Pain among Veterans Returning from Deployment in Iraq and Afghanistan: Update on the Veterans Health Administration Pain Research Program

Abstract

In November 1998, the former Undersecretary for Health for the Department of Veterans Affairs (VA), Dr. Kenneth Kizer, launched the Veterans Health Administration (VHA) National Pain Management Strategy establishing pain management as a national priority. The overall objective of the national strategy is to develop a comprehensive, multicultural, integrated, system-wide approach to pain management that reduces pain and suffering and improves quality of life for veterans experiencing acute and chronic pain associated with a wide range of injuries and illnesses, including terminal illness. Among the key elements of the strategy, a need to “expand basic and applied research on management of acute and chronic pain, emphasizing conditions that are most prevalent among Veterans,” was articulated. The importance of this initiative cannot be overemphasized. There are over 23 million U.S. Military Veterans, and in 2008, approximately 5.8 million veterans received care in any of the VHA's 154 medical centers, 765 community-based outpatient clinics, and/or 230 veteran outreach centers. Of those receiving primary care in VHA facilities, as many as 50% of male veterans and as many as 75% of female veterans report the presence of pain [1,2]). Similarly, high rates of pain are documented among veterans returning from deployment in the recent wars in Iraq and Afghanistan, and painful musculoskeletal conditions are by far the most common diagnosed medical problems among these veterans, far surpassing the prevalence of other medical and mental health disorders [3]. Among veterans who have experienced polytrauma, defined as injury to two or more body parts or systems that results in cognitive, physical, psychological, or other psychosocial impairments, rates of pain may be even higher [4,5]. The presence of pain is known to be associated with a high prevalence of other mental health conditions, including post-traumatic stress disorder (PTSD) and depression [4]. Beyond the …