War Is Hell - and It Lasts a Lifetime

The pain of war comes home in the bodies of the men and women who are fighting it. This pain is life long and severe and is defying the usual means of treating it. It is compounded by brain injury and post-traumatic stress disorder. As a consequence lives are ruined and levels of disability, depression and substance abuse are sky-rocketing. Suicide is epidemic. What it means to me is that human beings are not meant to kill other human beings. The killers and the killed have been violated. The lucky ones may be the dead. Those who killed another, simply because they were told to may suffer the most, enduring Hell while they live - if you can call that living. War is the ultimate insanity and must be stopped.

Multi-System Pain Disorders Plague Returning Service Men and Women

Newswise — Nine in 10 Iraq and Afghanistan veterans return with some form of pain and about 60 percent have significant pain, mainly from the cumulative effect of exposure to recurring blasts which cause unimaginable injuries, according to prominent VA pain clinicians speaking at the American Pain Society’s annual scientific meeting.

“We are talking about a complicated set of problems involving cognitive issues, deep emotional impacts, and acute and chronic pain that have serious, long-term implications for our veterans and make effective pain treatment outcomes far more difficult to achieve,” said Michael E. Clark, Ph.D., clinical director of the Veteran Administration’s largest and most comprehensive pain management and rehabilitation program in Tampa, and associate professor, department of psychology, University of South Florida. “The pain constellation exhibited by returning service members is the most complex situation I have ever seen in my 30 years of practice and calls for a revolutionary new approach to simultaneously address the spectrum of shared, common symptoms across these severe disorders.”

“These Middle East conflicts, with their very high level of blast injury survivors, call for the military, the VA and the civilian health system to treat post-injury pain as a priority after military discharge to prevent pathophysiology, with a focus of providing effective pain control and rapid restoration of function and social networks to prevent disability and secondary negative health and personal consequences of chronic pain,” said Rollin M. Gallagher, M.D. MPH, deputy national program director for pain management for the VA and clinical professor of psychiatry and anesthesiology, Penn Pain Medicine, University of Pennsylvania

Dr. Clark added that the severity and breadth of the problem has been aggravated by the prevalence of multiple tours of duty for many service members, including weekend National Guardsmen who can be older with families and jobs, a situation not seen in previous U.S. conflicts.

Dr. Gallagher further noted the VA’s pain care challenge is magnified by a 90 percent injury survivor rate from these conflicts compared with only 40 percent in the Vietnam War. VA clinicians are now challenged to manage pain in blast survivors with one or several other consequences of blast, such as head injuries causing mild to severe TBI, physical disfigurement and social stigma, emotional trauma, and often post traumatic stress disorder (PTSD).

“The evidence is compelling that the symptoms of these comorbidities, as well as others such as substance abuse, depression and sleep problems, overlap significantly,” Dr. Clark explained, “and there is ample reason to believe they will not respond as favorably to traditional interdisciplinary pain treatment when compared to other groups of former soldiers.”

“The need is for a fully integrated, system-wide and evidenced-based continuum of pain management from the battlefield to military hospitals to our community care facilities with increased pain care access, state-of-the art treatment protocols, high competence levels for care providers, and the integration of pain education into professional training,” said Dr. Gallagher.

Dr. Gallagher pointed out that earlier and more aggressive acute pain treatment intervention closer to the battlefield may help to prevent or lessen longer-term disabilities and secondary consequences of chronic pain. “Present research will tell us definitely what we know from our clinical experience – that early blockage of neurological pain impulses to the spinal cord and brain close to the site of injury using peri-neural catheters and nerve blocks , along with more aggressive analgesic treatment, is proving more effective than the traditional method of just morphine injections,” he said. “And the soldiers appreciate the earlier intervention.”

VA’s Integrated Pain Care Approach
The overlapping disorders of pain, mild traumatic brain injury (TBI), and post-traumatic stress (PTSD) among returning soldiers is leading to new initiatives at the VA.

“The VHA has directed a new pain management strategy with a stepped-care model that offers a comprehensive continuum of treatment from acute pain at injury to longitudinal management of chronic pain, and this approach is now being considered by the Department of Defense in collaboration with the VHA,” Dr. Gallagher said. “The goal is to reduce pain and suffering and improve the quality of life for our returning Iraq and Afghanistan service men and women suffering acute and chronic pain.”

“The use of silo treatment pathways in chronic pain treatment is insufficient, less effective and less efficient,” Dr Clark said, “because they typically focus solely or primarily on pain-related symptoms and either exclude those with concurrent PTSD and/or TBI symptoms or occasionally refer them to relevant specialty programs for simultaneous but independent treatment.”

As an example of the VA’s health care system refocus, Dr. Clark reviewed current work at the Tampa VA facility using a single team approach and a post-deployment behavioral health program with specialties in behavioral medicine, pain, PTSD, TBI, substance abuse, physical therapy and case management.

“Our objectives are to maximize function and life adjustment, prevent symptom development or exacerbation, and reduce stress through a single team effort,” Dr. Clark said. “Treatment involves established and modified cognitive behavioral therapy interventions targeting PTSD, pain, mild TBI, sleep and substance abuse, typically in combination, and with a physical training component.

