Chronic Pain Syndromes Common in Returning Veterans

BOSTON — Chronic pain was the most frequent complaint among U.S. soldiers returning from foreign war zones, according to findings from a new survey of patients at a Florida veterans' hospital.

The high prevalence and severity of chronic pain syndromes among veterans may result from stress and hardship rather than wounds, according to a report presented in a poster at the annual meeting of the American Pain Society.

Ronald Gironda, Ph.D., and his associates at the James A. Haley Veterans Affairs Medical Center in Tampa, Fla., reviewed records of 793 patients who were veterans of conflicts in Afghanistan and Iraq through November 2004.

None of the patients suffered gunshot wounds or blast injuries, he said.

About 47% of patients (373) reported pain. Some 28% (222 patients) reported pain scores of 4 or greater on a scale of 0–10. The researchers randomly selected 100 patient records from this group for closer inspection.

In the subgroup with significant pain, the average pain score was 6.6—considered “significant pain that is likely to interfere with functional activity,” said Dr. Gironda, a pain specialist.

The veterans' primary complaints were back pain (46%), lower limb pain (31%), upper limb pain (7.5%), neck pain (6%), and headache (4.5%).

“I think when all is said and done we're going to see even higher rates of pain in this new group of veterans than we saw in the Persian Gulf War,” Dr. Gironda told FAMILY PRACTICE NEWS.

The pain patients suffered a gauntlet of assaults on their well-being. Many had become physically inactive and deconditioned since their return. “They were often depressed, demoralized, unemployed, and had no social contact,” he noted.

“We know that there is a relationship between psychosocial factors and the report of pain—how it is experienced and how it develops and unfolds over time,” Dr. Gironda said. “One of the main goals of treatment is to help these individuals develop skills to cope with the pain.”

In addition to providing medical therapy, a 3-week interdisciplinary pain program introduces veterans to new exercise regimens, relaxation techniques, and cognitive-behavioral therapy to reduce fear of pain and fear of activity. Within the first week or so they also are weaned off of opiates.

“The VA has a real opportunity here,” Dr. Gironda added. “We know that the sooner we address these pain conditions the less likely they are to become truly chronic—or, if they become chronic, the less likely they are to be severe.”

Dr. Gironda said that it is unknown how many of these soldiers had chronic pain complaints before they entered a war zone. It also is difficult to say how the prevalence and severity of these complaints compare with those in the general public.

For example, a recent survey by researcher Michael Von Korff, Sc.D., and colleagues at Group Health Cooperative in Seattle estimated that nearly 20% of all adult Americans had chronic spinal pain in the prior 12 months (Pain 2005;113:331–9). The majority of those with chronic spinal pain (87%) reported at least one other chronic pain condition, physical ailment, mental disorder, or substance abuse problem.

By that standard, the prevalence of chronic pain conditions in hospitalized veterans may not be all that much greater than it is among their noncombatant peers. How the severity and duration of their complaints compare with the general population is unclear.

BOSTON — Chronic pain was the most frequent complaint among U.S. soldiers returning from foreign war zones, according to findings from a new survey of patients at a Florida veterans' hospital.

The high prevalence and severity of chronic pain syndromes among veterans may result from stress and hardship rather than wounds, according to a report presented in a poster at the annual meeting of the American Pain Society.

Ronald Gironda, Ph.D., and his associates at the James A. Haley Veterans Affairs Medical Center in Tampa, Fla., reviewed records of 793 patients who were veterans of conflicts in Afghanistan and Iraq through November 2004.

None of the patients suffered gunshot wounds or blast injuries, he said.

About 47% of patients (373) reported pain. Some 28% (222 patients) reported pain scores of 4 or greater on a scale of 0–10. The researchers randomly selected 100 patient records from this group for closer inspection.

In the subgroup with significant pain, the average pain score was 6.6—considered “significant pain that is likely to interfere with functional activity,” said Dr. Gironda, a pain specialist.

The veterans' primary complaints were back pain (46%), lower limb pain (31%), upper limb pain (7.5%), neck pain (6%), and headache (4.5%).

“I think when all is said and done we're going to see even higher rates of pain in this new group of veterans than we saw in the Persian Gulf War,” Dr. Gironda told FAMILY PRACTICE NEWS.

The pain patients suffered a gauntlet of assaults on their well-being. Many had become physically inactive and deconditioned since their return. “They were often depressed, demoralized, unemployed, and had no social contact,” he noted.

