Report: Nearly half of combat veterans complain of chronic pain
By NANCY MONTGOMERY | STARS AND STRIPES Published: June 30, 2014
Nearly half of a group of infantry soldiers who had seen combat in Afghanistan have reported experiencing chronic pain and 15 percent said they recently used opioid pain relievers, according to a study released Monday.
Of 2,597 active-duty Army troops surveyed three months after their redeployment, 44 percent said they experienced recurring or unceasing pain after returning from Afghanistan, according to the study, published in the Journal of the American Medical Association Internal Medicine.
The number of soldiers affected by chronic pain was a surprise to researchers, said Robin L. Toblin, the lead author of the study, one of the first to quantify the impact of recent wars on the prevalence of pain and narcotic use among soldiers.
”War is really hard on the body,” said, Toblin, who is affiliated with the Walter Reed Army Institute of Research. “I think that’s the take-home message.”
But she said that researchers didn’t expect that nearly half of young, otherwise healthy men who were not seeking medical treatment would suffer from chronic pain.
The percentage was far higher than an estimated 26 percent of chronic pain sufferers in a Kansas study of civilians ages 18 to 65. In that study, which looked at a group comparable to the soldiers — men aged 18 to 34 — only 15 percent reported chronic pain, Tobin said.
Chronic pain is defined as pain that continues beyond the normal time expected for healing or that accompanying chronic conditions like arthritis. It is associated with the onset of changes in the central nervous system that may adversely affect well-being, cognition, level of function and quality of life, according to the Defense Department’s Pain Management Task Force.
Opioids, whose pharmacological effects resemble morphine or other opiates, are strong medicines that can relieve pain caused by serious injuries.
Of the chronic pain sufferers, 48.3 percent reported pain duration of a year or longer. More than half — 55.6 percent reported nearly daily or a constant frequency of pain. About half — 51.2 percent — reported moderate to severe pain.
The survey did not ask for the location of the pain, Tolbin said.
The troops’ reported use of opioid pain relievers — 15.1 percent of all surveyed troops and 23 percent of those with chronic pain — was also far higher than the estimated civilian use of 4 percent. But that finding was less of a surprise, she Toblin said.
“ It’s consistent Army-wide,” she said. About a quarter of soldiers use opioids within a given year, she said.
The findings “suggest a large unmet need for assessment, management and treatment of chronic pain and related opioid use and misuse in military personnel after combat deployments,” the study authors note.
In commentary accompanying the study, Lt. Col. Dr. Wayne B. Jonas, and Lt. Gen. Eric B. Schoomaker, both retired, said that the study raised concerns.
“The nation’s defense rests on the comprehensive fitness of its service members — mind, body and spirit. Chronic pain and use of opioids carry the risk of functional impairment of America’s fighting force,” they wrote.
According to a 2010 report by DOD’s Pain Management Task Force, “Pain is a disease state of the nervous system and deserves the same management attention given to any other disease states,” according to a 2010 task force report.
But pain management is a special challenge in military settings, the report said.”
“The transient nature of the military population, including both patients and providers, creates extraordinary challenges to providing continuity of care, something very important to pain management.”
Data for the JAMA study were collected in 2011 from an infantry brigade redeployed from Afghanistan, and most of the 2,597 survey participants were men, 18 to 24 years old, high school-educated, married and of junior enlisted rank. Nearly half - 45.4 percent - reported combat injuries.