By Jane Norman, CQ HealthBeat Associate Editor
The Army is implementing a major initiative to better manage pain following a task force report that found no comprehensive strategy in place and a heavy reliance on prescription and over-the-counter medications.
The hope now is that the Army work might serve as model for non-military efforts aimed at assisting the millions of Americans who suffer from chronic pain. And the Army is also moving into nontraditional ways for soldiers and their family members to cope with pain, including acupuncture, biofeedback, therapeutic massage and yoga.
The objectives, many of which may take years to put in place, include establishing a common technique of classifying pain across the Department of Defense and Veterans Health Affairs, evaluating potential roles and certification requirements for nurses in the pain management strategy, adopting a clinical information data system that provides pain assessment screening and an outcomes registry and lessening the risk of prescription drug abuse in pain patients by focusing on those who are receiving controlled substances for their pain.
“The end result is I think we are going to shift and recalibrate this issue not only for the Department of Defense but for the country,” Col. Kevin T. Galloway, Army Pain Management Task Force chief of staff, said at a breakfast meeting with reporters on Tuesday. Galloway is an Army Nurse Corps officer and he’s been on repeated military deployments including Operation Iraqi Freedom with the 86th Combat Support Hospital.
Pain problems persist across society, he said. “This is not a military problem. But the military is uniquely poised to make certain adjustments to implement a certain strategy that you can’t do as easily on the outside,” said Galloway.
The Institute of Medicine recently called attention to the problem with a report that found 116 million adult Americans annually suffer from chronic pain and that the economic and medical costs involved total between $560 billion and $635 billion.
“Much of this pain is preventable or could be better managed,” said an Institute of Medicine (IoM) summary of the report (See related story, CQ HealthBeat, June 29, 2011).
While pain in the military is most often associated with soldiers severely wounded in combat, and there are many challenges with that group, that is just the “tip of the iceberg,” said Galloway. Numbers are difficult to pin down because pain hasn’t been measured in the past, he said.
Many other soldiers suffer from chronic musculoskeletal stress and injury produced by wearing heavy body armor or activities like constant climbing in and out of trucks. Some sustain stress fractures during training that can persist for years. Lower back pain is a problem. Extracurricular sports activities in a youthful force also produce injuries.
Pain has to be better treated among soldiers and family members no matter what the reason or source, he said. “Pain care is a basic need. As fast as possible we need to roll this out,” Galloway said.
Often pain can be controlled but patients’ functions and quality of life still are not good, he said.
The task force was chartered by the U.S. Army surgeon general in August 2009 to develop and recommend a pain management strategy, in line with a provision in the 2010 defense authorization law that required a pain management policy be adopted by the military health system. It worked in conjunction with other branches of the military and the Department of Veterans Affairs.
The task force came after a decade of military deployment to Iraq and Afghanistan that brought about a desire for a new approach to curbing pain. “Like every time we have any conflict, combat really becomes a catalyst for medical innovation — it has to,” said Galloway. “We highlight the weaknesses in medicine every time we fight a war.”
Working for more than six months, the task force found that while there are many ways of treating pain, one major component continues to be use of prescription and over the counter medication. It’s required and often appropriate but overreliance can cause problems as well including drug abuse and diversion.
For patients and their family members interested in solutions beyond drugs, complementary alternative medicine is a “popular option” though not yet accepted in traditional medicine, said the report.
The Army, though, is employing some if they are successful based on medical evidence. “A significant part of our strategy now is not what I would call traditionally medicine based,” said Galloway. “It’s investing in and embracing things like acupuncture and yoga and massage therapy and biofeedback.”
The report also said that the public expects the military to provide the highest level of care to those fighting in wars, but the transient nature of the military population makes continuity of care a challenge. The problems of severely wounded soldiers require integrated approaches to care that cross traditional medical specialties, not all of them available in all locations.
Some 109 “very ambitious” recommendations in the report are being implemented now, with the help of some collaboration on the outside as well, said Galloway.
“Years from now, looking back when we ask what came out of this war, I think this is going to be one of the improvements in medicine that will affect me as a retiree in the not too distant future, my family, my kids, I think they will benefit from this,” Galloway said.
Jane Norman can be reached at jnorman@cq.com
Source: CQ Online News
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