Army rethinks 'no pain, no gain'
June 14, 2012
Fort Bliss, Texas (June 14, 2012) -- A newly funded center on Fort Bliss is gearing up to face a persistent foe of the Department of Defense -- chronic pain.
"Ultimately our goal (in integrative medicine) is not to be the last resort," said Col. Richard Petri Jr., chief of the new Interdisciplinary Pain Management Center at William Beaumont Army Medical Center.
"We want to get to the patient's pain before it becomes chronic."
In the last few years, the Army has begun to pay attention not only to the numbers -- the annual cost of chronic pain in the United States is estimated to be about $100 billion -- but to service members returning from wars with pains that endure both physically and mentally.
The new Interdisciplinary Pain Management Center, which recently received $4 million in federal funding, will tackle the issue of pain beginning with Soldiers at the Fort Bliss Warrior Transition Unit.
Pain in the military
In 2009 the Army Pain Management Task Force, chartered by then Army Surgeon General Lt. Gen. Eric Schoomaker, recognized that pain is the most frequent reason patients seek physician care in the United States.
"Pain is a disease state of the nervous system," read the task force findings and recommendations. "(Pain) deserves the same management attention given to any other disease state."
The establishment of the Interdisciplinary Pain Management Center came as a task force recommendation -- which pushed for a holistic, multidisciplinary and multimodal approach to pain in the military.
The IPM Center will encompass an integrative medicine approach -- a combination of conventional and alternative treatments -- to pain management.
"A person has to be active in their own health care. Integrative medicine takes on empowerment and active participation," Petri said.
Beginning with a staff of eight providers and specialists, the center will have between 50 to 100 staff members when fully operational.
The IPM Center is a first for the DoD as was WBAMC's Center for Integrative Medicine -- which opened in November 2003. The integrative medicine center offers acupuncture and chiropractic services.
Dr. Aaron Harris, a chiropractic physician with William Beaumont Army Medical Center, hovered over a bed in the Center for Integrative Medicine on Fort Bliss.
The Vertebral Axial Decompression table --for nonsurgical lumbar decompression -- was used earlier this year on a 23-year-old Soldier suffering from a failed lower back surgery. Over the course of 20 sessions, the Soldier's pain shifted from a ranking of a four to a one (on a scale of 10).
"It helps some and not others," Harris admitted -- though his research findings released on the case call for the Army to recognize the high incidence of disc pathology among Soldiers and the need to study and use conservative technologies to treat the injury.
The Army Pain Management Task Force found that one major component of pain treatment in the United States is use of over-the-counter and prescription medications. However an overreliance on medication has had unintended consequences -- including increased prevalence of prescription medication abuse throughout the United States.
Do you even know where it hurts?
With the wars of the 21st century, a new battlefield injury emerged -- one caused by a concussive wave that echoes through a human skull like ripples in a pond.
"Traumatic brain injuries before the war happened were found in car accidents or playing football. You'd hit your head," Petri said.
"Iraq and Afghanistan have given us TBIs from improvised explosive devices. The hit disrupts and changes the brain. The white matter actually changes. We're looking at an anatomical change."
The injury occurs in the white matter or gray area of the brain -- linked to controlling human emotions, sensations and even motor skills, Petri said. What was once solely an anatomical injury with real pain is a more complex injury -- one which affects cognitive functions and stress levels.
The 2009 pain task force found that stress is a significant contributor to pain conditions and that chronic pain leads to increased stress.
"You can't treat a patient with pain unless you work with their stress as well. You can't find a patient that is solely with pain and not stress," Petri said noting the potential advantages of treating pain using both conventional medicine and alternative modalities which focus on calming the mind.
"Soldier's will get in the door because of their pain, but we will treat the whole patient."
What to expect
The pain task force recommended that the DoD should "continue to responsibly explore safe and effective use of advanced and non-traditional approaches to pain management."
Those non-traditional approaches include complementary and alternative medicines (CAM) -- diverse practices and products that are not generally considered part of conventional medicine.
"I know, most people in the military are skeptical," Petri said. "But anyone who does not believe in what I do (in integrative medicine) then experiences my services, they're usually the loudest advocates."
The IPM Center, which received its federal funding in March of this year, is still under development. The IPM Center will be located at the current Integrative Medicine Clinic, Building 2485 D on Fort Bliss. With a current staff of eight people, Petri said the center will have 31 staff members by September and as many as 100 when the center is fully operational.
The center will address another issue raised in the task force findings -- continuity of care. The center will house an acupuncturist, chiropractor, psychologist, primary care providers, pharmacist, massage therapists, yoga instructor, nurses, education specialists and administration all under one roof.
"The goal is to have everyone at the table talking about the patient," Petri said.