Working on better pain care for troops returning from war

WASHINGTON -- They call it the coming tsunami, veterans returning from Iraq who will suffer chronic pain years from now. Get ready, military doctors are warning pain specialists -- even as they hope that improving battlefield pain control may stem the tide.

The idea: Block the agony faster, and the body's pain network may not go into the overdrive that sets up the injured for lingering trouble long after they're officially healed.

"It's going to take the military to stop thinking of pain as a symptom, a consequence of war," says Lt. Col. Chester "Trip" Buckenmaier III, an acute pain specialist at Walter Reed Army Medical Center who is pushing for that change.

"Pain really is a disease. If you don't manage it early, it leads to serious consequences."

At risk aren't just troops who suffered severe wounds such as loss of a limb, but others with varying types of pain that goes untreated, or undertreated.

"If you don't ask, they don't report" pain, says Dr. Robyn Walker, a psychologist at the James A. Haley Veterans Affairs Hospital in Tampa, Fla.

Troops with traumatic brain injuries, a signature of the war, may not be able to express pain adequately. More common is a tough-it-out mentality, she says, a fear that admitting pain might block return to duty -- or hesitancy because they know wounds could have been worse.

Doctors have long known that suppressing acute pain aids short-term recovery. But it's also a factor in whether patients develop chronic pain.

Injured nerves send distress signals to the brain. If those signals go unabated, the brain can essentially memorize pain and become hypersensitive.

At the war's beginning, "we were using Civil War-era pain management," Buckenmaier said. Morphine was the main option as the wounded were evacuated to Germany. While morphine is a crucial painkiller, it doesn't actually block pain signals from reaching the brain.

What can? Continuous nerve blocks, developed at civilian hospitals using increasingly portable drug-infusion pumps. Doctors trace the roots of nerves signaling certain pain. They insert tiny catheters that allow drugs to bathe those nerves and block that signal.

Buckenmaier delivered the first battlefield nerve block in October 2003. A rocket-propelled grenade tore out a chunk of a soldier's lower leg; eventually, it would be amputated. But minutes after receiving the nerve block at a field hospital, he said he was pain-free.

Buckenmaier and Dr. Rollin Gallagher of the University of Pennsylvania are beginning to track injured troops to find out if early care can prevent chronic pain.