Mission Forward

Managing Pain: Chiropractic’s Increasingly Important Role in Veterans Affairs Services

According to a 2018 Centers for Disease Control and Prevention study, as many as 65 percent of American veterans and active duty service members suffer from chronic pain. Chiropractic care has been cited as an effective alternative to opioid use in pain management; over the last 15 years, Doctors of Chiropractic have become increasingly vital members of integrated care teams within Veterans Affairs (VA) facilities around the country.

Since 2005, Logan University has been an academic affiliate of the VA St. Louis Health Care System (VASTLHCS), a fullservice health care facility serving veterans and their families in east central Missouri and southwestern Illinois. Logan’s relationship with the VA gives Logan clinicians and trimester 8-10 students the opportunity to serve those who have served our country.

“At the VA, patients are typically referred to chiropractors for a narrow scope of issues: lower back pain, upper back issues, or neck, shoulder and knee pain. However, almost every patient comes with a complex set of comorbidities,” said Pam Wakefield, DC (’90), who provided chiropractic care to patients and oversaw Logan students through the VASTLHCS clinical rotation program for 15 years.

In addition, in 2013 Dr. Wakefield applied for funding for a first-of-its-kind chiropractic residency program through the VA Office of Academic Affiliations, and in 2014 Logan became one of only four chiropractic schools in the country to begin residency training at the VA. Dr. Wakefield directed the program until July 2020; it is now overseen by Jason Napuli, DC, VASTLHCS integrated chiropractic clinical practice residency program director.

The chiropractic team at VASTLHCS includes four staff chiropractors and a resident as well as several Logan student interns working under supervision. The team, led by Dr. Napuli, sees 400 new patients and more than 3,000 visits per year, and is committed to helping veterans improve their quality of life. Chiropractic care is aligned under the VA’s Whole Health and Primary Care services. According to the VA, Whole Health is a cutting-edge approach to care that supports veterans’ health and well-being, while Primary Care gives eligible veterans easy access to health care professionals familiar with their needs.

“We focus on the whole body as part of the multidisciplinary Whole Health initiative, which encourages patients to engage in activities that matter most to them and to take charge of their own health via the tools we provide,” said Dr. Napuli. “Chiropractic care is an important piece of the pie.”

Dr. Napuli joined the Whole Health chiropractic team and residency faculty in 2018. At that time, he assumed primary responsibility for the student training program and in 2020 assumed the residency program director role. Previously, he worked in VA facilities in New York (2006-2014) and Florida (2014-2018), where he started programs and created academic affiliations for chiropractic student training programs.

A veteran of the U.S. Air Force himself, Dr. Napuli emphasizes the importance of empowering veterans to improve their health and well-being. He also describes working at the VA as the best job in the world, as it encompasses clinical care, education, training and research.

“Working each day supporting our veterans is our way to thank them,” he said. “While a competitive career path, it is a great opportunity for DCs. For every VA chiropractic position, there are hundreds of qualified applicants.”

Nationwide, more than 200 chiropractors are employed in the VA, with more sites coming on board each month. To date, Logan has placed all seven of its residents in VA positions across the country. VA facilities, however, are just one of many paths to

Dr. Jason Napuli outside the VA St. Louis Health Care System office Continued on page 9

Dr. Napuli oversees a student intern adjusting a patient at the VA St. Louis Health Care System office.

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success for VASTLHCS residents, as the one-year program trains DCs to work in the VA, other integrated hospital positions or even academia. The residency is funded through the VA Office of Academic Affiliations. The VA is the largest educator of health professional trainees in the United States, with more than 1,000 trainees per year in medicine, dentistry and allied health programs.

“In addition to seeing patients, our residents rotate in various disciplines throughout the facility, including neurosurgery, orthopedic surgery, urgent care clinic, physical medicine and rehab, psychology and more,” said Dr. Napuli. “They also complete a research project and participate at Logan’s campus in the classroom and Health Centers.”

Kevin Meyer, DC (’20), who completed his preceptorship in fall 2020 at the St. Clair County VA Clinic, said the experience was invaluable. “Working with veterans helped broaden my understanding of pain and how to treat patients with complex presentations. It also gave me great perspective on how chiropractic enhances the growing integrative system of health care,” he said.

Dr. Meyer, along with Omar Al-Ryati, DC (’21), were among 10 individuals selected for the 2021-22 VA Chiropractic Integrated Clinical Practice Residency Program. Dr. Meyer matched with the Puget Sound Veterans Administration Medical Center, and Dr. Al-Ryati, who completed a clerkship as a student doctor at Walter Reed National Military Medical Center in Maryland, was matched with the Miami Veterans Administration Medical Center.

“I always tell students: You have to stand out among the applicants,” said Dr. Napuli. “Set yourself up to have an edge by, first and foremost, being a leader on campus and your profession, taking advantage of opportunities to participate in research projects, and learning as much as you can about evidence-based care. Ultimately, to succeed in this role, you have to have a passion for selfless service: serving your profession, peers and community.”

Logan University & Veterans Affairs Affiliations Congratulations to Dr. Pam Wakefield on Retirement

Dr. Wakefield retired in June of 2021 after 23 years at Logan. Dr. Wakefield came to Logan in 1987 as a DC student; following graduation, she moved to her home state of New York, where she practiced chiropractic until returning to Logan in 1998 as a clinical instructor. She worked as a clinician at various locations, primarily the Montgomery Health Center and Bogey Hills Health Center, until 2012, then part-time on Saturdays rotating to five different outpatient clinics. In 2006, she began seeing patients as a part-time clinician at the Jefferson Barracks Division of the VASTLHCS while continuing her work at Logan Health Centers a few days per week.

“It was a busy time, working at the VA and at Logan Health Centers while also teaching courses,” Dr. Wakefield said. Even with her busy schedule, she still found time to continue the VA clinical rotation program for Logan students.

“When we first started the clinical rotation at the VA, we would have up to 10 students rotating per trimester. But over the years, the curriculum has changed, and there are now more online course offerings and more options for students,” she said. “Now we have two to four students on VA rotation, where we are privileged to work with this fantastic group of chiropractors who are transformative to the profession.”

Dr. Wakefield reflects fondly on her years at Logan and her long-time experience caring for patients.

“Logan gave me an opportunity to teach, which I always wanted to do,” she said. “All of the opportunities I have had—teaching online and in person, working at Logan Health Centers, my time caring for veterans and helping to create a residency program—have kept my career interesting and rewarding.”

Thank you for your commitment to Logan, chiropractic, education and to your many patients over the years, Dr. Wakefield. Congratulations on your retirement!