Anesthesiologists Help Manage Non-Combat Pain Problems in Coalition Troops
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Source: American Society of Anesthesiologists (ASA)
Newswise — Back pain and other acute and chronic pain conditions are common among U.S. and coalition soldiers serving in Iraq, and anesthesiologists specializing in pain management can play an important role in managing these non-battle-related injuries.
The December issue of the journal Anesthesiology features an article describing the experience at a forward-deployed specialty pain clinic at Ibn Sina Hospital in Baghdad, the only fixed U.S. medical facility in Iraq.
While trauma management is the primary mission at Ibn Sina, Maj. Ron L. White, M.D., and Col. Steven P. Cohen, M.D.—anesthesiologists with special training in pain management—felt that "down time" at the hospital could be used to treat some of the non-battle-related pain conditions that are common among deployed troops.
"These soldiers had acute and recurrent chronic pain problems that, in the civilian sector, would normally be addressed by either a well-trained primary care doctor or a pain management specialist," says Dr. Cohen. "In a previous study, we found that low back pain—specifically sciatica—was the number one reason for treatment in pain clinics at U.S. Army hospitals among soldiers medically evacuated out of Iraq. However, when these soldiers were treated at pain clinics in the United States and Europe, less than two percent returned to duty."
At the Ibn Sina pain clinic, 113 U.S. and coalition soldiers were treated for pain problems over a six-month period. "Almost two-thirds were treated for sciatica, which is partly attributable to the heavy backpacks soldiers wear," according to Dr. Cohen. "Other common reasons for treatment included muscle pain, herniated disks in the neck, foot pain, hip pain, and groin pain."
Epidural steroid injections for sciatica were the most common treatment given. Others included local anesthetic "trigger point" injections for muscle pain, physical therapy, anti-inflammatory drugs, and drugs to treat nerve pain.
Ninety-five percent of the soldiers, including all of those with sciatica, were able to resume active duty after treatment at the pain clinic. However, other factors likely contributed to this high return-to-duty rate—for example, the soldiers treated at the pain clinic were a carefully selected group who were highly motivated to return to their units.
Drs. White and Cohen suggest that making pain specialist treatment available at combat support hospitals might help to improve the "abysmally low" return-to-duty rates among soldiers with non-battle-related injuries such as sciatica, and might also help to reduce long-term pain problems among soldiers wounded in combat.
However, this approach would be fraught with challenges—especially given an ongoing shortage of military anesthesiologists. "The reality of making decisions about deployment of anesthesiologists is that it will not always be possible to establish a pain clinic staffed by a practitioner with pain medicine subspecialty training within each CSH," write Drs. Kenneth C. Harris and James P. Rathnell in an accompanying editorial. "Nonetheless, the basic pain interventions rendered in this study should always be available to our military personnel."
For additional information on this study, go to: http://www.anesthesiology.org
Founded in 1905, the American Society of Anesthesiologists is an educational, research and scientific association with 41,000 members organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.
Visit the ASA Web site at http://www.asahq.org.
