{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T11:10:04Z","timestamp":1751368204880,"version":"3.41.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"7-8","funder":[{"DOI":"10.13039\/100030710","name":"Musculoskeletal Injury Rehabilitation Research for Operational Readiness","doi-asserted-by":"publisher","award":["HU00011920011"],"award-info":[{"award-number":["HU00011920011"]}],"id":[{"id":"10.13039\/100030710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100030710","name":"Musculoskeletal Injury Rehabilitation Research for Operational Readiness","doi-asserted-by":"publisher","award":["HU00011920011"],"award-info":[{"award-number":["HU00011920011"]}],"id":[{"id":"10.13039\/100030710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,30]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Shoulder stabilization surgery is common among military personnel, causing severe acute postoperative pain that may contribute to the development of chronic pain, thereby reducing military readiness. Battlefield Acupuncture (BFA) has shown promise as a non-pharmaceutical intervention for acute postoperative pain. The purpose of this study was to determine the effectiveness of BFA combined with standard physical therapy on pain, self-reported mood, self-reported improvement, and medication use in patients after shoulder stabilization surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>The study design was a single-blind, randomized clinical trial, approved by the Naval Medical Center Portsmouth Institutional Review Board and registered with ClinicalTrials.gov (NCT04094246). Ninety-five participants were recruited after shoulder stabilization surgery. Participants were randomized via concealed allocation into a standard physical therapy (PT) group or a group receiving standard PT and BFA. Both groups received standard postoperative pain medication. The BFA intervention followed a standard protocol with the insertion of gold aiguille d\u2019acupuncture emiermanente needles at 5 specific points in the ear. At 4 time points (baseline [24\u201348\u2009hours], 72\u2009hours, 1\u2009week, and 4\u2009weeks post-surgery), participants reported worst and average pain using a Visual Analog Scale (VAS), self-reported mood using the Profile of Mood States (POMS), self-recorded medication intake between study visits, and self-reported improvement in symptoms using a Global Rating of Change (GROC) Scale. Outcome assessors were blinded to treatment allocation. An alpha level of 0.05 was set a priori. For pain, a mixed-model analysis of variance was used to analyze the interaction effect between group and time. Differences in baseline data, total opioid usage, and pain change scores between groups were analyzed using independent t-tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 95 participants enrolled, 7 failed to provide complete study visits after the baseline, leaving 88 patients (43 BFA, 45 control, mean age 21.8 (2.1) years, 23% female). There were no significant group-by-time interactions for VAS worst pain (F\u2009=\u20090.70, P\u2009=\u2009.54), VAS average pain (F\u2009=\u20090.99, P\u2009=\u2009.39), the POMS (F\u2009=\u20091.04, P\u2009=\u2009.37), or GROC (F\u2009=\u20090.43, P\u2009=\u20090.63). There was a significant main effect of time for VAS worst pain (F\u2009=\u2009159.7, P\u2009&amp;lt;\u2009.001), VAS average pain (F\u2009=\u2009122.4, P\u2009&amp;lt;\u2009.001), the POMS (F\u2009=\u200911.4, P\u2009&amp;lt;\u2009.001), and the GROC (F\u2009=\u200978.5, P\u2009&amp;lt;\u2009.001). While both groups demonstrated statistically significant and clinically meaningful improvements in pain and self-reported mood over time, BFA did not provide any additional benefit compared to standard physical therapy alone. There was no significant difference in opioid usage between groups at 4\u2009weeks (t\u2009=\u20090.49, P\u2009=\u2009.63). Finally, both groups also demonstrated statistically significant and clinically meaningful self-reported improvements in function, but again, there was no additional benefit when adding BFA to standard physical therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The results of this study do not support the effectiveness of BFA for postsurgical pain management as there were no significant differences in pain, self-reported mood, self-reported improvement, and medication use between participants who received BFA and those who did not. As this is the only known study of BFA in postsurgical participants, continued research is needed to determine if BFA is effective for pain reduction in that setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trial Registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov, NCT04094246. Registered September 16, 2019, http:\/\/clinicaltrials.gov\/NCT04094246.