American Pain FoundationAmerican Pain FoundationVeterans and Pain Veterans and Pain

Meeting of the National Veterans Affairs and Meeting of the National Veterans Affairs and Rehabilitation CommissionRehabilitation Commission

American Legion National ConventionAmerican Legion National ConventionTamara Sloan Anderson, MSWTamara Sloan Anderson, MSW

What is Pain?What is Pain?

““Pain is a more terrible lord of mankind Pain is a more terrible lord of mankind than even death itself…”than even death itself…”

Albert SchweitzerAlbert Schweitzer

Pain is a unique personal Pain is a unique personal experience.experience.

The same painful stimulus may be The same painful stimulus may be perceived differently by different people, perceived differently by different people, and differently by the same people at and differently by the same people at different times.different times.

Consequences of PainConsequences of Pain

HumanHumanSuffering, fear, angerSuffering, fear, angerDepression/AnxietyDepression/AnxietyInsomniaInsomniaInadequate or delayed healing (decrease Inadequate or delayed healing (decrease in immune function)in immune function)Increase in co-morbiditiesIncrease in co-morbidities

Consequences of PainConsequences of Pain

Decreased quality of lifeDecreased quality of lifeDeterioration of relationships, marriages, Deterioration of relationships, marriages, intimacyintimacyLoss of employmentLoss of employmentLoss of independence (can’t perform Loss of independence (can’t perform activities of daily living)activities of daily living)Loss of self esteemLoss of self esteem

SufferingSuffering

The way we see pain and react to it The way we see pain and react to it determines the degree of suffering we will determines the degree of suffering we will experience. And it is suffering we fear experience. And it is suffering we fear most, not the pain. most, not the pain.

Full Catastrophe Living, 1990Full Catastrophe Living, 1990

““In the space of mere seconds, pain can so In the space of mere seconds, pain can so quickly invade and dominate the psychic quickly invade and dominate the psychic landscape that no room is left to attend to landscape that no room is left to attend to anything else.”anything else.”

Daniel Daniel Callahan in Callahan in

The Troubled Dream of LifeThe Troubled Dream of Life

Why Pain Relief is ImportantWhy Pain Relief is Important

Pain relief puts youback in control of your life

The Costs of PainThe Costs of Pain

Annual Cost For Healthcare and Lost Annual Cost For Healthcare and Lost ProductivityProductivity

$100 BILLION$100 BILLION

Annual Physician Visits Due To PainAnnual Physician Visits Due To Pain$40 MILLION$40 MILLION

Annual Percent of All Work Days Lost to Annual Percent of All Work Days Lost to PainPain

25%25%

(Journal of Pharmacoeconomics Outcomes and Decision Making, 2000)(Journal of Pharmacoeconomics Outcomes and Decision Making, 2000)

The Costs of PainThe Costs of Pain

Estimated 50 million citizens in Estimated 50 million citizens in chronic painchronic pain

# 1 reason for unscheduled doctor # 1 reason for unscheduled doctor visitsvisits

# 1 cause of disability# 1 cause of disability

1 in 4 have adequate pain 1 in 4 have adequate pain management management

The Costs of PainThe Costs of Pain

50% have moderate-severe pain during 50% have moderate-severe pain during the last days of lifethe last days of life

70% report pain with cancer; 50% are 70% report pain with cancer; 50% are inadequately treatedinadequately treated

Elderly and minorities get worst careElderly and minorities get worst care

Pain of Veterans WorsePain of Veterans Worse

Studies of VA patients show that the pain Studies of VA patients show that the pain of veterans is significantly worse than that of veterans is significantly worse than that of the general public (Kaziz et. al. 1999, of the general public (Kaziz et. al. 1999, 1998). 1998). Veterans have greater exposure to trauma Veterans have greater exposure to trauma and psychological stress (Arnstein et al. and psychological stress (Arnstein et al. 1999), both of which increase pain and 1999), both of which increase pain and compound therapy. compound therapy.

