Innovative Treatments Of Wounded Soldiers For Chronic Pain

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Chronic Pain

Newsweek looks at how innovative ways of treating wounded soldiers returning from the battlefield is leading to treatments for chronic pain that will help civilians.

While morphine is still the Army's most commonly used painkilling drug, the military is being forced to change its strategy as casualties mount in Iraq and Afghanistan. More than 90 percent of wounded soldiers have made it off the battlefield-the highest survival rate in American history-only to overwhelm chronic-pain clinics when they come home, Newsweek reports. "We're seeing the tip of a tidal wave of pain," says Lt. Col. Chester (Trip) Buckenmaier, an anesthesiologist at Walter Reed Army Medical Center, who has emerged as a sort of pain czar for the Army. After decades of "sucking it up," the military has finally started to respond in new and innovative ways to this escalating pain crisis. Even as the VA hospital system has come under fire for poor care, Army doctors haven't just joined up in medicine's larger war against pain-they're leading the charge.

In Newsweek's June 4 cover "The New War on Pain," (on newsstands Monday, May 28), General Editor Mary Carimichael looks at how those advances at the military hospitals will also help civilians. Chronic pain is one of the most pervasive and intractable medical conditions in the United States, with one in five Americans afflicted. Civilian chronic pain already costs the country $61 billion in lost productivity and many more in medical fees. Treating the soldiers in the coming years will add at least $340 billion to the toll.

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As the number of patients has grown, though, so has medicine's understanding of what pain is. "The public understanding of pain has been that it's a stubbed toe or a broken bone," says Will Rowe, executive director of the American Pain Foundation. "But that's just one aspect of it. Now there's a growing awareness that pain is a disease of its own."

The military is pioneering its own new approaches. Since 2003, a small but growing number of soldiers in Iraq have been treated at the front with high- tech nerve-blocking devices that are effective but not addictive. They are common in civilian life, but their use on the battlefield is unprecedented, Carmichael reports.

Back at home, many VA clinics are offering extensive and elaborate pain treatments, and they're learning how to get tough guys and girls to soften up and admit they need help. At Walter Reed, Buckenmaier's team is conducting groundbreaking research on the link between acute and chronic pain; his findings, due in the next few years, could revolutionize treatment. "The military needs people to be functioning out on the field," says Rollin (Mac) Gallagher, chief of pain medicine at the Philadelphia VA hospital. "What we're now starting to recognize is that if you control people's pain, they're not liabilities-they're assets."

Buckenmaier and Gallagher are jointly tracking soldiers who received the anesthetic pumps within hours of their injuries. If the ones who got pumps quickly have less chronic pain-and animal studies suggest they will-the research will not only point the way to new treatments, says Gallagher: for civilians and soldiers alike, "it will be a revolution." It may mean that injuries will be treated much more aggressively. That sprained ankle that only registered a 4 on the pain scale? If you want to avoid chronic pain later, you might need serious therapy, and right away.

Carmichael also reports on new brain science that also explains chronic pain. Docs now know that the brain and spinal cord rewire themselves in response to injuries, forming "pain pathways" that can become pathologically overactive years later. They are trying to sever this maladaptive mind-body connection with a host of new drugs and approaches, Carmichael reports. Some focus on recently discovered chemical receptors in the brain and muscles. Others pack all the punch of narcotics with less of the specter of addiction. New types of electrical stimulators targeting the brain, the spine and the muscles hit the market almost every year. Fentanyl skin patches, first introduced in 1990, have evolved into a patient-controlled, push-button device called IONSYS, available by the end of this year. And complementary and alternative medicine offers a parallel universe of treatments: herbs, yoga, acupuncture, chiropractic, massage and "prolotherapy," which injects various solutions, including cod-liver oil, into ligaments and tendons near the area of pain.

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