Veterans Experiencing Homelessness Find Relief with Battlefield Acupuncture

Homelessness among Veterans remains a major public health problem, and VA is dedicated to the health and well-being of homeless Veterans. It is currently estimated that up to 50% of homeless Veterans experience chronic pain. Research has noted that chronic pain can be significant among homeless populations, and that stigma and bias related to homelessness by the healthcare system can contribute to pain development. Chronic pain is a severe and persistent problem among Veterans experiencing homelessness, and additional research is needed to treat pain holistically.

VA and other healthcare systems are transforming to a Whole Health System of Care, a patient-centered approach that empowers Veterans to take an active role in their overall health and well-being. Complementary and Integrative Health (CIH) therapies are central to this transformation. The VA benefits package covers nine CIH therapies: acupuncture, biofeedback, massage therapy, meditation, guided imagery, chiropractic care, clinical hypnosis, tai chi, and yoga. Congress mandated these CIH benefits in the 2016 Comprehensive Addiction Recovery Act (CARA) to improve chronic pain treatment and reduce reliance on prescription opioids.

Battlefield Acupuncture (BFA) is a type of acupuncture involving the application of thin, sterile needles to the outer ear. It was developed in 2001 by Air Force Surgeon and acupuncturist Richard Niemtzow to treat pain in soldiers on the front lines of battle. BFA uses five specific treatment sites located on the ear and requires minimal equipment, making it a reasonable treatment to use in combat settings.

BFA is now offered nationally in the VA healthcare system. Unlike traditional Western medical approaches to pain-which can involve lengthy appointments, diagnostic testing, and pharmaceutical interventions-BFA visits typically last 15 to 20 minutes. A typical BFA appointment includes a pain questionnaire at the beginning of each visit, followed by the placement of ten small BFA needles-five on each ear. Once treated, patients rate their pain before leaving. This holistic approach can reduce pain quickly, and relief is not limited to one area of the body.

Previous studies have shown BFA's promising results. One study evaluating more than 750 patients in a BFA clinic found that 82% reported an immediate decrease in pain after the procedure. Another large-scale retrospective study of more than 11,000 Veterans from 57 VA medical centers indicated that up to 75% of patients found pain relief immediately post-treatment.

The aim of this pilot study, funded by the National Center for Homelessness Among Veterans, was to understand homeless Veterans' perspectives on the usefulness and impact of BFA. The research team examined changes in pain and how pain interfered with activities of daily living, the accessibility and utility of BFA as a treatment for chronic pain, and recommendations for improvement.

Participants were recruited from a larger study that examined the impact of BFA on Veterans experiencing homelessness. Eligibility included either a current episode of homelessness or a history of homelessness within the past five years, and a self-reported history of chronic pain that had lasted for at least three months. Veterans were recruited through flyers, word-of-mouth, and clinician referrals. During the consent process, all participants were asked if they would be willing to participate in a post-treatment interview.

In total, 12 out of 33 eligible Veterans consented to participate in the post-treatment qualitative interview, which occurred either after completion of the 12 sessions (10 Veterans) or after the Veterans indicated they would like to discontinue the BFA sessions (2). The 12 Veterans who participated in the interviews had an average age of 61years, 75% were men, and all were white.

Semi-structured interviews were conducted between September 2022 and March 2023 to understand the perceived effects of BFA on participants' pain, sleep, physical activities, mental health, and social activities. Participants were also asked about the usability and acceptability of BFA compared to other treatments for pain, barriers to BFA treatment, and recommendations for improvement. Interview length ranged from 18 to 54 minutes.

The research team identified three main themes among Veterans' accounts of BFA:

1. Prior experiences with chronic pain: Participants described living with chronic pain, often for many years, and the impact it had on their lives. Most often they reported either persistent musculoskeletal pain or neuropathic pain that significantly affected their quality of life:

I kind of equivocate [my pain] to the movie the Wizard of Oz and the Tin Man. He's rusted in place.

