Both acute and chronic pain related to trauma from an injury, have constantly been a common complication among troops. Fortunately, in recent years, efforts by the United States Department of Defense and Veterans Affairs officials to solve the issue of pain among active duty service members and veterans have started offering a larger variety of evidence-based treatment methods.
Lt. Col. Scott Griffith, MD, and Army’s pain management
consultant, quoted in a recent interview, “Chronic pain can be very challenging
so we focus a lot on their functionality, being able to restore their function
as well as bringing their pain down to the extent that we can. Even for people
who cannot have their pain eliminated, many of them can have an improvement in
the quality of their life.”
For military healthcare providers, managing acute and chronic
pain has become a tremendous problem than ever before. In a June 2014 report in
JAMA Internal Medicine, of 2,597 evaluated individuals, researchers found that
44 percent of troops experienced chronic pain symptoms after being deployed for
combat while 15.1% of those individuals reported regularly using opioids.
Furthermore, Veterans Affairs administrators gave a testimony before a Congress
hearing that chronic pain was among the most common medical complication in
veterans returning from the last decade of conflict. The frequent cause for
chronic pain is due to musculoskeletal injury, which is usually unrelated to
battlefield wounds. Causes for musculoskeletal injury include training and job
performance with the use of increasingly heavy protective equipment as well as
sports and recreation.
The challenge for federal medicine providers still lies on
relieving chronic pain symptoms among active duty military members and veterans
while also decreasing the chance of opioid addiction and abuse among
individuals. In 2003, the Defense & Veterans Center for Integrative Pain
Management (DVCIPM) was established to support and regulate pain research and
education as well as improving pain management methods. Six years later, the Army
surgeon general organized a pain task force membership that included
representatives from military services, TRICARE and VHA, to give guidance and
approval for a comprehensive pain management strategy. That same task force
distributed a report in May 2010 recommending the military to use a holistic,
multimodal and multidisciplinary approach to pain management, including
complementary and alternative medicine.
Simultaneously, the research for non-drug methods to
treating pain is still ongoing. VA and National Institutes of Health’s National
Center for Complementary and Alternative Medicine (NCCAM) declared that $21.7
million would be utilized for 13 different research projects over a period of
five years to examine further non-drug approaches to managing pain and related
health conditions such as post-traumatic stress disorder, drug abuse, and sleep
issues. The research will take place at academic institutions and VAMCs across the
United States.
Josephine P. Briggs, MD, director of NCCAM, said in a
written statement, “The need for non-drug treatment options is a significant
and urgent public health imperative. We believe this research will provide
much-needed information that will help our military and their family members,
and ultimately anyone suffering from chronic pain and related conditions.”
Through the project, the VA will analyze the extent and
cost-effectiveness of complementary and alternative medicine utilization among
veterans being treated at the Veterans Affairs Medical Clinics for
musculoskeletal disorder-related pain and other related conditions. On a wider
spectrum, changes in drug development are giving clinicians other means to helping
active-duty service members and veterans as well as others avoid opioid addiction.
The Food and Drug Administration (FDA) announced it had approved new labeling
for the third extended release opioid analgesic to be approved with
abuse-deterrent properties, making them more difficult to abuse orally, which
is the most common form of opioid abuse.
By Dr. Alex Jimenez
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