05/16/2007

Better pain care for returning U.S. troops

By Lauran Neergaard
The Associated Press

They call it the coming tsunami, veterans returning from Iraq who will suffer chronic pain years from now. Get ready, military doctors are warning pain specialists — even as they hope that slowly improving battlefield pain control may stem the tide.

The idea: Block the agony faster, and the body's pain network may not go into the overdrive that sets up the injured for lingering trouble long after they're officially healed.

"It's going to take the military to stop thinking of pain as a symptom, a consequence of war,” says Lt. Col. Chester "Trip” Buckenmaier III, an acute pain specialist at Walter Reed Army Medical Center who is pushing for that change.

"Pain really is a disease. If you don't manage it early, it leads to serious consequences.”

At risk aren't just troops who suffered severe wounds such as loss of a limb, but others with varying types of pain that isn't diagnosed or that soldiers don't report.

Troops with traumatic brain injuries, a signature of the war, may not be able to express pain adequately. More common is a a fear that admitting pain might block return to duty — or hesitancy because they know wounds could have been worse.

Remarkably, Walker says it's not unusual to discover fractures or shrapnel previously missed because a soldier didn't acknowledge continued pain at first.

"Most pain doctors won't see the severely injured. The VA will keep them,” says Dr. Michael Clark, chief of chronic pain rehabilitation at the Tampa VA.

But other veterans eventually will seek community care, Clark warned an American Pain Society meeting recently.

Doctors have long known that suppressing acute pain aids short-term recovery. But it's also a factor in whether patients develop a long-term misery, chronic pain.

Consider: Injured nerves send distress signals to the brain. If those signals go unabated, the brain can essentially memorize pain and become hypersensitive. An infamous example is the phantom limb pain that often strikes amputees. But less severe injuries can spur chronic pain, too, which in turn is linked to post-traumatic stress disorder, other anxiety disorders, and disability.

At the war's beginning, "we were using Civil War-era pain management, " is Buckenmaier's grim assessment. Morphine was the main option. While morphine is a crucial painkiller, it doesn't actually block pain signals from reaching the brain.

What can? Continuous nerve blocks, developed at civilian hospitals using increasingly portable drug-infusion pumps. Doctors trace the roots of nerves signaling certain pain, such as from arm or leg wounds.