American Pain Foundation Veterans and Pain

1. American Pain FoundationVeterans and Pain Meeting of the National Veterans Affairs and Rehabilitation Commission American Legion National Convention Tamara Sloan Anderson, MSW

2. What is Pain? “Pain is a more terrible lord of mankind than even death itself…” Albert Schweitzer

3. Pain is a unique personal experience. The same painful stimulus may be perceived differently by different people, and differently by the same people at different times.

4. Consequences of Pain • Human • Suffering, fear, anger • Depression/Anxiety • Insomnia • Inadequate or delayed healing (decrease in immune function) • Increase in co-morbidities

5. Consequences of Pain • Decreased quality of life • Deterioration of relationships, marriages, intimacy • Loss of employment • Loss of independence (can’t perform activities of daily living) • Loss of self esteem

6. Suffering • The way we see pain and react to it determines the degree of suffering we will experience. And it is suffering we fear most, not the pain. Full Catastrophe Living, 1990

7. “In the space of mere seconds, pain can so quickly invade and dominate the psychic landscape that no room is left to attend to anything else.” Daniel Callahan in The Troubled Dream of Life

8. Why Pain Relief is Important Pain relief puts you back in control of your life

9. The Costs of Pain • Annual Cost For Healthcare and Lost Productivity • $100 BILLION • Annual Physician Visits Due To Pain • $40 MILLION • Annual Percent of All Work Days Lost to Pain • 25% (Journal of Pharmacoeconomics Outcomes and Decision Making, 2000)

10. The Costs of Pain • Estimated 50 million citizens in chronic pain • # 1 reason for unscheduled doctor visits • # 1 cause of disability • 1 in 4 have adequate pain management

11. The Costs of Pain • 50% have moderate-severe pain during the last days of life • 70% report pain with cancer; 50% are inadequately treated • Elderly and minorities get worst care

12. Pain of Veterans Worse • Studies of VA patients show that the pain of veterans is significantly worse than that of the general public (Kaziz et. al. 1999, 1998). • Veterans have greater exposure to trauma and psychological stress (Arnstein et al. 1999), both of which increase pain and compound therapy.

13. Pain an Increasing Issue Among Veterans • Chronic pain is one of the most frequently reported complaints among veterans of the Persian Gulf War. • A large number of veterans from Iraq and Afghanistan experience clinically significant pain which will profoundly affect the healthcare system. • Pain patients use healthcare resources at a higher rate than do other groups of patients. In addition to developing long term pain conditions, these vets are also more likely to experience psychological distress and other medical comorbidities. (Ronald J. Gironda, PhD - James A Haley Veteran Center, Florida)

14. Increasing Number of Wounded Veterans • 144,424 American veterans have sought treatment from the VA system since returning from Iraq and Afghanistan. • The Insurance Institute reports, that unless there is a significant withdrawal of troops in the near future, 60,000 to 80,000 troops may ultimately end up wounded. Add to this the older veterans, especially from the Vietnam era, pouring into the system as their war wounds deepen with age.

15. Long Term Problems with Chronic Pain • Instances of amputation are reportedly double previous rates – and while the military medical care is the best in the world, there are still long term problems with disability and chronic pain (Dr. Gene Bolles, chief of neurosurgery at Landstuhl Regional Medical Center)

16. More Survivors with More Pain • Current wars with body armor and rapid evacuation to medical care save more lives but there are more maimed shattered limbs than ever before. • In Vietnam, one out of every three soldiers hurt in combat was killed. In Iraq, it’s one in 8. • The bad news is pain. The injuries suffered by those who survive are more severe than in previous conflicts…it’s a war on extremities (Wired Magazine)

17. Pain Overtakes • “Pain is a powerful thing. It changes everything. Your whole life is altered to accommodate it. In military hospitals all around the nation I witnessed strong young Infantrymen, Medics, and Snipers buckle under its crushing weight. Exhausted emotionally and physically they cried out in pain.” (Captain Jonathan D. Pruden, US Army – Testimony for Congressional Hearing on Chronic Pain, December 8th, 2005)

18. Pain Stigma a Barrier • “Unfortunately, some of the wounded soldiers I’ve been working with do not get the pain care they need because they are afraid to ask for it, are ashamed to ask for drugs to control their pain due to social stigmas associated with the abuse of pain medications, or are simply trying to be tough. The fear of addiction and the associated stigma of drug use ironically may lead to more profoundly addictive behavior. One of my old soldiers was wounded and returned from Iraq this past summer. As we were talking he bragged how he was not using his pain meds, but unfortunately it turns out he was self medicating with alcohol to cope with the pain.” (Captain Jonathan D. Pruden, US Army – Testimony for Congressional Hearing on Chronic Pain, December 8th, 2005)

19. No Pain, No Pain • Long term pain is highly correlated with the development of post traumatic stress disorder, depression, anxiety, panic attacks and substance abuse. It’s also a factor in veteran suicide. (Lieutenant Colonel Buckenmaier, Chief Army Regional Anesthesia and Pain Management Initiative, Walter Reed Army Medical Center)

20. Pain Robs You of Life • “We will have tens of thousands of veterans home with us for the rest of their lives, trying to restore a life, following blast injuries causing severe tissue and nerve damage that leave them in a state of permanent severe pain. Mechanical devices can help restore functioning of limbs. However, more often than not, it’s the severe and unrelenting pain that will prevent them from obtaining a reasonable quality of life, for it takes over a person’s brain.” (Rollin M. Gallagher, MD, MPH – Director of Pain Management, Philadelphia VA Medical Center – testimony for Congressional Briefing on Pain -June 13, 2006)

21. Pain Robs You of Life • “Additionally, many thousands of veterans are still suffering from their serious injuries from services during Vietnam and other earlier wars. Pain, much more often than heart disease, robs people of their vitality in mid-life and older life.” (Rollin M. Gallagher, MD, MPH – Director of Pain Management, Philadelphia VA Medical Center – testimony for Congressional Briefing on Pain -June 13, 2006)

22. Why Such Poor Care? • Public’s Awareness is Low: patients and families lack information, expectations and advocacy skills • Little Pain Management Education for most MDs, nurses and pharmacists • No Reimbursement for many therapies • Little Research on the basic science of pain (less than 1% of the federal research budget) • Lack of Institutional Commitment despite new JCAHO pain standards

23. What We Need to Do? • Increase research • Increase resources for pain education and training • Educate veterans and wounded military about pain • Educate veterans advocates about pain • Make sure that all healthcare providers are adequately accessing and treating pain • Support those in pain, and their families

24. What APF Provides http://www.painfoundation.org

25. Free Educational Materials

26. Quarterly Newsletter

32. I feel like I fought for my country, now when is someone going to fight for me now that I can no longer fight for myself. RJ Veteran