The Weight Of War: New Efforts To Treat Pain
A Seattle Times/KUOW Report
Soldiers and Marines in Iraq and Afghanistan routinely carry from 60 to more than 100 pounds of gear. The heavy load shouldered over many months of duty contributes to the chronic pain suffered by many soldiers.
Specialist Joseph Chroniger deployed to Iraq in 2007. Chroniger is 25 years old and he suffers debilitating pain from a form of degenerative arthritis and bone spurs.
Chroniger: "My neck hurts every day, every day. You can't concentrate on anything but that, because it hurts that bad."
Pain care is an emerging field. Currently most doctors rely on some combination of painkillers and physical therapy. The Army is starting to incorporate other forms of treatment like yoga, acupuncture and meditation.
KUOW's Patricia Murphy has the second part of our collaborative series with the Seattle Times: "The Weight Of War."
Specialist Joseph Chroniger was young, fit and motivated when he deployed to Iraq.
He was also overloaded.
Like many soldiers and Marines, every day Chroniger shouldered 70 to 80 pounds of gear — well above the Army's recommended limit for a combat fighting load.
Chroniger: "I mean we were doing three, four, five missions a night sometimes. You're jumping out, you're running. It hurts. It hurts."
Sometimes he would stand for hours ignoring the deep burning pain in his neck.
The warrior creed: mission first, never accept defeat, never quit. And by extension, never complain about an injury.
Chroniger: "You looked weak, they made it sound like you were a weak person. And then in turn you never wanted to go to sick hall again because you didn't want to look like the weak link. Especially in Iraq, we had a new private come in and he had a kink in his neck so he went to sick hall. Pfft. He never lived that one down. I mean within a week of being in Iraq you're going to sick hall. And at the time we were all the same way. It's instilled in you to be like that, to think you're tougher than what your body can actually take."
It's unclear whether Chroniger's decision to push on in pain would have changed the outcome. What is clear is that thousands of chronic muscular skeletal injuries in service members started out as treatable sprains and strains.
And physical therapists that could help manage these acute injuries during deployments are still mainly located at combat support hospitals. Colonel Diane Flynn is Chief of Pain Medicine at Madigan Army Medical Center.
Flynn: "We've always thought of soldiers as elite athletes. And I think we've acknowledged over the years that we could do more."
An ounce of prevention could potentially save the taxpayers millions.
Veterans Affairs (VA) disability payments to veterans of the wars in Iraq and Afghanistan retired with muscular skeletal conditions are around $500 million a year. That's a conservative estimate. The figure could soar much higher as tens of thousands of military personnel leave the armed forces and file for disability.
Kumar: "OK, I have three different size needles here, but since it's the neck area I will use the smallest needle which is 30 millimeters in length."
On a recent day at Madigan Army Medical Center, Chroniger lies prone on an examination table. It's his first acupuncture treatment with Dr. Shashi Kumar.
In an effort to provide better pain care, the Army Surgeon General has directed the Army's hospitals to incorporate more alternative therapies into patients' treatment plans.
Kumar: "Does it feel to you that this is the right area?"
Chroniger stiffens as Kumar inserts the small needles into his damaged neck.
It's too soon to tell in Chroniger's case, but many patients report that regular acupuncture treatments help relieve some of their chronic pain. That means less reliance on strong and potentially addictive prescription painkillers like Vicoden and Dilauded. And that's important because the Army is reporting a significant spike in prescription abuse and dependence among troops.
Col. Flynn admits when it comes to pain care, there are few options.
Flynn: "Primary care providers who provide most of the pain management to patients have had very limited tools in their toolbox, and it's medications for the most part and maybe physical therapy, but very little to offer in addition to that."
Experts say pain is complex, subjective and deeply linked to a patient's state of mind. The message resonates among military personnel — many of whom, like Chroniger, are also being treated for Post Traumatic Stress Disorder.
Mind–body therapies like yoga and meditation can help patients manage stress and in turn help them deal with chronic pain. Flynn says this type of introspective care model is a major cultural shift for military docs, some of whom have a reputation for being too tough on patients complaining of pain.
Flynn: "That's an important component of this and we try to teach that to providers: Whatever the patient says their pain is what their pain is. If they say they have ten–out–of–ten pain, for them it's ten–out–of–ten pain. Don't bother trying to figure out if that's true or not. It's true. If they say it's true, it's true, let's start from there."
There's also a long waitlist for receiving treatments like acupuncture. Right now Madigan has three practitioners.
Under the Army Surgeon General's plan, these therapies will become part of a standard of care. Until then some patients may choose to go outside the army medical system. And they'll have to pay out of pocket.
TRICARE is the health plan that covers nearly 4 million active–duty military and retirees. In a statement TRICARE said it would not cover alternative therapies until proper clinical trials have been conducted.
Colonel Kevin Galloway heads the Army Pain Task Force. He says the Army Surgeon General is committed to implementing this comprehensive, integrated care model, though he wouldn't speculate about how long it might take.
Galloway: "But I'm confident that we're doing it as we speak. We're talking with clinicians and coordinating this effort across our huge complex medical system that spans from the battlefield across the world."
Madigan told us it hopes to get its new holistic pain care program fully running by 2013. But Dr. Stephan Xenakis, a retired brigadier general, says times are tough and the Department of Defense budget is facing intense scrutiny.
Xenakis: "And when that starts to happen, particularly medical care is looked at very carefully and you find that you have to justify almost every dollar that you're spending."
Xenakis says the Army's mission is admirable, but he does have concerns.
Xenakis: "All I can say is that I hope that they can, but I think that, particularly with the financial pressures that they're facing, it's going to be difficult."
Specialist Joseph Chroniger looks worn out after his first acupuncture treatment. If he's in pain, which is likely, he doesn't show it, as he contemplates his future.
Chroniger: "You just realize there's nothing you can do about it. You try and do what the doctors recommend. But I'm just hoping that it doesn't get any worse."
Chroniger will take an early retirement soon and is in the process of applying for disability from the Department of Veterans Affairs.
But that's another day's hurdle. For now he'll focus on the 40–mile drive back home to his wife.
I'm Patricia Murphy, KUOW News.
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