Managing Post-deployment Chronic Pain

Ilene R. Robeck, MDVeterans are coming back with a number of key problems that are impacting their pain and their lives. Many patients are coming back with not only chronic pain, but post-traumatic stress disorder. They are coming back with traumatic brain injuries that are related to either direct trauma or exposure to improvised explosive devices (IEDs). They’re also coming back with substance misuse problems that may be related to alcohol, opiate medications, benzodiazepine medicines, or illicit substances.

All of those not only impact the patient but also impact the family. The important thing to note is although these are complex comorbidities when you address them as such, and you take care of all the problems and not just one, these patients respond incredibly well to treatment. If you are a provider who understands post-traumatic stress disorder completely but doesn’t perhaps understand what may happen with that and a TBI or a substance use disorder or chronic pain, it’s important to get other people involved in care early on so that each is addressed simultaneously by providers who are working together.

Many providers don’t really understand that the VA welcomes co-management of these patients. If you’re a provider who’s not within the VA, frequently just getting that patient referred to the VA to understand what services are available can solve many problems or begin the process of accessing specialists who understand the complexity of the problems.

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