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae577","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T07:50:12Z","timestamp":1736581812000},"page":"e1509-e1517","source":"Crossref","is-referenced-by-count":1,"title":["Battlefield Acupuncture Does Not Provide Additional Improvement in Pain When Combined With Standard Physical Therapy After Shoulder Surgery: A Randomized Clinical Trial"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1025-0380","authenticated-orcid":false,"given":"Michael S","family":"Crowell","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, University of Scranton , Scranton, PA 18510,","place":["USA"]},{"name":"Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University , West Point, NY 10996,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin M","family":"Florkiewicz","sequence":"additional","affiliation":[{"name":"Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University , West Point, NY 10996,","place":["USA"]},{"name":"Rocky Mountain University of Health Professions , Provo, UT 84606,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie B","family":"Morris","sequence":"additional","affiliation":[{"name":"Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University , West Point, NY 10996,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S","family":"Mason","sequence":"additional","affiliation":[{"name":"Army-Baylor University Doctoral Program in Physical Therapy , Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Will","family":"Pitt","sequence":"additional","affiliation":[{"name":"Army-Baylor University Doctoral Program in Physical Therapy , Fort Sam Houston, TX 78234,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Benedict","sequence":"additional","affiliation":[{"name":"Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University , West Point, NY 10996,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth L","family":"Cameron","sequence":"additional","affiliation":[{"name":"John A Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital , West Point, NY 10996,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald L","family":"Goss","sequence":"additional","affiliation":[{"name":"Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, Baylor University , West Point, NY 10996,","place":["USA"]},{"name":"Department of Physical Therapy, High Point University , High Point, NC 27268,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"issue":"3","key":"2025070106322164100_R1","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1097\/JSA.0000000000000160","article-title":"Posterior shoulder instability","volume":"25","author":"Brelin","year":"2017","journal-title":"Sports Med Arthrosc Rev"},{"issue":"7","key":"2025070106322164100_R2","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1177\/0363546506295179","article-title":"The incidence and characteristics of shoulder instability at the United States Military Academy","volume":"35","author":"Owens","year":"2007","journal-title":"Am J Sports Med"},{"issue":"4","key":"2025070106322164100_R3","doi-asserted-by":"publisher","first-page":"791","DOI":"10.2106\/JBJS.H.00514","article-title":"Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population","volume":"91","author":"Owens","year":"2009","journal-title":"J Bone Joint Surg"},{"issue":"11","key":"2025070106322164100_R4","doi-asserted-by":"publisher","first-page":"2150","DOI":"10.1249\/MSS.0000000000001011","article-title":"Incidence of shoulder dislocations and the rate of recurrent instability in soldiers","volume":"48","author":"Kardouni","year":"2016","journal-title":"Med Sci Sports Exercise"},{"issue":"4","key":"2025070106322164100_R5","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.arthro.2014.01.003","article-title":"Management of primary acute anterior shoulder dislocation: systematic review and quantitative synthesis of the literature","volume":"30","author":"Longo","year":"2014","journal-title":"Arthroscopy"},{"issue":"2","key":"2025070106322164100_R6","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1177\/1941738109359507","article-title":"Systematic review of rehabilitation versus operative stabilization for the treatment of first-time anterior shoulder dislocations","volume":"2","author":"Godin","year":"2010","journal-title":"Sports Health"},{"issue":"36","key":"2025070106322164100_R7","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001498","article-title":"Subacute pain as a predictor of long-term pain following orthopedic surgery: An Australian prospective 12 month observational cohort study","volume":"94","author":"Veal","year":"2015","journal-title":"Medicine (United States)"},{"issue":"3","key":"2025070106322164100_R8","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1097\/JSA.0000000000000158","article-title":"Rehabilitation following surgery for glenohumeral instability","volume":"25","author":"Johnson","year":"2017","journal-title":"Sports Med Arthrosc Rev"},{"issue":"3","key":"2025070106322164100_R9","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1177\/1941738117750553","article-title":"Physical therapy protocols for arthroscopic bankart repair","volume":"10","author":"DeFroda","year":"2018","journal-title":"Sports