“We know that there is a relationship between psychosocial factors and the report of pain—how it is experienced and how it develops and unfolds over time,” Dr. Gironda said. “One of the main goals of treatment is to help these individuals develop skills to cope with the pain.”

In addition to providing medical therapy, a 3-week interdisciplinary pain program introduces veterans to new exercise regimens, relaxation techniques, and cognitive-behavioral therapy to reduce fear of pain and fear of activity. Within the first week or so they also are weaned off of opiates.

“The VA has a real opportunity here,” Dr. Gironda added. “We know that the sooner we address these pain conditions the less likely they are to become truly chronic—or, if they become chronic, the less likely they are to be severe.”

Dr. Gironda said that it is unknown how many of these soldiers had chronic pain complaints before they entered a war zone. It also is difficult to say how the prevalence and severity of these complaints compare with those in the general public.

For example, a recent survey by researcher Michael Von Korff, Sc.D., and colleagues at Group Health Cooperative in Seattle estimated that nearly 20% of all adult Americans had chronic spinal pain in the prior 12 months (Pain 2005;113:331–9). The majority of those with chronic spinal pain (87%) reported at least one other chronic pain condition, physical ailment, mental disorder, or substance abuse problem.

By that standard, the prevalence of chronic pain conditions in hospitalized veterans may not be all that much greater than it is among their noncombatant peers. How the severity and duration of their complaints compare with the general population is unclear.

BOSTON — Chronic pain was the most frequent complaint among U.S. soldiers returning from foreign war zones, according to findings from a new survey of patients at a Florida veterans' hospital.

The high prevalence and severity of chronic pain syndromes among veterans may result from stress and hardship rather than wounds, according to a report presented in a poster at the annual meeting of the American Pain Society.

Ronald Gironda, Ph.D., and his associates at the James A. Haley Veterans Affairs Medical Center in Tampa, Fla., reviewed records of 793 patients who were veterans of conflicts in Afghanistan and Iraq through November 2004.

None of the patients suffered gunshot wounds or blast injuries, he said.

About 47% of patients (373) reported pain. Some 28% (222 patients) reported pain scores of 4 or greater on a scale of 0–10. The researchers randomly selected 100 patient records from this group for closer inspection.

In the subgroup with significant pain, the average pain score was 6.6—considered “significant pain that is likely to interfere with functional activity,” said Dr. Gironda, a pain specialist.

The veterans' primary complaints were back pain (46%), lower limb pain (31%), upper limb pain (7.5%), neck pain (6%), and headache (4.5%).

“I think when all is said and done we're going to see even higher rates of pain in this new group of veterans than we saw in the Persian Gulf War,” Dr. Gironda told FAMILY PRACTICE NEWS.

The pain patients suffered a gauntlet of assaults on their well-being. Many had become physically inactive and deconditioned since their return. “They were often depressed, demoralized, unemployed, and had no social contact,” he noted.

“We know that there is a relationship between psychosocial factors and the report of pain—how it is experienced and how it develops and unfolds over time,” Dr. Gironda said. “One of the main goals of treatment is to help these individuals develop skills to cope with the pain.”

In addition to providing medical therapy, a 3-week interdisciplinary pain program introduces veterans to new exercise regimens, relaxation techniques, and cognitive-behavioral therapy to reduce fear of pain and fear of activity. Within the first week or so they also are weaned off of opiates.

“The VA has a real opportunity here,” Dr. Gironda added. “We know that the sooner we address these pain conditions the less likely they are to become truly chronic—or, if they become chronic, the less likely they are to be severe.”

Dr. Gironda said that it is unknown how many of these soldiers had chronic pain complaints before they entered a war zone. It also is difficult to say how the prevalence and severity of these complaints compare with those in the general public.

For example, a recent survey by researcher Michael Von Korff, Sc.D., and colleagues at Group Health Cooperative in Seattle estimated that nearly 20% of all adult Americans had chronic spinal pain in the prior 12 months (Pain 2005;113:331–9). The majority of those with chronic spinal pain (87%) reported at least one other chronic pain condition, physical ailment, mental disorder, or substance abuse problem.

By that standard, the prevalence of chronic pain conditions in hospitalized veterans may not be all that much greater than it is among their noncombatant peers. How the severity and duration of their complaints compare with the general population is unclear.