AAPM 2009: Doctors Contend With Pain in War Vets

Allison Gandey

February 10, 2009

February 10, 2009 (Honolulu, Hawaii) – As soldiers serving in Iraq and Afghanistan return to the United States, doctors can expect an influx of new patients. Speaking here at the American Academy of Pain Medicine 25th Annual Meeting, specialists provided an overview of what doctors might expect.

"As people leave the military and join the community, Veterans Affairs is not necessarily going to be available to all these individuals and you are going to be dealing with them," presenter Chester Buckenmaier, MD, from the Walter Reed Army Medical Center, in Bethesda, Maryland, told meeting attendees.

He pointed out that the pain-management needs of war veterans can be diverse and can include complications from amputations, spinal cord injuries, burns, and what is known as the polytrauma triad of traumatic brain injury, posttraumatic stress disorder, and chronic pain.

"In a blink of an eye, they go from being young and healthy to being a traumatically injured human being," Dr. Buckenmaier said. "In the military, we often think more pain means more phine (morphine). We view pain as a symptom rather than the disease process to the nervous system that it is."

Pain can too often be overlooked, he said, and viewed as nonlifethreatening, rather than a serious problem. With advances in body armor, Dr. Buckenmaier reported that less than 10% of injured soldiers died of wounds.

With fewer casualties, he said, military officials might be less concerned about the pain surviving soldiers are experiencing. "But there are serious consequences of unrelieved pain," Dr. Buckenmaier emphasized.

Serious Consequences of Unrelieved Pain

Drs. Chester Buckenmaier and Norman Harden take questions at the meeting.

Also presenting during the session was Norman Harden, MD, from the Northwestern University Feinberg School of Medicine, in Chicago, Illinois. He gave a talk on the long-term management of combat-related neuropathic pain.

"When a person is in pain, the central nervous system undergoes profound changes," Dr. Harden told Medscape Neurology & Neurosurgery. "It is a dynamic process as the nervous system adapts."

Dr. Harden urged clinicians not to limit treatment to drug therapies and encouraged the use of multidisciplinary teams. "We need the support of cognitive behavioral specialists to assess posttraumatic stress disorder," he said during his presentation.

Dr. Harden also recommended that physician teams enlist the help of nurses, rehabilitation specialists, and recreational therapists. "It's important that we give these people back something that they can enjoy. Recreational activities can help people get on with their lives and pain management," Dr. Harden said.

Both physicians raised concerns about the lack of available data assessing pain in war veterans. Dr. Harden called the situation "embarrassing," and Dr. Buckenmaier wondered why a randomized controlled trial has yet to be done. "Why don't we even have a pain question on the trauma registry?" he asked.

"My crusade right now is to provide comprehensive pain care and make sure these men and women have these services," Dr. Buckenmaier said.

"This illuminates some of the more brutal aspects of the human experience," session moderator Perry Fine, MD, from the University of Utah School of Medicine, in Salt Lake City, said at the meeting.

He applauded the speakers and called the presentations excellent. "They are doing good work, and it is my sincere hope that it carries forward."

Dr. Harden reports having received research funding from Endo Pharmaceuticals, USB Corporation, and GlaxoSmithKline, and he has served on advisory committees for PriCara and Xenoport Inc.

American Academy of Pain Medicine 25th Annual Meeting: Plenary session 111. Presented January 31, 2009.

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