Army takes a hard look at chronic, acute pain
August 5, 2010
- Army's Pain Management Task Force results
- New pain management clinic at Ireland Army Community Hospital
- Alternative methods of pain treatment being encouraged
- Cases of pain management growing in numbers and complexity
Last August the Army Surgeon General Lt. Gen. Eric Schoomaker chartered the Army Pain Management Task Force to make recommendations for a Medical Command comprehensive pain management strategy that was holistic, multidisciplinary, and multimodal in its approach, utilized state-of-the-art/science modalities and technologies, and provided optimal quality of life for Soldiers and other patients with acute and chronic pain, according to the TF.
The TF overview of pain in the U.S. and the Military Health System indicated pain is the most frequent reason patients seek physician care in the U.S., and more than 50 million Americans suffer from chronic pain. The annual cost of chronic pain in the United States is estimated at $100 billion, including health care expenses, lost income, and lost productivity, according to the TF.
To help combat the issues of pain, the Army has implemented pain clinics, which are treating the whole individual and not just dispensing pills to Soldiers.
Although the pain management clinic is new to Fort Knox, Col. Ronald Place, the Ireland Army Community Hospital commander, said most of the Army's medical centers have pain clinics, but it hasn't been used in the Medical Department Activity.
"Americans today are challenged with finding good solutions for their pain," explained Col. Place.
Although most physicians prescribe what Capt. Christopher Finch, IACH's medical director in the Department of Anesthesia, calls the "pill for every ill," many seek alternative medical solutions to treating pain.
"There are so many medications for patients with acute (and) physical pain," said the director. "Opiates are effective with helping them get to their healing process."
Capt. Finch pointed out that using the holistic approach allows chronic pain patients the opportunity to use other methods when treating their pain.
"(Patients can) incorporate exercise, dieting, chiropractor, or acupuncture," he explained. "I think the Army is very open to incorporating each of those into a treatment (regimen). We need to work on helping the general populous."
Although IACH doesn't have an acupuncturist on its staff, Col. Place is considering having that form of modality in the clinic as part of the treatment process.
"I see pain as a complex challenge," explained Col. Place. "(It's) the most challenging thing health care providers deal with."
Capt. Finch added that treating pain involves people changing their life styles. He said instead of sitting on the couch, he encourages patients to take walks.
He said that the first step in treating Soldiers is asking them about their diet, exercise regime, and sleep. He added that during this process spouses should accompany their Soldier because they can provide vital information not known, such as sleep patterns.
Using various methods isn't new to military treatment facilities. Capt. Finch said that Walter Reed Medical Center in Washington, D.C., and Bethesda Naval Hospital in Bethesda, Md., has used chiropractic methods to treat patients.
"There have always been multiple modalities to treat pain," he said. "People are aware now. So much centers around mentality (and) being open-minded is now the focus of pain management."
Capt. Finch stressed that a team effort is needed to treat Soldiers who have chronic pain. He said that dieting and exercising help guide the Soldier with physical therapy.
Col. Place added that the goal in treating pain using these methods is helping those who haven't been successful using conventional techniques.
Although Soldiers are being treated for pain more now than in past years, the commander believes there are a lot of challenges to treating pain.
"Pain is a subjective issue," explained Col. Place. "(We) haven't done a great job (with) figuring out details (of the) disease process that started pain. Scientifically, (we) will likely struggle to eliminate pain.
"(The Department of the Army) and Medical (Command are) looking at studies. We have to better handle pain."
Even though more doctors are treating pain issues, Col. Place said there are tens of thousands of primary care physicians in America, but less than 1,000 are trained in the methods of pain treatment.
"There is more demand, (but) we're fairly confident we can find the staff," said Col. Place. "My fear is the demand for staff will overwhelm the capability."
Although many Soldiers might be optimistic about treating pain using the holistic modality, Col. Place said the Army is taking the necessary steps in trying to alleviate and treat Soldiers who endure chronic pain.
"In my opinion there are a hundreds of steps (in treating pain)," he explained. "The goal is to eliminate (pain). This is the first step in what will be many steps."
Capt. Finch added that, "The mentality is going from the suck-it-up mentality to treating pain. Now we are addressing pain."
The TF stated in its assessment that the failure to adequately address pain in the health care system continues to result in unnecessary suffering, exacerbation of other medical conditions, and huge financial and personnel costs, according to the TF.
The TFs final recommendations were divided into four areas:
* Provide tools and infrastructure that support and encourage practice and research advancement in pain management.
* Build a full spectrum of best practices for the continuum of acute and chronic pain, based on a foundation of best available evidence.
* Focus on the warrior and family-sustaining the force.
* Synchronize a culture of pain awareness, education, and proactive intervention.