Many participants reported they were either currently taking or had previously tried medications for pain management including gabapentin, acetaminophen, and cortisone shots. Often these pharmacological therapies provided some relief, but only to a limited extent:

I do gabapentin. That's for my neuropathy. It helps when they're-it helps with it but doesn't take it all out of me.

1. The appeal of a non-pharmacologic treatment: Participants reported they appreciated how BFA provided another non-pharmacologic option to help manage their chronic pain. Many said they were already on "too many" medications, and wanted to find alternative, non-pharmacologic treatments that provided additional pain relief:

Well, one it's a natural thing and it's not some more medicine that I have to take which I don't, I don't like taking as much as I got.

Participants also valued how short and easy to access the BFA appointments were:

One, it's convenient. Two, it's short. It's a short treatment span. Three, it's natural. It's-it has to do with the chakras and the electrical system in your body and tapping into it.

Most participants reported no major disadvantages to trying BFA; the most common side effects were minor discomfort during needle insertion and, after treatment, occasional pain when sleeping on the ear. However, most participants found these side effects to be minor inconveniences and worth the positive results they had from BFA.

1. BFA had a positive impact on health and well-being: Overall, participants indicated that BFA had a positive impact on their health and well-being, specifically noting improvements in their ability to participate in physical activities and a reduction in stress and anxiety. One participant noted:

[I have] extremely improved mobility to-from going from a 1, I'm up to like I'd say 8-1/2.

With their improved mobility, the participants mentioned they had resumed activities they once enjoyed but hadn't been able to participate in due to their chronic pain, like golf and community outings offered at their VA Supportive Housing. Participants also described an overall improvement in their well-being and a sense of freedom once their pain improved:

Just a sense of freedom, a sense of being young. I don't know-just a general-other parts of, you know, life-dealing with stuff that didn't-you know, you didn't think, you know, was a problem, but it is.

When asked if they would recommend BFA to other Veterans with experiences of homelessness, all the participants said they would, with many using the phrase "Just try it!" They indicated it would be particularly useful for Veterans who had exhausted other options:

You know, try it. I mean if you exhaust all other things, you might as well. I mean, you're not putting any substance in your body or anything like that. You're just getting nifty jewelry.

Many recommended that BFA be freely accessible and incorporated into existing programs and locations for Veterans in the community including Veterans of Foreign Wars (VFWs) and American Legions. Others recommended incorporating BFA into VA clinics:

I think it should be offered more freely, you know. Including pain management and primary care.

This study offers important insights for addressing chronic pain among Veterans experiencing homelessness. Many participants had a history of substance use disorders, making their perspectives particularly valuable. These Veterans reported that one of BFA's greatest benefits was pain relief without additional medications-a crucial advantage for this high-risk population where substance use disorders are common.

Veterans in this study recommended making BFA more widely available in locations where homeless Veterans regularly spend time, not just at VA medical centers. This recommendation is especially important given that only 25% of homeless Veterans use VA homelessness services, even though nearly all utilize some form of health or social care. Providing BFA in easy-to-access community locations could significantly expand outreach to Veterans experiencing homelessness.

Future research should explore best practices for introducing BFA to Veterans and integrating it with other VA healthcare services. Researchers also need to investigate how BFA works and its effects on mental illness, addiction, and social dysfunction.

Kimberlee Flike, PhD , MSN, RN, is with HSR's Center for Health Optimization and Implementation Research (CHOIR) at the VA Bedford Healthcare System.

Cathy St. Pierre, PhD, MSN, FNP was Associate Chief Nurse of Research and a nurse practitioner at the VA Bedford Healthcare System. She retired from VA in September 2025, and was inducted as a Fellow of the American Academy of Nursing (FAAN) in October of 2025.

Study Publication

Flike K, St. Pierre C, Howard A, and Tsai J. Perceptions of the Impact and Utility of Battlefield Acupuncture Among Veterans Experiencing Homelessness: A Qualitative Pilot Study.Global Advances in Integrative Medicine and Health. August 17, 2025;14:1-6.

⇪

The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.