The rate of chronic pain among US veterans remains high, but many treatment approaches are available.
Chronic pain, or pain that lasts for more than 12 weeks,1 is common among the approximately 20 million veterans in the United States today.2 More than 50% of veterans receiving care at Veterans Health Administration (VHA) facilities across the country are affected by the condition.3 Below are a few more stats you may not be aware of regarding this unique population, as well as some best practices for pain management.
- Musculoskeletal pain (often caused by an injury to the bones, muscles, nerves, and/or connective tissue) is the most common chronic pain complaint among veterans. Between 2000 and 2011, approximately 5 million veterans (nearly 55% of VHA patients) were diagnosed with one or more musculoskeletal disorders.
- Since 2000, more than 370,000 US service members have been diagnosed with traumatic brain injuries (TBI).4 These types of head injuries can also lead to chronic pain,5 especially headache.6
- Chronic pain syndromes are more common among female veterans.7 For example, musculoskeletal conditions are among the leading contributors to the health profile of female veterans, and are more common in women than in men.7
- An estimated 15 to 35 % of veterans with chronic pain have post-traumatic stress disorder (PTSD).9Witnessing or experiencing life-threatening traumas or injuries can lead to PTSD, which is often characterized by symptoms such as persistent thoughts about the event, nightmares, and jitters, even months after the incident.10
- Opioid use is falling among veterans. Under the VA’s Opioid Safety Initiative (OSI), by mid-2016, the number of veterans dispensed an opioid each quarter had decreased by about 25%.8
Pain management in general tends to fall into one of four treatment categories, says David Cosio, PhD, a pain psychologist at the Jesse Brown VA Medical Center in Chicago. (Dr. Cosio notes that he is not talking on behalf of, nor does he represent, the Veterans Administration; views expressed are his own). These categories include:
- traditional options, such as medications, interventions (injections, surgery, implantable devices), and physical medicine and rehabilitation approaches (exercise, using proper body mechanics)
- psychological interventions, such as hypnosis, biofeedback, and talk therapies
- complementary and alternative medicine, such as acupuncture, relaxation, mindfulness, spinal manipulation, massage therapy, and healing touch
- lifestyle management, including diet, sleep hygiene, spiritual needs, and physical activity.
“All of these options represent different ways veterans can address their pain,” explains Dr. Cosio, who personally recommends a biopsychosocial approach for treating chronic pain symptoms. “A biopsychosocial approach means that a doctor will not only focus on the biological, but also the psychological and social factors related to pain,” he explains. “Veterans should decide which options to pursue based on their pain intensity” and the invasiveness of the treatment, “using the least invasive first.”
According to VA Spokespersons, the health administration offers many non-medication approaches to pain management, including cognitive behavioral therapy, exercise/movement therapies, acupuncture, massage, and spinal manipulation. For PTSD, in particular, the agency recommends trauma-focused psychotherapy, which may include:11
- prolonged exposure (PE): a cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations,12
- cognitive processing therapy (CPT): a specific type of cognitive behavioral therapy that helps patients learn how to modify and challenge unhelpful beliefs related to the trauma,13
- eye movement desensitization and reprocessing (EMDR): a structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements). EMDR is associated with a reduction in the vividness and emotion associated with the trauma memories,14
- narrative exposure therapy (NET): in which individuals establish a coherent life narrative that helps to contextualize traumatic experiences. NET is known for its use in group treatment.15
“Often times, the veteran is avoiding their PTSD symptoms and chronic pain, which indicates that they may need to learn better coping skills,” says Dr. Cosio. “Remember, the goal in chronic pain management is not to cure the pain, but rather to help patients feel better.”
With regard to declining opioid use among veterans, Dr. Cosio says he believes “medications and interventions are mostly used because they are covered by insurance companies, are more accessible around the country, and people perceive them to be the standard of care. The alternatives to opioid therapy are harder because they take time, commitment, and money. This is challenging for the provider and for the patient because we would all like a quick fix. But using these other options, as opposed to opioid therapy, is better for everybody.”
You can learn more about the treatments and services available for veterans suffering from chronic pain, including PTSD, at the country’s 1,200-plus VA medical centers and outpatient clinics (searchable here).16
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