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Combat vets' use of painkillers troubling, researchers say

Jul. 1, 2014 - 02:48PM   |  
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A new study of an Army infantry brigade following an Afghanistan deployment finds that soldiers used opiate painkillers at three times the rate of civilians — even though 40 percent of the troops who took the drugs had not had any severe pain in the previous month.

In an article that appeared Monday online in JAMA Internal Medicine, Walter Reed Army Institute of Research scientists said nearly half the soldiers returning from combat reported chronic pain three months after deployment ended, nearly twice the prevalence of chronic pain — 26 percent — in the general civilian population.

Researchers also found that 15 percent of soldiers had used opioid pain medications, with 5.6 percent of those troops saying they had no pain in the prior month.

The estimated opiate use rate in the general population is 4 percent.

“These findings suggest a large unmet need for assessment management and treatment of chronic pain and related opioid use and misuse in military personnel,” wrote Public Health Service Lt. Cmdr. Robin Toblin.

Despite the dire results, the study also contained several positives: 85 percent of the 2,597 participants reported never taking opiates and more than three-quarters of soldiers who said they actually have chronic pain don’t use them, instead preferring over-the-counter medications.

But the 5.4 percent who reported using the potentially addictive drugs daily, and the 6 percent who took them despite not having pain, are “worrisome,” Toblin said.

“This is cause for concern because opioids ... have high abuse and overdose potential,” she wrote.

In a response published in the same issue of JAMA Internal Medicine, retired Army Lt. Col. Wayne Jonas of the Samueli Institute and retired Lt. Gen. Eric Schoomaker, a former Army surgeon general, said the data indicate more investment is needed in pain research and physicians should encourage proven “self-management” techniques such as yoga, tai chi and music therapy to treat chronic pain.

Jonas and Schoomaker noted that the National Institutes of Health spends only 1 percent of its $30 billion budget on pain research, compared to private-sector spending on pharmaceuticals estimated at $48.5 billion for research and development and $57.5 billion for drug promotion.

They said the Defense Department has been at the forefront in reducing opioid prescriptions for chronic pain and medication management by monitoring prescriptions, limiting prescription authorizations and improving drug testing.

But a nationwide “cultural transformation” must take place regarding “self-management,” such as acceptance of complementary and alternative treatments. Without it, veterans could face a “lifetime progression of increasing disability” from chronic pain and concurrent conditions like post-traumatic stress disorder and traumatic brain injury.

“The loss of human potential is inestimable,” the pair warned. “This staggering cost will become the greatest threat to national defense as the nation is crushed under debt.”

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