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A Dozen Things I’ve Learned About Pain Treating Marines With Chronic Pain

July 11, 2011 | Filed Under: Uncategorized | Comments(0)

Naval Hospital Camp Pendleton/Camp Pendleton, July 11, 2011

As most of my readers know, I’ve been here for almost a year treating Marines who returned from Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom) with unresolved chronic pain. I do not see post-amputation pain mainly because that’s done elsewhere by specialists in amputation rehab. I see Marines who have pain that is no different than yours and, like you, whose physicians told them, “There’s nothing else our field can offer you.” That way of thinking wasn’t enough for me when I developed 7-8/10 level pain that practically made it impossible for me to go to work.

My goal in this post is to briefly lay out a dozen new things I’ve learned about chronic pain from treating my Marine patients.

1.  “Age” is a relative concept. Chronic pain isn’t caused by age. It’s caused when we purposely or unknowingly exceed the tolerance limits of human physiology. In Afghanistan, under the war conditions created by the Taliban, it takes 20 year-old Americans 7 months – the length of their tour of duty – to exceed the limits of human physiology and come back with chronic pain conditions that it takes the average American living under peacetime conditions until they’re age 45 to develop. If age really were a factor, we’d be no different than birds or fish, where things really do happen because of age. Since we’re one of the most adaptive organisms around it makes sense that it is the quality of the environment that leads us to exceed the tolerance limits of human physiology. That leads me to two thoughts. First, to be meaningful, we need to identify pain patients based on another determinant: their chronological or their physiological age. Take the case of my average Marine infantryman with back and upper and lower-extremity chronic pain. They may have a chronological age of 20, but their physiological age is 45. Then take the case of the Marines that go out on patrol and have a mortar, rocket or IED explode close to them and they develop a Transient Brain Injury (TBI). On their problems concentrating, focusing, and remembering more than past events, their chronological age may be 20, but their physiological is 75, no different than your grandfather with the first signs of Alzheimer’s. Marines with TBI will tend to improve over the next year if they get the right treatment on a consistent basis, where the 75 year-old will not, regardless of treatment or the continuing care they get. But clearly the Marine will not improve if treatment is fragmented, inappropriate or inconsistent. And, more often than not, it is because specialty physicians wind up being transferred elsewhere.

Final food for thought. Not too long ago fighter pilots began to exceed the tolerance limits of human physiology in flight. The speed of the planes and the speed of the reactions that were needed from fighter pilots exceeded the tolerance limits of human physiology. So we used technology, and today, effective air combat relies on sophisticated computerization to save pilots’ lives. Given what is happening in combat on the ground, isn’t it time to apply technology to the needs of infantrymen on foot patrols and develop the Cyborgs who will save Marine lives?

#2 “In 2011, Does Military Medicine Treat Chronic Pain Any Differently Than Civilian Medicine?”

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