On Patrol

In an attempt to manage chronic pain and even stress, the military is incorporating more nontraditional complementary and alternative treatments, including yoga and acupuncture. DOD photoA newly funded center on Fort Bliss is gearing up to face a persistent Defense Department foe—chronic pain.

“Ultimately our goal [in integrative medicine] is not to be the last resort,” said Colonel Richard Petri Jr., chief of the new Interdisciplinary Pain Management Center at William Beaumont Army Medical Center on Fort Bliss, Texas. “We want to get to the patient’s pain before it becomes chronic.”

In the last few years, the Army has begun to pay attention not only to the numbers—the annual cost of chronic pain in the United States is estimated to be about $100 billion—but to troops returning from wars with pains that endure both physically and mentally.

The new Interdisciplinary Pain Management Center (IPMC), which recently received $4 million in federal funding, will tackle the issue of pain, beginning with soldiers at the Fort Bliss Warrior Transition Unit. The IPMC, which received its federal funding in March 2012, is still under development and will be located at the current Integrative Medicine Clinic on Fort Bliss.

Pain in the military

In 2009, the Army Pain Management Task Force, chartered by then-Army Surgeon General Lieutenant General Eric Schoomaker, recognized that pain is the most frequent reason patients seek physician care in the United States.

“Pain is a disease state of the nervous system,” the task force findings and recommendations stated. “[Pain] deserves the same management attention given to any other disease state.”

The establishment of the IPMC came as a task force recommendation—which pushed for a holistic, multidisciplinary and multimodal approach to pain in the military.

The IPMC will encompass an integrative approach to pain management—a combination of conventional and, in a nod to the Far East, alternative, holistic treatments.

“A person has to be active in their own health care. Integrative medicine takes on empowerment and active participation,” Petri said.

Beginning with a staff of eight providers and specialists, the center will have between 50 and 100 staff members when fully operational.

The IPMC is a first for the Defense Department, as was WBAMC’s Center for Integrative Medicine, which opened in November 2003. The integrative medicine center offers acupuncture and chiropractic services.

Approaching pain

Dr. Aaron Harris, a chiropractic physician with WBAMC, hovered over a bed in the Center for Integrative Medicine on Fort Bliss.

The Vertebral Axial Decompression table—for nonsurgical lumbar decompression—was used earlier this year on a 23-year-old soldier suffering after a failed lower back surgery. Over the course of 20 sessions, the soldier’s pain shifted from a ranking of a four to a one on a scale of 10.

“It helps some and not others,” Harris admitted, though his research findings released on the case call for the Army to recognize the high incidence of disc pathology among soldiers and the need to study and use conservative technologies to treat the injury.

Do you even know where it hurts?

In an attempt to manage chronic pain and even stress, the military is incorporating more nontraditional complementary and alternative treatments, including yoga and acupuncture. DOD photoWith the wars of the 21st century, a new battlefield injury emerged—one caused by a concussive wave that echoes through the skull like ripples in a pond.

“Iraq and Afghanistan have given us TBIs from improvised explosive devices," Petri said. "The hit disrupts and changes the brain. The white matter actually changes. We’re looking at an anatomical change.”

The injury occurs in the white matter or gray area of the brain linked to controlling human emotions, sensations and even motor skills, Petri said. What was once thought to be solely an anatomical injury with real pain is actually a more complex injury—one that affects cognitive functions and stress levels.

The 2009 pain task force found that stress is a significant contributor to pain conditions and that chronic pain leads to increased stress.

“You can’t treat a patient with pain unless you work with their stress as well. You can’t find a patient that is solely with pain and not stress,” Petri said, noting the potential advantages of treating pain using both conventional medicine and alternative modalities which focus on calming the mind. “Soldiers will get in the door because of their pain, but we will treat the whole patient.”

What to expect

The pain task force recommended that the DoD should “continue to responsibly explore safe and effective use of advanced and nontraditional approaches to pain management.”

Those nontraditional approaches include complementary and alternative medicines—diverse practices and products not generally considered part of conventional medicine.

The center will address another issue raised in the task force findings—continuity of care. The center will offer acupuncture, yoga, massage, chiropractic and a pharmacy. It will also employ primary care providers, nurses, education specialists and administration all under one roof.

“The goal is to have everyone at the table talking about the patient,” Petri said.