Health"},{"issue":"3","key":"2025070106322164100_R10","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1177\/1941738120913293","article-title":"Opioid use after common sports medicine procedures: a systematic review","volume":"12","author":"Sheth","year":"2020","journal-title":"Sports Health"},{"issue":"9","key":"2025070106322164100_R11","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1093\/pm\/pnw015","article-title":"Time-to-cessation of postoperative opioids: a population-level analysis of the veterans affairs health care system","volume":"17","author":"Mudumbai","year":"2016","journal-title":"Pain Med (Malden, Mass)"},{"issue":"8","key":"2025070106322164100_R12","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1093\/pm\/pnaa474","article-title":"The implementation and effectiveness of battlefield auricular acupuncture for pain","volume":"22","author":"Taylor","year":"2021","journal-title":"Pain Med"},{"issue":"5","key":"2025070106322164100_R13","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.outlook.2016.07.008","article-title":"Battlefield acupuncture: opening the door for acupuncture in Department of Defense\/Veteran\u2019s Administration health care","volume":"64","author":"Walker","year":"2016","journal-title":"Nurs Outlook"},{"issue":"(3)","key":"2025070106322164100_R14","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/S1047-9651(18)30180-3","article-title":"Auricular acupuncture and auricular medicine","volume":"10","author":"Soliman","year":"1999","journal-title":"Phys Med Rehabil Clin N Am"},{"issue":"8201","key":"2025070106322164100_R15","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1016\/S0140-6736(80)92106-6","article-title":"Increased \u03b2-endorphin but not Met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain","volume":"316","author":"Clement-Jones","year":"1980","journal-title":"Lancet"},{"issue":"4","key":"2025070106322164100_R16","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1089\/107555302760253577","article-title":"Acupuncture: the search for biologic evidence with functional magnetic resonance imaging and positron emission tomography techniques","volume":"8","author":"Cho","year":"2002","journal-title":"J Altern Complement Med"},{"issue":"5","key":"2025070106322164100_R17","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1089\/acu.2017.1237","article-title":"Does ear acupuncture have a role for pain relief in the emergency setting? A systematic review and meta-analysis","volume":"29","author":"Jan","year":"2017","journal-title":"Med Acupunct"},{"issue":"01","key":"2025070106322164100_R18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1142\/S0192415X21500026","article-title":"Battlefield acupuncture for adult pain: a systematic review and meta-analysis of randomized controlled trials","volume":"49","author":"Yang","year":"2021","journal-title":"Am J Chin Med"},{"issue":"4","key":"2025070106322164100_R19","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.annemergmed.2024.03.014","article-title":"An adaptive pragmatic randomized controlled trial of Emergency Department Acupuncture for acute musculoskeletal pain management","volume":"84","author":"Eucker","year":"2024","journal-title":"Ann Emergency Med"},{"issue":"6","key":"2025070106322164100_R20","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1016\/j.ajem.2018.02.038","article-title":"Battlefield acupuncture to treat low back pain in the emergency department","volume":"36","author":"Fox","year":"2018","journal-title":"Am J Emergency Med"},{"issue":"4","key":"2025070106322164100_R21","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.jemermed.2021.07.017","article-title":"Battlefield acupuncture versus standard pharmacologic treatment of low back pain in the Emergency Department: a randomized controlled trial","volume":"61","author":"Johnston","year":"2021","journal-title":"J Emergency Med"},{"issue":"3","key":"2025070106322164100_R22","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1111\/1742-6723.13642","article-title":"Battlefield acupuncture added no benefit as an adjunct analgesic in emergency department for abdominal, low back or limb trauma pain","volume":"33","author":"Jan","year":"2021","journal-title":"Emerg Med Australas"},{"issue":"Suppl 1","key":"2025070106322164100_R23","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1093\/milmed\/usy277","article-title":"Modified battlefield acupuncture does not reduce pain or improve quality of life in patients with lower extremity surgery","volume":"184","author":"Crawford","year":"2019","journal-title":"Mil Med"},{"issue":"4","key":"2025070106322164100_R24","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1089\/acu.2019.1372","article-title":"Battlefield acupuncture and physical therapy versus physical therapy alone after shoulder surgery","volume":"31","author":"Collinsworth","year":"2019","journal-title":"Med Acupuncture"},{"issue":"1","key":"2025070106322164100_R25","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04909-8","article-title":"The