This article explores the nature of chronic pain in veterans, including the causes of that pain and how pain clinicians can provide treatment for specific types of pain.
Combat operations in Afghanistan and Iraq have resulted in a steady flow of casualties, with over 6500 British personnel admitted to field hospitals in Afghanistan as of January 2013. As a consequence, there is substantial government and media interest in the health of veterans. Military trauma care has improved, both in the field and in the UK, such that servicemen and women are surviving severe injuries that would have proved fatal in previous conflicts. Improved body armour has also increased survival rates. Thus, there are an increasing number of servicemen and women who will go on to survive with the long-term consequences of serious injury (i.e. amputation, head injury, pain). In the USA, veterans are treated in the Veterans Affairs (VA) system, a dedicated and extensive network of 1700 nationwide treatment facilities. However, in most other countries, veterans will be treated in the public health system after discharge. American data suggest a high rate of persisting pain in veterans seeking healthcare treatment, with moderate to severe pain intensity identified in 28% of US veterans seeking healthcare in a chart review. Pain appears to have a unique negative impact on the physical functioning of veterans, above and beyond variables such as depression and post-traumatic stress disorder (PTSD). This paper addresses this growing issue, and focuses on the treatment of chronic pain in veterans; we will emphasise the treatment of British veterans, but refer to international data, particularly that gathered in the VA system in the USA.
Gauntlett-Gilbert, J. and Wilson, S., 2013. Veterans and chronic pain. British Journal of Pain, 7(2), pp. 79-84.