Battlefield medication evolves from decades of reliance on morphine
January 3, 2006
Lt. Col. Trip Buckenmaier, who leads a military medical effort to combat pain, recalled receiving an e-mail in 2003 from a general who said wounded American troops were “in agony” on flights from Iraq to Germany and the United States.
Buckenmaier, an anesthesiologist at Walter Reed Army Medical Center, said he proposed using local nerve blockers to ease the troops’ pain. And, he said, he was “shocked” at the way the military treated pain when he arrived in Balad, Iraq, in October 2003.
“The answer to more pain on the battlefield was morphine,” he said.
But nurses have to be careful administering morphine because it depresses patients’ respiratory systems and can prove fatal if patients are not closely monitored, he said. It’s difficult to monitor patients on crowded flights, which are dark, full of patients and have only a few medical personnel, making nurses hesitant to use morphine, he said.
“They know if the patient is moaning, he’s going to arrive alive,” Buckenmaier said.
He said he also found that pain pumps, which have been commercially available for 20 years, were nonexistent in U.S. military hospitals in Iraq.
Buckenmaier said he and his study group took a different approach to pain control.
“Our idea is pain is really a disease process and deserves the same attention as any other disease like cancer or wounds from warfare,” he said.
He said the new technique of using localized nerve blockers took off like wildfire because it eased patients’ pain on medical flights. The technique has proved especially effective for wounds to the extremities and gunshot wounds to the chest, he said.
While the technique is being used more and more, challenges still remain, Buckenmaier said.
For example, the military has been having a hard time getting pain pumps to Iraq. Also, patients on some medical flights do not yet have access to pain pumps even though the pumps have been approved for flight, he said.
Buckenmaier said the problems are in part due to “logisticians dragging their feet,” but he said the situation is not unique to the Iraq war.
“Logistics are always a problem with warfare,” he said.
Buckenmaier said that his group has received funding secured by U.S. Rep. John Murtha, D-Pa.
Since the Iraq war began, easing wounded U.S. troops’ pain has evolved from a carpet-bomb approach to a smart-bomb technique, said Dr. Zachary Kitchen, director of the pain management clinic at Bethesda Naval Hospital.
By using a combination of local nerve blockers, opiates and pain pumps, medical providers can keep wounded troops conscious and comfortable while numbing part of their bodies, said Kitchen, who is also an anesthesiologist.
In wars past, wounded troops were given morphine, which affects the whole body and does more than just dull pain, Kitchen said.
“The amount of narcotic … for a traumatic blast injury to the leg to make them comfortable would pretty much make them unconscious,” he said.
Side effects of morphine include nausea and constipation.
The technique of using local nerve blockers and other tools to control pain was known before the Iraq war began, but it was not used extensively because it requires additional time and expertise to perform, he said.
That changed when the Iraq war broke out.
Medical providers have now learned how to provide quick pain relief while cutting down on the amount of equipment needed, Kitchen said. Pain pumps have evolved from an electric machine to a largely plastic, single-use and durable machine, he said.
The new technique makes medical flights safer, Kitchen said.
“A patient at 3,000 feet, you don’t want them to stop breathing because they’ve had too much narcotic,” he said.
Numbing only part of the body also makes physical therapy more bearable, Kitchen said. As part of the recovery process, physical therapists must move the injured parts of patients’ bodies to prevent scar tissue from making the patient immobile.
Traditionally, this has been extremely painful for patients, but by numbing the injured parts of patients’ body, local nerve blockers have removed the “agony” from physical therapy.
Kitchen said he expects the new pain control process to continue to be used.
“I definitely think that we’re not only going to keep on improving on the process, but also have a process that can be long-term,” he said.