Veterans and Chronic Pain

 

Veterans Experience More Pain

Veterans are more likely to develop severe, chronic pain than general public. Veterans have greater exposure to both physical trauma and psychological stress-- conditions that compound pain.  Pain is often more complex among Veterans than for others because of the severity of physical and emotional trauma experienced in combat.  Complex pain requires comprehensive treatment.

Addiction to Prescription Opioids

In 2014, the VA came under a great deal of public scrutiny for treatment delays and service quality issues. The over-prescribing of addicting opioid medications was one of the criticisms about quality of care rendered to veterans treated for chronic pain.

In an article entitled "The enemy at home: Veterans addicted and dying from VA pain pills", WTHR Eyewitness News Indianapolis (4/25/14) reported "Military records and independent studies obtained by 13 Investigates show many returning veterans received staggering amounts of powerful narcotics to treat their physical and emotional wounds. Veterans and military insiders are now coming forward to expose the Department of Veterans Affairs' flawed and dangerous pain management program."

In response to concerns about opioid prescribing, In 2014, the VA launched a Opioid Safety Initiative, described as a multi-faceted approach to reduce the use of opioids among Veterans using VA health care and to improve the quality of life for the hundreds of thousands of veterans suffering from chronic pain.

For those veterans who have become addicted to prescription opioids, access to pain management may be more difficult than for those without addiction. Unfortunately, some veterans who misused or abused drugs, find themselves "cut off" from their medications without access to needed integrated pain-addiction treatment.

Opioids in Combination with "Benzo's"

Many veterans receive prescriptions for both opioids and benzodiazepines (e.g. diazepam, alprazolam, clonazepam).  This is NOT a good combination; current treatment guidelines for pain management and psychiatric conditions advise against  benzodiazepines with opioids because of proven risks without any proven benefit.

 Benzodiazepines are NOT indicated for PTSD; according to the VA's National Center for PTSD (2013), about 30% of veterans treated in the VA system for PTSD continue to receive prescriptions for the benzodiazepines despite the fact that this treatment is inconsistent with the VA's own guidelines. Many of these same veterans receive opioid prescriptions for chronic pain, often from a different clinician, thus increasing the risk of injury and addiction.

The VA's Commitment to Improve Services


Most of the VA's pain management services are provided by primary care physicians; some are more knowledgeable than others as acknowledged by the Department of Defense/VA's Pain Management Task Force (2010)... "each medical provider's understanding and approach to pain management is unique and variable, as it is significantly influenced by each physician's academic medical training, mentors, cultural beliefs ,and personal experiences with pain. In addition, there is a lack of clear ownership of pain medicine by any one medical specialty." As noted above, there appears to be an overreliance on the use of opioids with the VA system.

Since addiction, chronic pain, and psychiatric disorders (e.g. PTSD) often overlap, good care requires coordination between the VA's medical, psychiatric, and addiction treatment services. This can a challenge at some VA clinics. The Pain Management Task Force (2010) acknowledged the need to improve services in detailed report with 109 recommendations and four (4) key steps toward achieving a "comprehensive pain management strategy that is holistic, multidisciplinary, and multimodal in its approach" 

For many veterans, access to evidence-based, multidisciplinary pain management remains a challenge. Relatively few veterans are able to participate in the VA's specialized inpatient or outpatient pain programs.

Consider these Action Steps


1) If you are addicted or think you may be become addicted, share your concerns with a family member or a friend. 

2) If you are worried about the medications you are taking, discuss this with your healthcare provider.

3) If you are receiving care both within and outside the VA system, encourage your providers to communicate. Integration of medical services is essential to quality care. Sometimes providers outside the VA system use addiction and mental health "confidentiality regulations" as an excuse for not communicating.  With your consent, information can and should be shared. You are in charge how much, when, and how often information is communicated.

4) Be informed about all the services available to you through the VA system especially its specialty pain programs.

5) Advocate for the care you need. Bring a list of your questions/concerns to each appointment.

6) If you completed any of the self assessment tests on this website, share the results with your healthcare provider.