Pain an Increasing Issue Among Pain an Increasing Issue Among VeteransVeterans

Chronic pain is one of the most frequently reported Chronic pain is one of the most frequently reported complaints among veterans of the Persian Gulf War. complaints among veterans of the Persian Gulf War. A large number of veterans from Iraq and Afghanistan A large number of veterans from Iraq and Afghanistan experience clinically significant pain which will profoundly experience clinically significant pain which will profoundly affect the healthcare system. affect the healthcare system. Pain patients use healthcare resources at a higher rate Pain patients use healthcare resources at a higher rate than do other groups of patients. In addition to than do other groups of patients. In addition to developing long term pain conditions, these vets are also developing long term pain conditions, these vets are also more likely to experience psychological distress and more likely to experience psychological distress and other medical comorbidities. (Ronald J. Gironda, PhD - other medical comorbidities. (Ronald J. Gironda, PhD - James A Haley Veteran Center, Florida) James A Haley Veteran Center, Florida)

Increasing Number of Wounded Increasing Number of Wounded Veterans Veterans

144,424 American veterans have sought 144,424 American veterans have sought treatment from the VA system since returning treatment from the VA system since returning from Iraq and Afghanistan. from Iraq and Afghanistan. The Insurance Institute reports, that unless there The Insurance Institute reports, that unless there is a significant withdrawal of troops in the near is a significant withdrawal of troops in the near future, 60,000 to 80,000 troops may ultimately future, 60,000 to 80,000 troops may ultimately end up wounded. Add to this the older veterans, end up wounded. Add to this the older veterans, especially from the Vietnam era, pouring into the especially from the Vietnam era, pouring into the system as their war wounds deepen with age.system as their war wounds deepen with age.

Long Term Problems Long Term Problems with Chronic Painwith Chronic Pain

Instances of amputation are reportedly Instances of amputation are reportedly double previous rates – and while the double previous rates – and while the military medical care is the best in the military medical care is the best in the world, there are still long term problems world, there are still long term problems with disability and chronic pain with disability and chronic pain

(Dr. Gene Bolles, chief of neurosurgery at (Dr. Gene Bolles, chief of neurosurgery at Landstuhl Regional Medical Center)Landstuhl Regional Medical Center)

More Survivors with More Survivors with More PainMore Pain

Current wars with body armor and rapid Current wars with body armor and rapid evacuation to medical care save more lives but evacuation to medical care save more lives but there are more maimed shattered limbs than there are more maimed shattered limbs than ever before. ever before. In Vietnam, one out of every three soldiers hurt In Vietnam, one out of every three soldiers hurt in combat was killed. In Iraq, it’s one in 8. in combat was killed. In Iraq, it’s one in 8. The bad news is pain. The injuries suffered by The bad news is pain. The injuries suffered by those who survive are more severe than in those who survive are more severe than in previous conflicts…it’s a war on extremities previous conflicts…it’s a war on extremities (Wired Magazine)(Wired Magazine)

Pain OvertakesPain Overtakes

““Pain is a powerful thing. It changes everything. Pain is a powerful thing. It changes everything. Your whole life is altered to accommodate it. In Your whole life is altered to accommodate it. In military hospitals all around the nation I military hospitals all around the nation I witnessed strong young Infantrymen, Medics, witnessed strong young Infantrymen, Medics, and Snipers buckle under its crushing weight. and Snipers buckle under its crushing weight. Exhausted emotionally and physically they cried Exhausted emotionally and physically they cried out in pain.”out in pain.”

(Captain Jonathan D. Pruden, US Army – Testimony for (Captain Jonathan D. Pruden, US Army – Testimony for Congressional Hearing on Chronic Pain, December 8Congressional Hearing on Chronic Pain, December 8thth, 2005), 2005)

Pain Stigma a BarrierPain Stigma a Barrier““Unfortunately, some of the wounded soldiers I’ve been Unfortunately, some of the wounded soldiers I’ve been working with do not get the pain care they need because working with do not get the pain care they need because they are afraid to ask for it, are ashamed to ask for drugs they are afraid to ask for it, are ashamed to ask for drugs to control their pain due to social stigmas associated with to control their pain due to social stigmas associated with the abuse of pain medications, or are simply trying to be the abuse of pain medications, or are simply trying to be tough. The fear of addiction and the associated stigma of tough. The fear of addiction and the associated stigma of drug use ironically may lead to more profoundly addictive drug use ironically may lead to more profoundly addictive behavior. One of my old soldiers was wounded and behavior. One of my old soldiers was wounded and returned from Iraq this past summer. As we were talking returned from Iraq this past summer. As we were talking he bragged how he was not using his pain meds, but he bragged how he was not using his pain meds, but unfortunately it turns out he was self medicating with unfortunately it turns out he was self medicating with alcohol to cope with the pain.”alcohol to cope with the pain.”

