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Chronic Pain

Chronic Pain

Chronic pain is the most common reason for medical evacuation from Iraq and Afghanistan deployments, and spinal pain is the most frequent reason for medical boards across military services.  Risk factors for the development of chronic pain in deployed Service members include heavy packs that create shearing forces that cause lower back pain, operational driving and flight (especially all-terrain vehicles and rotary wing aircraft), and the psychological risks of combat. Service members face unique challenges in coping with chronic pain, including role loss, the psychological impact of combat, and negotiating the limited duty/profile/medical board process.

Chronic pain and Post-traumatic Stress Disorder frequently occur together in military and civilian populations.  A recent study of veterans receiving treatment for PTSD found that 66 percent also had chronic pain diagnoses. Similarly, 47 percent of OIF/OEF veterans seeking care for neck and back pain also met diagnostic criteria for PTSD.

Many patients with chronic pain and PTSD turn to prescription pain medication abuse to cope with their symptoms. A recent study of OIF/OEF veterans with pain found that Veterans with PTSD were significantly more likely to be prescribed opioid medications, as well as to report risky use of this medication (for example, taking more than prescribed or taking combinations of opioids and benzodiazepines). Veterans with PTSD who received opioid medications were also more likely to experience adverse outcomes, such as accidents, overdoses, and suicide.

Many mental health providers do not have specialized training in treating chronic pain and instead focus only on the emotional issues that pain patients experience. However, there are a number of effective psychological interventions that target pain directly. Cognitive behavioral therapy for pain typically involves psychoeducation about how psychological and social factors can affect pain; relaxation training to ease muscle tension and autonomic arousal; sleep hygiene and stimulus control education to help with insomnia; activity pacing to increase pleasant activities without increasing pain; and cognitive restructuring of negative thoughts and beliefs about the pain. Other frequent interventions include coping with family and marital issues related to the pain; anger management; acceptance and commitment therapy; anger management; and preparation for setbacks.

Chronic Pain | Center for Deployment Psychology

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