effectiveness of battlefield acupuncture in addition to standard physical therapy treatment after shoulder surgery: a protocol for a randomized clinical trial","volume":"21","author":"Crowell","year":"2020","journal-title":"Trials"},{"issue":"7211","key":"2025070106322164100_R26","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1136\/bmj.319.7211.703","article-title":"How to randomise","volume":"319","author":"Altman","year":"1999","journal-title":"BMJ"},{"issue":"4","key":"2025070106322164100_R27","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1089\/acu.2007.0603","article-title":"Battlefield acupuncture","volume":"19","author":"Niemtzow","year":"2007","journal-title":"Med Acupuncture"},{"issue":"10","key":"2025070106322164100_R28","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1111\/j.1553-2712.2003.tb00586.x","article-title":"Clinically important change in the visual analog scale after adequate pain control","volume":"10","author":"Lee","year":"2003","journal-title":"Acad Emerg Med"},{"issue":"2","key":"2025070106322164100_R29","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/0304-3959(94)90097-3","article-title":"A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales","volume":"56","author":"Price","year":"1994","journal-title":"Pain"},{"issue":"1","key":"2025070106322164100_R30","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/0304-3959(83)90126-4","article-title":"The validation of visual analogue scales as ratio scale measures for chronic and experimental pain","volume":"17","author":"Price","year":"1983","journal-title":"Pain"},{"issue":"3","key":"2025070106322164100_R31","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1093\/bja\/aew466","article-title":"Measuring acute postoperative pain using the visual analog scale: the minimal clinically important difference and patient acceptable symptom state","volume":"118","author":"Myles","year":"2017","journal-title":"Br J Anaesth"},{"issue":"6","key":"2025070106322164100_R32","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1016\/s0885-3924(99)00092-5","article-title":"A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients","volume":"18","author":"Briggs","year":"1999","journal-title":"J Pain Sympt Manage"},{"issue":"2","key":"2025070106322164100_R33","first-page":"93","article-title":"Preliminary evidence for the reliability and validity of an abbreviated Profile of Mood States","volume":"23","author":"Grove","year":"1992","journal-title":"Int J Sport Psychol"},{"issue":"1","key":"2025070106322164100_R34","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1080\/10413200008404210","article-title":"Profile of mood states research in sport and exercise psychology: past, present, and future","volume":"12","author":"Leunes","year":"2000","journal-title":"J Appl Sport Psychol"},{"issue":"3","key":"2025070106322164100_R35","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1179\/jmt.2009.17.3.163","article-title":"Global rating of change scales: a review of strengths and weaknesses and considerations for design","volume":"17","author":"Kamper","year":"2009","journal-title":"J Man Manip Ther"},{"issue":"3","key":"2025070106322164100_R36","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.13718","article-title":"Re: Battlefield acupuncture added no benefit as an adjunct analgesic in emergency department for abdominal, low back or limb trauma pain","volume":"33","author":"Cummings","year":"2021","journal-title":"Emerg Med Australas"},{"issue":"3","key":"2025070106322164100_R37","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.otsr.2011.02.003","article-title":"Pain after shoulder arthroscopy: a prospective study on 231 cases","volume":"97","author":"Stiglitz","year":"2011","journal-title":"Orthop Traumatol Surg Res"},{"issue":"5","key":"2025070106322164100_R38","doi-asserted-by":"publisher","first-page":"301","DOI":"10.2519\/jospt.2017.0604","article-title":"Placebo mechanisms of manual therapy: a sheep in Wolf\u2019s clothing?","volume":"47","author":"Bialosky","year":"2017","journal-title":"J Orthop Sports Phys Ther"},{"issue":"7","key":"2025070106322164100_R39","doi-asserted-by":"publisher","first-page":"439","DOI":"10.2519\/jospt.2013.0105","article-title":"Placebo, nocebo, and expectations: Leveraging positive outcomes","volume":"43","author":"Benz","year":"2013","journal-title":"J Orthop Sports Phys Ther"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/7-8\/e1509\/61412489\/usae577.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/7-8\/e1509\/61412489\/usae577.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:32:31Z","timestamp":1751365951000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/7-8\/e1509\/7951595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,11]]},"references-count":39,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2025,1,11]]},"published-print":{"date-parts":[[2025,6,30]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usae577","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,1,11]]}}}