acupuncture Training Across Clinical Settings (ATACS)



Materials and methods:

Course content was developed to be applicable to the MHS and VHA environments and training was open to many types of providers. Training included a 4-hr didactic and “hands on” clinical training program focused on a single auricular acupuncture protocol, Battlefield Acupuncture.


Results: Over the course of a 19-mo period, 2,712 providers completed the in-person, 4-hr didactic and hands-on clinical training session. Due to the increasing requests for training, additional ATACS faculty were trained. Overall, 113 providers were approved to be training faculty.



Modified Battlefield Acupuncture Does Not Reduce Pain or Improve Quality of Life in Patients with Lower Extremity Surgery (2019 March 21)


This is a three-armed, multisite randomized controlled trial investigating mBFA plus standard of care versus sham auricular acupuncture plus standard of care versus standard of care alone conducted at two United States Air Force hospitals in the western USA.

mBFA utilizes 10 needles (Fig. 1). The acupuncture points on the right ear include cingulate gyrus, thalamus, omega 2, shen-men, and point zero (Fig. 1). The subject received five needles in each ear. Six different physicians placed needles, and intermittent placement checks by a medical acupuncturist were performed. True BFA requires placing needles in alternating ears and walking after each needle. The mBFA used in this study did not alternate ears nor have subjects walk.


The use of modified battlefield acupuncture protocol does not change pain opioid use or quality of life in those with lower extremity surgery.




Battlefield Acupuncture Use for Perioperative Anesthesia in Veterans Affairs Surgical Patients: A Single-Center Randomized Controlled Trial (2022 Aug 10)


Results: A total of 72 subjects were included in this study (36 subjects in each study group). The median 24-h opioid postoperative consumption measured in morphine milligram equivalent (MME) was lower in the BFA group compared to the sham acupuncture group (18.3 [±12.2] MME vs. 38.6 [±15.9] MME, p < 0.001). Pain intensity reported by patients at 6, 12, 18, and 24 h postoperatively was lower in the BFA group compared to the sham acupuncture group. The incidence of postsurgical nausea and vomiting was lower in patients receiving BFA compared to patients receiving sham acupuncture. There were no intergroup differences in terms of postoperative anxiety or hospital length of stay.

Conclusion: The results from this study reveal the potential clinical benefits of using BFA for reducing pain intensity and opioid requirements in surgical patients.




Battlefield Acupuncture as a Treatment Option for Chronic Tinnitus: A Pilot Study (2023 Nov 3)

Results: TFI and TRQ group means were both significantly reduced at 1 month after treatment, and these reductions persisted through the 2- and 4-month follow-ups. The TRQ group mean remained significantly reduced after 6 months.


Conclusions: Findings from eight chronic tinnitus sufferers who received two BFA treatment sessions are reported here, suggesting at least short-term treatment benefits observed as reductions in tinnitus-related psychological distress and impact. Although these findings are constrained by the study’s small sample size and limited treatment period, its findings underscore the need for further research to determine the potential benefits of BFA for individuals who suffer from chronic tinnitus. Future research should consider the possibility of more lasting benefits through extended BFA treatment, with a comparison of BFA treatment against other treatment methods.




Does Offering Battlefield Acupuncture Lead to Subsequent Use of Traditional Acupuncture?


Objectives: Veterans Health Administration encourages auricular acupuncture (Battlefield Acupuncture/BFA) as a nonpharmacologic approach to pain management. Qualitative reports highlighted a “gateway hypothesis”: providing BFA can lead to additional nonpharmacologic treatments. This analysis examines the subsequent use of traditional acupuncture.


Subjects: We identified 41,234 patients who used BFA across 130 Veterans Health Administration medical facilities between October 1, 2016, and March 31, 2019. These patients were matched 2:1 on Veterans who used VA care but not BFA during the same period resulting in a population of 24,037 BFA users and a comparison cohort of 40,358 non-BFA users. Patients with prior use of traditional acupuncture were excluded.


Results: Among Veterans receiving BFA, 9.5% subsequently used traditional acupuncture compared with 0.9% of non-BFA users (P<0.001). In adjusted analysis, accounting for patient characteristics and regional availability of traditional acupuncture, patients who used BFA had 10.9 times greater odds (95% confidence interval, 8.67-12.24) of subsequent traditional acupuncture use.


Conclusions: Providing BFA, which is easy to administer during a patient visit and does not require providers to be formally certified, led to a substantial increase in use of traditional acupuncture. These findings suggest that the value of offering BFA may not only be its immediate potential for pain relief but also subsequent engagement in additional therapies.