Mayo Clinic Minute: Avoid opioids for chronic pain
When Veterans Cope With Chronic Pain
For many veterans returning from deployment in Iraq and Afghanistan, chronic pain is taking the joy out of coming home. Here's how to get help.
By Chris Iliades, MD
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Darisse Smith was an Army captain flying reconnaissance helicopter missions in Iraq from 2005 to 2006 when her back began to cause her constant pain. "The pain kept getting worse and worse, but as an officer, I felt it was my duty to finish the mission," says Smith.
Smith isn't alone. Because of better body armor and improved battlefield medicine, survival from military war wounds is much higher now than during the Vietnam era — but many more veterans are coming home with complex wounds and chronic pain issues. According to the Department of Veterans Affairs (VA), more than half of returning veterans from Iraq and Afghanistan report issues with pain persisting for longer than six months. It is both physically and psychologically stressful and can turn every day into a struggle for survival.
"It is a huge problem for so many veterans," Smith says. "It's not just traumatic battle injuries — it's also the wear and tear of doing a tough job in a tough environment."
How Chronic Pain Affects a Veteran's Life
Under the best of circumstances, chronic pain makes daily life difficult. But for returning veterans, issues such as physical and mental disability, post-traumatic stress disorder (PTSD), or traumatic brain injury can make a difficult situation much worse. Studies show that chronic pain in veterans is often associated with such issues as:
- Alcohol abuse
- Drug addiction
- Chronic fatigue
"Nobody comes back from a war the same person," says Smith. "Chronic pain just makes everything worse. For a high-functioning person who has a great deal of pride, it can be very hard to come home and not be able to hold down a job."
Treatment of Chronic Pain
The VA enacted a National Pain Management Strategy in 1998 to provide a standardized system for chronic pain management and to ensure prompt, appropriate pain treatment for all veterans. But managing chronic pain is very complex and often requires a variety of approaches. Treatment can include medication, surgery, physical and occupational therapy, and psychiatric or psychological therapy.
Smith says she tried pain medications, back surgery, physical therapy, and various alternative medical interventions before finally getting relief from an implanted spinal cord stimulator. "There is not one kind of treatment that works for everybody," she says. "Chronic pain involves every aspect of your life. If all you are getting for chronic pain is painkillers, you need to find better treatment."
When Pain Leads to Addiction
Substance abuse is another issue that many veterans with pain struggle with. Opiate drugs are important in the management of chronic pain, and the VA has guidelines for appropriate use of these drugs to prevent addiction. But according to the National Institute on Drug Abuse, prescription drug abuse tripled among military veterans between 2005 and 2008. Other research found that four months after returning from active duty, 27 percent of Army veterans met the criteria for alcohol abuse, and that drug or alcohol use was involved in 30 percent of Army suicides from 2003 to 2009.
"The danger of addiction is very real in veterans suffering from chronic pain," Smith says. "It's not just the pain that causes drug abuse, it’s also the depression. I went from being an active person who participated in triathlons to a person who needed pills just to survive a normal day."
Where to Get Help
Smith, who has advocated for returning veterans, notes that the VA is "an excellent resource." But, she says, it's not the only place where veterans with pain can get the help they need. "The VA does have excellent programs for chronic pain as well as substance abuse, but they are not evenly distributed around the country," Smith says. "If you are not near a big VA medical center, there may not be much available. When I tried to get help for substance abuse, there were no programs for women available." She recommends Alcoholics Anonymous or Narcotics Anonymous as options for veterans with substance abuse issues.
Another great resource for veterans is the . The group's Military/Veterans Pain Initiative advocates for veterans with chronic pain and offers educational materials, online support, and help finding community resources and special programs.
"If you are a veteran with chronic pain, get help early and treat it like a mission. Don't give up," says Smith.
Video: Saving Sergeant Savage: One Soldier's War on Pain | The New York Times
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