“As we extend and refine our PMD treatment components and complete more research on PMC treatment and how overlapping comorbidities interact, our hope is that this raised awareness level for integrated care within the VA will eventually be reflected in community care center treatment for our returning service personnel,” Dr. Clark summarized.

About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.

Suicide Explosion in the US Military

Why do 1 out of every 35 enlisted men and women in the US military attempt suicide every year? Why is physical and sexual abuse inside the military skyrocketing? Why is drug abuse and alcoholism rampant? What about the exploding breakup of families and an exponential rise in divorce? Or how about the massive increase in sexual activity among male and female soldiers - many times in adulterous affairs - while deployed abroad? Meanwhile, back home, 'abandoned' wives have 'Jody' coming in the back door.

What will become of the abandoned children whose fathers are aabsent, not to mention the absolutely shocking absense of mothers who also are soldiers? What are the long-term consequences of all of these factors on society? To the defense contractors, 'perpetual war' has a nice sounding economic ring to it, but to society as a whole, can we afford the spreading circles of violence, confusion and disruption of orderly life now set in motion endlessly?

All militaries throughout the ages have used 'mind control' techniques as a part of 'military training'. This always has included the use of alcohol and other drugs to numb the reality of the murderous business of war. Human beings are not natural cold-blooded killers, but that is exactly what military duty is all about. In the confusion of battle, blood thirty acts of war are viewed as valorous and heroic. Upon return to normal civilian life, many soldiers experience severe regret and profound guilt over the things that they were ordered to do. This can become especially the case when the 'war vet' is unemployed, homeless, debt ridden, injured and alone due to the break up of family.

Where are the marching bands and grand speeches to reaffirm to the 'war vet' that the unspeakable acts of war violence were necessary and for the good of all? After a while, the vet does not feel like a war hero any more. He or she may feel like someone who does not deserve to live. What drug is going to erase the memories? What counsellor is going to make the guilt go away? How pervasive is this syndrome of guilt called Post Traumatic Stress Disorder? What are its long-term consequences?

When is the vet going to be able to look his own children in the eye and feel good about the fact that he destroyed other families in other countries just because someone gave the order to "...take out some bad guys." Were those dead children and civilians 'bad guys'? Even if the wars ended tomorrow, what is society going to do with the literally millions of war veterans whose minds have been warped by the violence of modern war? Can they ever find peace, even in a time of peace, if we ever see a time of peace again?

Is this why WAR IS HELL?

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'U.S. Navy Attempted-Suicide Rate Near 3 Percent'

The Navy Times website reported on December 28 that a Defense Department survey of service members for 2008 showed a higher attempted-suicide rate in the U.S. Navy than any other branch of the armed forces.
Sailors attempted suicide at a rate of 2.8 percent, or approximately one out of every 35 sailors. This rate is three times higher than that recorded by the last survey in 2005.In comparison, the next highest attempted-suicide rate was found in the Marine Corps at 2.3 percent. The Army rate followed at 2 percent, and the Air Force rate came in the lowest at 1.6 percent.The 2008 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel included responses from 28,546 service members. They were randomly selected from all branches of service, including the Coast Guard, and represent a mix of men and women of different ages, races, and ranks.The survey findings show an increase in illegal prescription drug use across the military branches and “dangerous levels” of drinking. The frequency and length of combat deployment “is no doubt playing a part in the stress levels that we’re seeing,” said Jack Smith, acting deputy assistant secretary for clinical and program policy for the assistant defense secretary for health. “It’s a challenging environment.” Smith indicated that since Marines and soldiers are more likely to face close combat, they are exhibiting higher rates of stress-related activities.Illicit drugs, including prescription drugs such as muscle relaxants and painkillers, were used by 28 percent of service members in 1980, but that dropped to 3 percent in 2002. By 2008, such drug use had risen to 12 percent.The reason for this may be that many of those who have been injured have found it difficult to get off their medication; they may still be experiencing pain or may have become addicted. Illegal drug use outside of prescription medication was at 2 percent in 2008. “I think that we’re still trying to determine the meaning of this,” Smith stated. “It’s the first time we’ve drilled down on that as a major issue.”According to the survey, 18 percent of service members reported major family stress, 23 percent said they were stressed by being separated from their families, and 27 percent noted high levels of stress in their work.About 42 percent of respondents reported physical or sexual abuse, with 8 percent saying the abuse had occurred since joining the military. “I think certainly it’s high,” Smith said. “I think we’re disturbed by those results.”Almost 50 percent of female Marines and sailors, and 43 percent of female soldiers, reported feeling stress simply because they are women in the military. Robert Bray, the survey’s chief investigator, noted that this could be due to being a single mother or to leaving behind children at home while they are deployed abroad.“I think the survey results speak for themselves,” declared Bray. “Being one of a minority in a largely male force — particularly in a deployed force — is something we need to be aware of and give some attention to.”It is also time to give some attention to the stress of perpetual war, to fighting in foreign lands with no end in sight. This is certainly taking its toll on America’s fighting forces. Our Founding Fathers warned of the dangers of foreign entanglements and of going abroad in search of monsters to destroy.The men and women in the U.S. military are bravely answering their country’s call to the very best of their ability, but it is time now to call them back home to America.