(Captain Jonathan D. Pruden, US Army – Testimony for Congressional (Captain Jonathan D. Pruden, US Army – Testimony for Congressional Hearing on Chronic Pain, December 8Hearing on Chronic Pain, December 8thth, 2005), 2005)

No Pain, No PainNo Pain, No Pain

Long term pain is highly correlated with Long term pain is highly correlated with the development of post traumatic stress the development of post traumatic stress disorder, depression, anxiety, panic disorder, depression, anxiety, panic attacks and substance abuse. It’s also a attacks and substance abuse. It’s also a factor in veteran suicide.factor in veteran suicide.

(Lieutenant Colonel Buckenmaier, Chief Army Regional Anesthesia (Lieutenant Colonel Buckenmaier, Chief Army Regional Anesthesia and Pain Management Initiative, Walter Reed Army Medical Center)and Pain Management Initiative, Walter Reed Army Medical Center)

Pain Robs You of LifePain Robs You of Life

““We will have tens of thousands of veterans home with We will have tens of thousands of veterans home with us for the rest of their lives, trying to restore a life, us for the rest of their lives, trying to restore a life, following blast injuries causing severe tissue and nerve following blast injuries causing severe tissue and nerve damage that leave them in a state of permanent severe damage that leave them in a state of permanent severe pain. Mechanical devices can help restore functioning of pain. Mechanical devices can help restore functioning of limbs. limbs. However, more often than not, it’s the severe However, more often than not, it’s the severe and unrelenting pain that will prevent them from and unrelenting pain that will prevent them from obtaining a reasonable quality of life, obtaining a reasonable quality of life, for it takes over for it takes over a person’s brain.”a person’s brain.”

(Rollin M. Gallagher, MD, MPH – Director of Pain Management, (Rollin M. Gallagher, MD, MPH – Director of Pain Management, Philadelphia VA Medical Center – testimony for Congressional Philadelphia VA Medical Center – testimony for Congressional Briefing on Pain -June 13, 2006)Briefing on Pain -June 13, 2006)

Pain Robs You of LifePain Robs You of Life

““Additionally, many thousands of veterans Additionally, many thousands of veterans are still suffering from their serious injuries are still suffering from their serious injuries from services during Vietnam and other from services during Vietnam and other earlier wars. Pain, much more often than earlier wars. Pain, much more often than heart disease, robs people of their vitality heart disease, robs people of their vitality in mid-life and older life.”in mid-life and older life.”

(Rollin M. Gallagher, MD, MPH – Director of Pain Management, (Rollin M. Gallagher, MD, MPH – Director of Pain Management, Philadelphia VA Medical Center – testimony for Congressional Philadelphia VA Medical Center – testimony for Congressional Briefing on Pain -June 13, 2006)Briefing on Pain -June 13, 2006)

Why Such Poor Care?Why Such Poor Care?

Public’s Awareness is Low: Public’s Awareness is Low: patients and families patients and families lack information, expectations and advocacy lack information, expectations and advocacy skillsskills

Little Pain Management Education Little Pain Management Education for most MDs, for most MDs, nurses and pharmacistsnurses and pharmacists

No Reimbursement No Reimbursement for many therapiesfor many therapies

Little Research Little Research on the basic science of pain (less on the basic science of pain (less than 1% of the federal research budget)than 1% of the federal research budget)

Lack of Institutional Commitment Lack of Institutional Commitment despite new despite new JCAHO pain standardsJCAHO pain standards

What We Need to Do?What We Need to Do?

Increase researchIncrease researchIncrease resources for pain education and Increase resources for pain education and trainingtrainingEducate veterans and wounded military Educate veterans and wounded military about painabout painEducate veterans advocates about painEducate veterans advocates about painMake sure that all healthcare providers are Make sure that all healthcare providers are adequately accessing and treating painadequately accessing and treating painSupport those in pain, and their familiesSupport those in pain, and their families

What APF ProvidesWhat APF Provides

http://www.painfoundation.orghttp://www.painfoundation.org

Free Educational MaterialsFree Educational Materials

Quarterly NewsletterQuarterly Newsletter

I feel like I fought for my country, I feel like I fought for my country, now when is someone going to fight for me now when is someone going to fight for me

now that I can no longer fight for myself. now that I can no longer fight for myself.

RJ RJ VeteranVeteran