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Treating Pain on the Battlefield: A Warrior’s Perspective

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Abstract

The current conflicts in Afghanistan (Operation Enduring Freedom; commenced October 2001) and Iraq (Operation Iraqi Freedom; commenced March 2003) have been remarkable due to the more than 90% survival rate among wounded warriors. Although this statistic is a historic achievement by the military’s medical services, other medical issues have taken on greater emphasis as more casualties from war survive than ever before. Pain management of United States wounded, in particular, has been a medical issue of increasing importance, as modern understanding of the detrimental effects of pain on recovery and rehabilitation becomes clearer. In this review, a warrior’s perspective of military pain management is explored and potential for improvement discussed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gawande A: Casualties of war: military care for the wounded from Iraq and Afghanistan. N Engl J Med 2004, 351:2471–2475.

    Article  CAS  PubMed  Google Scholar 

  2. Holcomb JB, McMullin NR, Pearse L, et al.: Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001–2004. Ann Surg 2007, 245:986–991.

    Article  PubMed  Google Scholar 

  3. Beekley AC, Starnes BW, Sebesta JA: Lessons learned from modern military surgery. Surg Clin North Am 2007, 87:157–184, vii.

    Article  PubMed  Google Scholar 

  4. Wheeler M, Oderda GM, Ashburn MA, Lipman AG: Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain 2002, 3:159–180.

    Article  PubMed  Google Scholar 

  5. Richman JM, Liu SS, Courpas G, et al.: Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 2006, 102:248–257.

    Article  PubMed  Google Scholar 

  6. Condon-Rall ME: A brief history of military anesthesia. In Anesthesia and Perioperative Care of the Combat Casualty. Edited by Zajtchuk R, Grande CM. Washington DC: Office of the Surgeon General; 1995:855–896

    Google Scholar 

  7. Joshi GP, Ogunnaike BO: Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America 2005, 23:21–36.

    Article  Google Scholar 

  8. Gallagher RM, Polomano R: Early, continuous, and restorative pain management in injured soldiers: the challenge ahead. Pain Med 2006, 7:284–286.

    Article  PubMed  Google Scholar 

  9. Lounsbury DE, Bellamy RF: Levels of medical care. In Emergency War Surgery, edn 3. Washington DC: Bordon Institute; 2004:2.1–2.10.

  10. Stamatos J, Boedeker BH, Crowl FD: Perioperative pain management. In Anesthesia and Perioperative Care of the Combat Casualty. Edited by Zajtchuk R, Grande CM. Washington DC: Department of the Army, Office of the Surgeon General; 1995:287–319.

    Google Scholar 

  11. Buckenmaier CC 3rd: Acute pain management in field and disaster situations. In Acute Pain, edn 2. Edited by Rice AS. London: Hodder Arnold; 2008:374–388

    Google Scholar 

  12. Buckenmaier III CC: Basic medical skills: pain assessment and control. In Special Operations Forces Medical Handbook, edn 2. Edited by Farr WD. Washington DC: US Government Printing Office; 2008:8-33–8-36.

    Google Scholar 

  13. Wedmore IS, Johnson T, Czarnik J, Hendrix S (2005) Pain management in the wilderness and operational setting. Emerg Med Clin North Am 23:585–601

    Article  PubMed  Google Scholar 

  14. Svenson JE, Abernathy MK: Ketamine for prehospital use: new look at an old drug. Am J Emerg Med 2007, 25:977–980.

    Article  PubMed  Google Scholar 

  15. Visser E, Schug SA: The role of ketamine in pain management. Biomed Pharmacother 2006, 60:341–348.

    Article  CAS  PubMed  Google Scholar 

  16. Meiler SE: Long-term outcome after anesthesia and surgery: remarks on the biology of a newly emerging principle in perioperative care. Anesthesiol Clin 2006, 24:255–278.

    Article  CAS  PubMed  Google Scholar 

  17. Peoples GE, Gerlinger T, Craig R, Burlingame B: Combat casualties in Afghanistan cared for by a single Forward Surgical Team during the initial phases of Operation Enduring Freedom. Mil Med 2005, 170:462–468.

    PubMed  Google Scholar 

  18. Buckenmaier CC, McKnight GM, Winkley JV, et al.: Continuous peripheral nerve block for battlefield anesthesia and evacuation. Reg Anesth Pain Med 2005, 30:202–205.

    Article  PubMed  Google Scholar 

  19. Hampton T: Researchers probe nerve-blocking pain treatment for wounded soldiers. JAMA 2007, 297:2461–2462.

    Article  CAS  PubMed  Google Scholar 

  20. • Buckenmaier III CC, Rupprecht C, McKnight G, et al.: Pain following battlefield injury and evacuation: a survey of 110 casualties from the wars in Iraq and Afghanistan. Pain Med 2009, 10:1487–1496. This is the first survey of pain in American combat casualties since World War II.

    Google Scholar 

  21. • Clark ME, Bair MJ, Buckenmaier CC III, et al.: Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: implications for research and practice. J Rehabil Res Dev 2007, 44:179–194. This article defines the pain health care challenge combat casualties from the current conflicts and outlines a plan for improved pain care in future polytrauma patients.

  22. Joshi GP: Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North America 2005, 23:185–202.

    Article  CAS  PubMed  Google Scholar 

  23. Woolf CJ: Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004, 140:441–451.

    PubMed  Google Scholar 

  24. Malchow RJ, Black IH: The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Crit Care Med 2008, 36(Suppl 7):S346–S357.

    Article  PubMed  Google Scholar 

  25. Rawal N: Organization, function, and implementation of acute pain service. Anesthesiol Clin North America 2005, 23:211–225.

    Article  PubMed  Google Scholar 

  26. •• Brennan F, Carr DB, Cousins M: Pain management: a fundamental human right. Anesth Analg 2007, 105:205–221. This article surveys worldwide medical, ethical, and legal trends and initiatives related to the concept of pain management as a human right.

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Disclosure

Departmental support: Walter Reed Army Medical Center, Department of Anesthesia. Congressional grant: John P. Murtha Neuroscience and Pain Institute. No other potential conflicts of interest relevant to this article were reported.

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The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government.

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Correspondence to Chester C. Buckenmaier III.

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Buckenmaier, C.C., Brandon-Edwards, H., Borden, D. et al. Treating Pain on the Battlefield: A Warrior’s Perspective. Curr Pain Headache Rep 14, 1–7 (2010). https://doi.org/10.1007/s11916-009-0090-1

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  • DOI: https://doi.org/10.1007/s11916-009-0090-1

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