Wavey Walker Alston used to take morphine three times a day for chronic back pain. Now he is down to once a day, and, with the help of doctors at the Durham Veterans Affairs Health Care System, plans to be off his pain medication soon.
“We’re close, man. Next time, we were going to stop it,” said Ann Miller Maxwell in a recent session with Alston. “We’re going to see if everything is going fine,” said Miller Maxwell, a physician at the VA who treats chronic pain patients.
Jules Harris, a veteran of the Iraq War, has chronic pain from injuries to his ankles from carrying heavy backpacks, and post-traumatic stress disorder. While he has used painkillers in the past, his doctor at the VA has steered him in other directions. He has been learning to fight pain through writing, recreation therapy and judo.
Alston, 69, and Harris, 35, are among many patients at VA hospitals locally and nationally who are benefiting from a new approach to treating chronic pain. As the use of opoid painkillers has led to addiction and overdoses, the VA has begun trying to decrease long-term use of the painkillers, while still using them for patients with acute pain.
The Durham VA hospital has seen some success from use of alternative methods of treating pain. In January, the Durham VA reported a drop in the number of patients who are prescribed opioids – from 21 percent in 2012 to 13 percent in 2017.
For about two years, Alston has been receiving acupuncture, first in his back, and now in his ears, a technique called “battlefield acupuncture.” Morphine helped with his pain, but it also made him sleepy, Alston said. Then Miller Maxwell urged him to try acupuncture.
“Getting the acupuncture really helped,” Alston said. “I didn’t believe it at first. Dr. Maxwell, she’s great. I started with her, then we gradually reduced the morphine a few units at a time. [I am] down to one now, one in the morning. Before, I was taking it three times a day.
“The way it’s going, I believe I can kick it all. It surprised me.”
Alston also has begun physical therapy, another of many alternatives to painkillers that Veterans Affairs is promoting. Those treatments include yoga, music and other creative arts therapies and exercise classes, said Miller Maxwell. Later this year, the hospital will offer tai-chi.
Crowds and noises can trigger panic attacks for Harris. He was writing poems as part of his creative arts therapy at the VA. One night during bowling, Recreation Therapist Tiffany Smith approached him and said, “We have something good for you that I think you ought to try. They told me about sensei [Chester] Evans." Evans, 68, a Vietnam War veteran who also has learned to cope with PTSD, teaches at El Toro Judo in Raleigh. Smith told Harris, “We think you ought to try this because he’s helping veterans.”
The unpredictability of judo has helped Harris cope with PTSD. With other recreation activities, like kayaking, “you practice so much that you know how to deal with it," Harris said. "In judo, you never know what situation is going to be thrown at you and how you may have to react. It pushes you because it's something that you won't ever conquer."
Judo "allows me to get my frustration, my anger out, get that weight of the world off me. I have many days where I’m down and out, but I come to judo and it just helps pull me back together.”
Evans' experiences as a veteran also are crucial to his therapy, Harris said. During an interview, Harris looked over at Evans and said of his sensei: “It helps me a lot with him being a vet and having a purple heart. He understands me more than a lot of people because he’s been there. I have my breakdowns. He'll pat me on my back. He'll help pull me together….”
‘Hungry for options’
“People are hungry for options,” Miller Maxwell said. “People come to me and they say, Don’t give me another pill. I don’t want any more of this mess.”
The change in treatment culture began before the problems with opioids became apparent. Around 2000, Richard Niemtzow, a physician, invented battlefield acupuncture for use in the battlefield, when it was not advisable to use Western pain medications, according to the website. In battlefield acupuncture, tiny needles are placed in different points of the earlobes to send signals to the healing centers of the brain.
The Air Force was the first service branch to use the technique. “I think the [Department of Defense] realized they needed some options, that what was going on in terms of pain management wasn’t necessarily working, especially in the long run, so they started to look around,” Miller Maxwell said. In 2011, a group of physicians in the VA pulled together “to figure out how we are going to deal with this pain management crisis that is occurring,” she said.
That push led to battlefield acupuncture and other therapies spreading throughout the VA and Department of Defense, Miller Maxwell said. She trained in acupuncture during her residency, and later became certified in integrative and holistic medicine. Hospitals in the VA system are now committing to an approach called the whole health initiative. The whole health approach seeks “to provide personalized, proactive, patient driven healthcare,” according to a statement from the VA’s Office of Patient Centered Care and Cultural Transformation. The VA wants to transform “from a problem-based disease care system to one that is patient centered and focused on whole health,” the statement reads.
Life without painkillers
To put whole health into practice, the VA is using peer-facilitated groups that help veterans with managing problems with chronic pain, as well as diabetes and other health problems, Miller Maxwell said.
Alston has benefited from those approaches, which also include prayer and meditation. Many of Miller Maxwell’s patients are from the Korea and Vietnam era, she said. A lot of the injuries the VA treats “may have begun during the service, but over time have gotten worse,” she said.
Alston went into the Air Force in 1967, where he learned to be an airplane mechanic. He was discharged in 1971. He thinks his back pain may date back to his service days. “Being a mechanic, you are in all kinds of positions, standing ... bending over,” along with lifting, Alston said. He had surgery in 1978, “but it didn’t do any good, really,” he said. “I always had the pain, but not as bad.” He also has diabetes, which led to neuropathy in his hands.
He lists the planes he worked on as a mechanic: C-47s, T-28s, 119s, C-141s and C-5s. Today, he restores cars, and his therapy has allowed him to move and stand better. He is teaching his granddaughter, 13, to work on the cars. Alston runs off the models his has restored: a ‘57 Chevy Nomad wagon, a ‘56 Chevy pickup truck, and a ‘71 Chevy pickup. He takes out some photos of his cars. “I did everything but paint,” he said.
“He’s a different man than when I first met him,” Miller Maxwell said. Alston said he will continue with the acupuncture “’til she throws me out.”
Harris said that writing has always been a form of expression and comfort for him. He credits Creative Arts Therapist Jillian Thompson with encouraging him to keep writing. “I just always loved to write," Harris said. "That was probably the best way for me to express myself. Even in war I would sit down and I would just write,” he said.
He reads a poem about insomnia that Evans (Harris also calls him "Gunny," short for gunnery sergeant) helped to inspire. Evans encourages him and will sometimes give him a prompt. “I just give him a couple of lines, and leave him alone,” Evans said.
He credits VA therapists and Evans with helping him cope with PTSD, and plans to stick with his therapy and judo. "I learned that if I'm not in therapy and I'm not doing judo, I go into this depressive state,” he said. A lot of young veterans "try to say we're all right and we don't need this and we're ashamed because of what other people will say,” Harris said.
Evans "can look at me and he can tell when I'm about to break down, and he'll just pull me right on through. A lot of people don't have that, but that's what a lot of vets need. They need that support system.”