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Regional Anesthesia Eases Wounded Soldiers' Pain in Iraq and Afghanistan

HONOLULU, Jan. 29 /PRNewswire/ -- Body armor, rapid transport, and artificial blood products have exponentially improved care and survival for soldiers during the wars in Iraq and Afghanistan. However, the treatment of their pain during medical transit from battlefield to combat hospitals is still often treated only with morphine. New data from researchers working with wounded soldiers showed that continuous peripheral nerve block (CPNB) could be a viable new option for physicians treating casualties and that soldiers' perception of care is as important as the care itself.

Two abstracts were presented today at the American Academy of Pain Medicine's 25th Annual Meeting revealing insights into pain treatment for soldiers in Iraq and Afghanistan. The results could have broader implications for the growing evidence that when pain is treated as a disease, overall medical outcomes have the potential to improve.

In the first abstract, Dr. Trip Buckenmaier and his colleagues from Walter Reed Army Medical Center surveyed 110 soldiers who had been injured severely enough to need transport from the battlefields in the Middle East to Lundstahl Regional Medical Center (LRMC) in Germany from July 2007 through February 2008. Instead of just morphine, some of the soldiers were given CPNB -- a regional anesthetic technique -- to treat their pain, or morphine and CPNB. During airlift transport, all soldiers were asked about the following: pain they were experiencing 'now,' percent pain relief on a scale from 0 (no pain relief) to 100 (complete pain relief), as well as measures of anxiety, distress, and worry during flight on a scale of 0 (none) to 10 (extreme).

Results revealed that 45 percent of these soldiers' pain was alleviated during transport and 65 percent while at LRMC. Soldiers given CPNB had significantly less average pain and less pain 'right now' when compared to the soldiers without CPNB This may mean there is a benefit to treating pain multi- modally, versus with morphine alone as merely a symptom of injury. Regardless of the type of treatment, the more pain a soldier had, the more likely they were to also have higher scores for anxiety, distress, and worry.

"We saw first hand, and our research confirmed, that options beyond morphine for early, aggressive pain intervention and control are needed to support our soldiers, and reduce their pain during transport and at combat hospitals," said Trip Buckenmaier, III, MD COL MC, chief, Army Regional Anesthesia and Pain Management Initiative Walter Reed Army Medical Center, and lead author of the study. "Traditionally viewed as a symptom to alleviate, our research shows that treating pain as a separate disease, and employing multiple options could improve overall outcomes."

These wounded soldiers were also interviewed to explore their concerns, fears, worries, and perceptions of pain control during airlift to LRMC to measure what soldiers' greatest and least concerns were to help identify areas for improvement.

The following themes emerged, illuminating what soldiers were concerned about during transit: making the experience better (defined by issues around pain medication, comfort measures, communication, and 'confidence in care providers'); communication of the unknown (wanting a sense of location, what to expect, and being informed); and fear (of injury, pain, and helplessness).

"The first priority has always been saving lives, but what we experienced and showed with our data was that in addition to the need for a more sophisticated pain care continuum, addressing psychological issues is critical," Dr. Buckenmaier continued. "Not attending to these perceived priorities of care could impede recovery, lead to post-traumatic stress disorder, or increased pain."

    Poster Session Information (Posters 252 and 253)
      Begins: 3:30 PM (Hawaiian Time), Thursday, January 29, 2009
      Ends:  10:00 AM (Hawaiian Time), Friday, January 30, 2009
      Location:  Coral Ballroom Foyer, Hilton Hawaiian Village

About the AAPM

For more than 25 years, the American Academy of Pain Medicine (AAPM) has been the medical specialty society representing more than 2,200 physicians practicing in the field of pain medicine. The Academy is involved in education, training, advocacy and research in the specialty of pain medicine. Information is available on the practice of pain medicine at

SOURCE American Academy of Pain Medicine
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