U.S. military veterans who sustained injuries while serving their country often return to civilian life facing another seemingly endless battle — chronic pain. Vets who saw action in Iraq or Afghanistan are more likely to suffer ongoing pain than veterans of any other conflict in American history due to different patterns of multiple injuries, often from explosions, that were not seen in previous wars, according to the Veterans Administration (VA).
John, a Navy veteran, sustained nerve damage to his back and a traumatic brain injury when his helicopter crashed in Iraq. Back home, his physical discomfort worsened. “It’s hard to walk… You suck up the pain and go as long as you can,” he said.
Although chronic pain has long been known to affect the veteran population, a 2014 Walter Reed Army Institute of Research study of over 2,500 soldiers who had served in Afghanistan or Iraq revealed how pervasive the problem is. Forty-four percent of soldiers studied had chronic pain, according to the research. Over 48 percent reported pain that had lasted for a year or longer, 55.6 percent said their pain was daily or constant, and over half described their pain as moderate to severe. The researchers also found that over 23 percent of the service members regularly used potentially addicting opioids to cope with their unrelenting pain, leading to significant numbers of overdose-related hospitalizations and even deaths.
“Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury. Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based ‘self-management’ skills are improved,” Eric B. Schoomaker, MD, PhD, a retired U.S. Army lieutenant general and professor at the Uniformed Services University of the Health Sciences and colleague Wayne B. Jonas, MD, a retired U.S. Army lieutenant colonel, wrote in a commentary that accompanied the Walter Reed study.
The urgent need to help thousands of veterans suffering from ongoing pain and other trauma has spurred new initiatives to help find better treatments and support. For example, VA researchers are searching for ways to improve recovery of brain function after traumatic brain injuries occur. They are also working on brain-computer interfaces that allow prosthetic devices to be controlled by the brain to help vets with amputations live as independently as possible. Cognitive Processing Therapy, a form of psychotherapy developed by VA research, has been found to effectively treat posttraumatic stress disorder (PTSD).
The VA, the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute on Drug Abuse have launched thirteen research projects to help veterans suffering long-term effects from combat injuries. Over the next five years, studies based at academic institutions and VA medical centers nationwide will concentrate on non-drug approaches to managing pain and related health conditions including PTSD, drug abuse, and sleep issues. The VA has online information about the research for veterans who are interested in participating in the studies.
“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,” said Josephine P. Briggs, MD, director of NCCAM.
Matthew Bair, MD, a former military doctor who now treats patients at the VA Medical Center in Indianapolis, and colleagues have developed the ESCAPE (Evaluation of Stepped Care for Chronic Pain) program for veterans to help decrease pain severity and to improve mood, physical activity, social activity, and overall quality of life.
(See our Veteran’s Behavioral Health section for more information on these problems.)
The two-step program combines 12 weeks of medical pain relief with analgesics and instruction in self-management strategies (like deep breathing and meditation). Then for another 12 weeks, patients undergo cognitive behavioral therapy aimed at relieving both pain and depression and finding ways to become more active, despite ongoing physical problems. For example, if a former soldier is depressed because he can no longer jog due to pain, a counselor can help find a substitute athletic activity, such as swimming, that is athletic and may reduce pain, too.
A study of vets who suffered from chronic musculoskeletal pain of the back, knee, neck, or shoulder put the ESCAPE program to the test. "The decrease in pain severity and 30 percent improvement in pain-related disability we achieved in the ESCAPE study are clinically significant, and we found that improvement lasted for at least nine months,” said Bair.
Veterans suffering from chronic pain, PTSD, and other service-related ongoing health problems can find support and resources through the VA’s Make the Connection program.
“When I got out of the service, I had absolutely no support. The drinking really got bad,” said Navy vet, John, who shared his story about finding ways to live and cope with his ongoing injuries on the Make the Connection website.
“It was really hard when I finally called for help. When they say about calling the veterans help line that ‘it takes the strength of a warrior,’ they are not kidding. It’s not being weak to reach out. Our best support is each other.”
April 27, 2015
Christopher Nystuen, MD, MBA