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UW doctor working with Army to rethink pain treatment for veterans

Post by Adam Ashton / The News Tribune on Feb. 9, 2011 at 2:24 pm |
February 9, 2011 2:24 pm
Dr. Alex Cahana/ Photo by Clare McLean, University of Washington Medicine

A push to rethink pain treatment for soldiers and veterans aims for fewer pill prescriptions and a varied approach to easing chronic suffering among patients at Madigan Army Medical Center.
The hospital south of Tacoma last week hosted a summit to spread the word, building on a pain reduction initiative from the Army Surgeon General.
The forum followed the Army’s disclosure of a report that said up to 35 percent of wounded soldiers in so-called warrior transition units are dependent on prescription and illegal drugs.
Alex Cahana, director of the University of Washington’s Division of Pain Medicine, declared at the Madigan forum that he’s neither an advocate nor an opponent of painkillers such as Oxycontin. But he wants doctors to measure whether pills work before prescribing them for too long because painkillers can lead to depression and exacerbate a wounded soldier’s ailments.
Cahana, a combat veteran from the Israeli Defense Forces, is working with the U.S. Army to shape its pain-management regimen. Eventually, Madigan and other hospitals in the Army’s Western Regional Medical Command intend to have their own pain-treatment teams offering comprehensive plans covering therapy, pills, exercise and alternative treatments such as acupuncture.
Cahana spoke with The News Tribune about how the wars in Iraq and Afghanistan have changed pain treatment and what’s next for the UW’s partnership with the military.

Q: How will your partnership with Madigan and the Department of Veterans Affairs evolve?
A: There is an effort to harmonize the three systems so they mostly look the same. They’d share protocols, guidelines and resources. The UW would take unique cases. The idea in the collaboration is not really to take away capacity from the military or any other system, but to render service and empower them.

Q: How have the wars in Iraq and Afghanistan changed the treatment of pain in the past decade?
A: They pushed developments in three things. The first is to really recognize the under-treatment of pain. The second is to understand the importance of pain care in the battlefield. And the third is to understand the nexus between untreated pain, mistreated pain, post-traumatic stress and addiction.

Q: You said you’re not a fan of prescription drugs, and you’re not opposed to them, either. Are they being overused now?
A: There is an over-reliance on certain treatments, but mostly prescription drugs. They are appropriate for acute pain. The problem is when you get it for a long time without an exit strategy. Then it starts to cause problems.
This is not about denying soldiers treatment. It’s about giving the right person the right treatment at the right time.

Q: How does a soldier’s or veteran’s pain affect military families?
A: It strains emotional ties. It fatigues the whole dynamic and the spouse can react in different ways. Some spouses and families become overprotective so they demand more: If one pill is not working, give me 10; If not 10, then 100. They can make a problem even worse.
The flip side of that is to disengage. They divorce; they leave and anything in between. We see violence in some situations. It’s the destruction of the life plan. It aggravates the post-traumatic stress of the soldier and turns into family post-traumatic stress.

Q: What message are you leaving with the doctors and caregivers here at Madigan?
A: We are using the relative high incidents of pain and the problems associated with high opioid addiction as an opportunity to improve care for our soldiers, veterans and their families.
This is not about complaining, it’s about implementing solutions. And it will discourage bad practices that are out there in the civilian world.

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