Among active-duty U.S. infantry soldiers who were not seeking treatment, more than 45 percent reported combat injuries and 44 percent said they had chronic pain, according to a study published today in the Journal of the American Medical Association (JAMA). Over 15 percent of all soldiers surveyed said they had used an opioid pain medication like Vicodin in the past month. Of those with chronic pain, more than 48 percent reported pain lasting for a year or longer, and more than 23 percent reported using an opioid painkiller in the past month.
Opioid drug use in military populations is nearly triple what is observed in civilian populations. Researchers estimate about 26 percent of the general population experiences chronic pain and 4 percent have used opioids in the past month.
If pain management isn’t well monitored or is too heavily reliant on short-term fixes like opioids, it can lead to drug dependence. Because of the physically and mentally taxing nature of their job, soldiers are at a greater risk for both chronic pain and opioid use.
“They get beat up a lot more. The deployments, the physical exertion, the extreme environment,” said co-author of the accompanying study commentary Dr. Wayne Jonas, president and CEO of the Samueli Institute in Alexandria, Va.
"Opioid pain relievers are highly addictive, and if someone doesn't build up the necessary tolerance, it is easy to overdose on opioids. This is why they are a Schedule II controlled substance," added study co-author Dr. Robin Toblin, M.P.H., of the Walter Reed Army Institute of Research in Silver Spring, Md. Like any addictive drug, it is easy to build up a tolerance to opioids and require more to achieve the same effect, Toblin said.
What Is Causing All This Pain?
Chronic musculoskeletal pain is one of the most common complaints heard in pain clinics. For U.S. military members, chronic pain is often a result of wear and tear to the body. “You see younger people come in with pain because they’ve been jumping out of airplanes, etc. That accelerates arthritis,” Jonas said.
And physical pain can often be compounded by mental angst. Many soldiers experience traumatic brain injuries, blast injuries, and post-traumatic stress, but continue working. Over time, the injuries build on one another.
A third contributing factor to chronic pain is comorbidity. Anxiety disorders, depression, and post-traumatic stress disorder (PTSD) may be compounded by combat environments. Because of the stigma surrounding mental health problems, some patients report physical pain instead. “They say, ‘Gee, I’ve got this back pain...,’” Jonas said.
While opioid use and chronic pain in military populations is not a surprise, this study is one of the first to provide hard data. Nearly 2,600 participants, mostly men between the ages of 18 and 24, were surveyed. "We know that a lot of soldiers come home injured and that war is hard on the body, but we didn’t expect nearly half of these young, and otherwise healthy, men and women to report chronic pain," Toblin said.
A Short-Term Fix for a Long-Term Problem
Early intervention and careful monitoring are key to managing chronic pain in soldiers. “If you’re able to intervene early with pain and get them on a good pain management program, it’s much less likely that it’ll spread to the trauma response spectrum,” Jonas said.
Ideally, opioid drugs should be used for acute pain management, not for long-term pain care. Substance use, and opioid use for pain treatment, can impair both physical and mental function.
In 2011, the Institute of Medicine released a blueprint for long-term, sustainable management of pain in the U.S. The idea is to manage pain without diminishing quality of life, contributing to drug dependency, or impairing function. But before integrative pain management campaigns can work in military populations, there must be a change in the culture around treating pain, Jonas said.
For soldiers, working through a tough situation is considered part of the job. “These are tough guys and gals. They’re like athletes. They’re out there and take the pain because it’s part of the job. It shows that you’re a team player,” Jonas said. “However, pain does impair your ability to function and your cognitive ability. It impairs your ability to execute your job or your mission.”
Sustainable treatments for long-term pain management are sorely needed. Already, there have been moves to add alternative treatments like acupuncture to the regimen for treating veterans, Jonas said.