Pain Relief in the Iraq War

Anaesthetist Drags US Military into the 21st Century

Recently I caught this article from Wired.com from 2005. With the war in Iraq, US military medical services have had to cope with large number of acute trauma in their soldiers. Morphine was the standard treatment for them but this still left them in acute and severe pain much of the time, hampering their recovery and causing great suffering.

Dr Chester “Trip” Buckenmaier, a pain specialist at the Walter Reed Army Medical Center in Washington, DC, has worked hard to make pain relief for injured soldiers much more effective. Pain specialists often use peripheral nerve blocks where they inject an anaesthetic drug directly around a nerve which has been identified as on the pain pathway, but this was not being used in the US military.

This article in Wired – The Painful Truth – is worth reading even though it’s quite long and spread over 6 pages so you have to click to continue each time. It shows what a determined person can do to change a big, slow organisation for the better.

My Standing Desk

Standing Desks Are Great

standing deskI write quite a lot for my work. This means, as I’m sure you realise, that I spend a heap of time sitting down. This is bad. Not only do I get backache after sitting too long but it’s not good for fitness, circulation and who knows what else.

Varying your working position, pacing yourself to avoid static postures for too long is a really good idea but I’d been lazy about this. I just got up when I became too achy and cramped which is not a good plan.

So I thought I’d look at a standing desk, because a physio should really think of these things. But they are expensive! Cheapest look around £220 / $355 and the most expensive at way over £1000/$1500 if you add bells and whistles for this and that.

Then I had a brainwave! Well, what counts as one for me anyhow. I could use my Ikea chest of drawers in my bedroom as a standing desk. The second drawer was almost the right height for typing, perhaps a little low, so I needed a plan. Here is my standing desk.

5 Ways A War Can Hurt You

The Syrian Civil War and Pain

We hear reports of wars around the world, the engagement with the enemy, the soldiers killed or injured, the civilians killed or injured, and the distance makes them seem like dry numbers. Of course we know they are not but the reality of what’s going on is not obvious if we live in a peaceful country.

And we hear very little about pain. There must be a huge amount, much more than we realise. For every dead person in the Syrian civil war there are a larger number of injured people who survive the conflict and live on. But how do they live on?

So what can hurt someone in a war? Well my list is really quite long, perhaps you might have some more:

  • First the direct military assaults, the bombs, shrapnel and bullets and even chemical weapons. This is what we hear about most clearly.
  • Second there are the causes of death and injury which are directly related to military action such as building collapses, malnutrition and starvation, absent or dangerous water supplies and less obvious things such as dust from damaged buildings.
  • Thirdly a war is a fertile ground for all sorts of indirect accidents such as falls with broken limbs or head injury, cuts on metal fragments or burns from makeshift cooking fires. Gas and electricity supplies, when not cut off, may present risks to the local populations.
  • Fourthly musculoskeletal complaints such as back and neck pain, joint pains and arthritis and overuse pains must be caused or worsened by cramped conditions, the inability to move about and the need to do everything manually because labour saving devices are no longer available.
  • Psychological trauma is very great but I am not addressing this here. This goes on long after the war is forgotten.

 

Casualties of War

So what do bomb fragments, shrapnel and bullets doing to people in the Syrian civil war? As a California mayor said recently, I paraphrase, “It’s not like the movies, most people who get shot die”.

However, many of those who survive have not just had a tissue injury which is now healed. The aftermath can be much nastier. If the bullet broke a bone, damaged some muscle tissue or an internal organ then once recovered the person might be ok.

Joint Arthritis

But there are tissues in the body that are far less forgiving of traumatic insults than these. A bullet which damages a joint changes the architecture of the joint which can then function abnormally. As the stresses of life are put through the joint, it wears at a higher rate and becomes arthritic and a source of lifelong pain.

Neuropathic Pain

But even that is not the baddest of bad news. If you are unlucky enough for a bullet to hit one of the areas rich in nerve junctions then you could have an even worse time. Cutting a major nerve, with its thousands of smaller nerves like a telephone cable, causes paralysis of the muscles supplied by the nerve and loss of feeling in the skin and other areas where that nerve goes. While the paralysis can be a huge loss even this is still not the really bad news.

The central nervous system hates being cut off from part of its domain, so when a nerve is damaged or cut and the input from the nerve alters or stops, it throws a tantrum.

Since all our pain is in our mind (reminder – subject for another post!) the central nervous system is capable of generating pain without any incoming stimulation. And without those incoming signals from the damaged nerve, that’s just what it does.

This is neuropathic pain. The nervous system is normally a conductor of what’s going on, telling us if it’s hot or cold, sharp or blunt, painful or not. However in this case it becomes a generator of pain and causes a type of pain both particularly unpleasant and particularly hard to treat.

The basic numbers of casualties, the dead and injured, must be the bare minimum of the suffering of a local population in a conflict such as the Syrian civil war. Without even giving any thought to the huge and longlasting psychological effects of a war, the incidence and persistence of pain must be a huge problem.

When the Syrian civil war is over and the headlines have moved on to another conflict, all will seem resolved. Underneath however there will still be large numbers of people who suffer intractable pain with little or no help from medical sources.

Pain – Why A Blog About This?

Personally I’m not enthusiastic about pain! Like you I try hard to avoid it. But for me pain is also a fascinating subject when I’m not suffering from much, which fortunately is much of the time.

The Problem with Pain

Great strides have been made in the last 50 years in the understanding and treatment of pain conditions. However it is often poorly recognised and under treated, even in medical units such as hospitals. Outside these units there is very little understanding of how common and how limiting pain conditions are.

In countries without developed medical services the situation is even worse, but it is war zones which may show the greatest number of hidden pain casualties. We hear of how many people have died and been injured, but how they are or how they suffer for the years following the war is not reported.

My aims are to help bring pain further up the agenda of people’s attention and to help individuals who are suffering to change their lives in ways they wish to.

A Bit About Me

I was a physiotherapist working in pain management for over ten years. I was very fortunate to work with a great team which included clinical psychologists, nurses, occupational therapists and consultants. I learned so much about how pain works, the underlying reasons for many conditions, the treatments and management approaches, helping people to change their behaviour and the psychological impact.

I enjoy teaching people who have pain problems what they want to know. They usually want to understand what’s going on and then to form a logical management plan they can stick to with too much difficulty.

Over the years I developed a way of imparting this knowledge and hope to share this with you if you have a similar problem. I’ll be posting on many subjects related to the topic and am developing a series of presentations on explaining pain as a starter.

Let me know if you have any comments or would like me to help you in any way. I’m starting this blog off and hope it will be useful in time but for the moment I’m not clear how it is going to develop. Any suggestions are always welcome.