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Aggressive treatment of pain prevents future complications

By C. Todd Lopez

WASHINGTON (July 25, 2010) -- Treating pain aggressively, at the time of injury all the way to healing, means fewer complications.

Surgeon General of the Army Lt. Gen. Eric B. Schoomaker spoke July 22 about pain management in the armed forces, including the final report of the Pain Management Task Force, which came out in May.

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"Aggressive management of pain almost from the moment of the injury through regional anesthesia, for example ... results in pain relief for the combatant, but also, we believe, few complications for recovery.

The general said that the brain and the spinal cord has a "plasticity" to it that, if you provide anesthesia early enough, you can have fewer complications of phantom pain and residual pain down the road.

Also of concern, Schoomaker said, is inconsistent standards for management of pain across the Department of Defense. That includes treatment options as well as the language to describe pain.

"We don't' have a consistent plan to deliver a standard set of services for both the management of acute pain and chronic pain," he said. "We don't have a common lexicon to describe it. We don't have a common or useful way to measure and look at the treatments of pain and we don't have a wide enough aperture that brings in other non-pharmacological treatments of pain."

Some of those non-pharmacological treatments include acupuncture, chiropractic therapy, yoga and biofeedback, for instance.

The general also discussed a policy in the Army that now takes responsibility for reporting brain concussions out of the hands of Soldiers -- because, he said, in order to avoid breaking up the team, Soldiers won't fess up to having their skulls rattled by a concussive blast.

"If you give the Soldier the option of self identifying, what we learned from the last few years is they won't do that," Schoomaker said. "They come back from combat, many of them now saying 'I've been concussed multiple times, and I knew it.'"

The solution, Schoomaker said, is that the Army is "pushing our protocols aggressively down to the battlefield and ... taking it out of the hands Soldiers, and saying it's a mandatory event."

For instance, Soldiers who have been involved in an IED attack would be targeted for assessment. "Anybody within a 50-meter radius of that explosion, you don't have a choice ... you come in and get evaluated," the general said. Soldiers assessed without injury get a 24-hour break, those who are concussed are out until symptoms resolve.

The Army is also looking into a rule the Marine Corps now uses, the general said. "If you have multiple concussions, you've had three documented concussions, then you probably ought to be out off the fight altogether."

An interesting program that takes knowledge and data learned from injuries and helps prevent future injuries is the Joint Trauma Analysis and Prevention of Injury in Combat program. There, the general said, data from both lethal and non-lethal injuries are correlated with the type of protective armor a Soldier was wearing, the type of aircraft they were in, or the type of vehicle they were driving when injured.

"It correlates with the material developers to develop the next generation of more protective equipment and things," he said. He said the outcome of JTAPIC could include a better designed helmet, goggles, or body armor. It might also include a redesigned vehicle that could "withstand an underbelly blast."

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