For the Relief of Suffering
For the Relief of Suffering
Eric B. Schoomaker 0 1
Chester C. Buckenmaier III 0 1
0 Defense and Veterans Center for Integrative Pain Management , Rockville, MD , USA
1 Department of Military & Emergency Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences , Bethesda, MD , USA
pain; opioids; epidemic; Department of Defense
-
T ious and erosive health epidemics in its history—an
he nation currently struggles with one of the most
insidepidemic of poorly managed pain that has spawned an opioid
crisis. In fact, the health system in this country is immersed in
an epidemic of epidemics with each issue spawning other new
health crises. This complex emergency involves the misuse
and abuse of chronic prescription opioids and opiates, as well
as heroin and other illegal street drugs. The crisis has had
second-order effects including hepatitis C from needle
sharing, in addition to destroyed families and the staggering loss of
human potential derived from the increasing prevalence of
addiction or the criminal consequences of addiction and
chronic use. It is critically important to retrace the causes of
this blossoming Bperfect storm^ of destructive social and
health trends. The Centers of Disease Control and Prevention
(CDC) have attributed them to poorly managed chronic pain.1,
2The magnitude of the national problems emanating from
poorly managed chronic pain cannot be understated.
Accidental deaths from drug overdoses, half of which now are from
prescription opioids, are staggering in number. Between 1999
and 2015 over 183,000 people died from overdoses of these
prescription opioids.3, 4 Prescription opioid deaths are
approaching 20,000 a year; in 2016, combined prescription and
illicit drug deaths—many of which can be attributed to
gateway use of prescription opioids—topped 64,000. Just a few
years of these ghastly losses exceed the number of American
combat deaths in 15 years of fighting in Iraq and Afghanistan,
the U.S. toll from the ten-year war in Vietnam and all of the
American non-combat deaths in World War I when the most
lethal modern epidemic—the Spanish Flu—was the leading
killer. We are fast approaching the peak deaths from the HIV/
AIDS epidemic that occurred in the mid-1990s.
These facts had not gone unrecognized by the Departments
of Defense (DoD) and Veterans Affairs (VA). For over a
decade, close cooperation between the DoD and VA
communities in medical research, medical practice, and policy
development have resulted in a shared perspective of the centrality
of effective acute and chronic pain management and the need
to combine efforts to find best practices and co-develop tools
to address pain. This institutional insight began in the
mid2000s during the peak of fighting in Iraq and Afghanistan
when unprecedented survival from combat wounds, training
and other injuries, and serious illnesses was being realized
through a concerted effort to improve the protection, lifesaving
measures, and recovery and rehabilitation of uniformed
service members and veterans.5 Attending these improvements in
survival and recovery of patients was the development of
persistence of often crippling chronic pain—pain too often
managed with potent psychotropic drugs and narcotics alone.
A variety of internal reports and media stories made clear that
many untoward effects of drug treatment were occurring,
including accidental overdoses—even deaths—suicides,
long-term addictions, and disability. The VA was the first to
begin a comprehensive campaign to improve pain
management. The DoD followed soon thereafter.
In 2009–2010, the Office of the Army Surgeon General,
united with the Navy and Air Force medical services,
partnered with the VA in reviewing the extent of problems in
managing pain and to adopt a more Bwhole-person^ approach
that examined all existing evidence-based approaches and
modalities that could be applied. The focus was on the
wellbeing of the patient and return to optimal function. The result
was the publication in 2010 of a Pain Management Task Force
Report and the creation of a DoD pain management strategy to
implement the report’s 109 recommendations.6 The
recommendations fell into four broad categories: tools and
infrastructure for advancing pain management—including a robust
research program; a full spectrum of best practices—including
complementary and integrative approaches—to address the
continuum of acute and chronic pain; a patient and provider
focus to manage pain with the goal of improve function; and
synchronizing a culture of pain awareness, education, and
proactive intervention. The PMTF Report was followed within
a year by a landmark Institute of Medicine Report, Relieving
Pain in America—A Blueprint for Transforming Prevention,
Care, Education and Research.7 It closely mirrored the DoD
report and called for a major cultural shift in how pain was
understood, prevented, mitigated, and managed.
The past decade since these collective efforts wer (...truncated)