Classical Values :: In the war against pain relief, there is no exemption for wounded soldiers!

March 17, 2010

In the war against pain relief, there is no exemption for wounded soldiers!

One of my quirks is that I don't like being lied to or manipulated, especially by people whose job is to simply gather the news and report facts. So I found myself more than a little annoyed by the manipulative nature of a USA Today story which attempts to promote a meme I wish had died with the Vietnam War -- that large numbers of soldiers are drug abusers:

WASHINGTON -- The military is trying to curb the volume of narcotics given to troops as the number of prescriptions for painkillers and instances of drug abuse continue to soar, according to Pentagon data and recent congressional testimony.

Military doctors wrote almost 3.8 million prescriptions for pain relief for servicemembers last year -- more than four times the 866,773 doses handed out in 2001, according to data from the Pentagon health office.

Jim Webb thinks the statistics are stunning:

"These are stunning statistics," says Sen. Jim Webb, D-Va., who intends to look into the issue next week during a Senate subcommittee hearing that he will chair. Surgeons general of the Army, Navy and Air Force will testify. "I would really like to dig down in the data here and get their thoughts about what is driving this."

I find myself stunned too, but not in the way Webb seems to be. I'm stunned by the fact that the above "statistics" are so garbled as to be so incomprehensible. First off, the number of "prescriptions" written is being contrasted to the number of "doses" said to have been "handed out." Handing out a "dose" is hardly the same as writing a prescription. Furthermore, not all "prescriptions for pain relief" involve narcotic drugs. There's no way to make sense out of it. To call the above "misleading" would be too kind.

But even if the numbers represented an accurate comparison, is it really fair to contrast the number of pain prescriptions written in 2001 with the number that would be written after nine years of ongoing wars in two countries? I don't know what the numbers are, but I would think that the number of wounded soldiers in acute and chronic pain should have been gone up by a huge ratio -- maybe more than whatever number is indicated by the increase in the number of prescriptions written. Moreover, when a soldier is wounded in battle, his need for pain relief often does not end with his discharge from the hospital. Injuries resulting in permanent tissue or nerve damage, amputations, retained foreign particles like shrapnel and plastic -- all of these things can result in severe, ongoing, and chronic pain. The longer that a war drags on, the more such injuries can be expected to accumulate. That there would be an ongoing, cumulative need for pain relief should not surprise anyone. Does it require rocket science to understand that there are many more wounded soldiers there are now than there were in 2001? (Bear in mind that this does not even factor in the numerous injuries other than wounds inflicted by the enemy.)

According to an Iraq War Wiki entry, in the Iraq War alone "as of February 23, 2010 there were 31,693 wounded in action." The same entry states that according to October 18, 2005 USA Today article,

"More than one in four U.S. troops have come home from the Iraq war with health problems that require medical or mental health treatment, according to the Pentagon's first detailed screening of service members leaving a war zone.'

To the above add Afghanistan.

As to how many of the wounded have chronic pain, I don't know, but if we consider the huge number of American civilians who have chronic pain, the military's numbers (high and unfortunate as they are) are neither surprising nor disproportionate:

An estimated 76.5 million Americans suffer from chronic pain, affecting more people than diabetes, heart disease, and cancer combined. Pain is a serious public health issue that does not discriminate based upon age, race, gender, or occupation. Since 2001, over 1.5 million servicemen and women have served in Iraq and Afghanistan, with nearly 33,000 sustaining severe wounds from roadside bombs and improvised explosive devices (IEDs). These very visible wounds include traumatic amputation, some forms of traumatic brain injury, burns, and shrapnel damage, resulting in chronic--or lifelong--pain.

Pain is the number-one cause of disability in returning veterans from Iraq and Afghanistan. Thousands more soldiers will endure the often invisible wounds of war, including high rates of depression, post-traumatic stress disorder (PTSD), and chronically painful injuries of the spine, joints, and muscles due to combat.

76 million chronic pain sufferers out of 300 million Americans is about 25%, and 33,000 out of 1.5 million is around 2.2%. (And even that is only if we assume that all wounded soldiers suffer from chronic pain, which is not the case.)

But the important fact is that in 2001 we simply did not have those 33,000 wounded soldiers (or the innumerable non-battlefield injuries which accompany all wars), so it is ridiculously misleading to look at a rise in pain prescriptions as evidence for the claim that soldiers are "abusing" drugs. As to what they might mean by the term "abuse," I shudder to wonder.

Ramped up drug war rhetoric has been coming from all directions lately and I am sorry to see that the military is being dragged into the ongoing war against prescription pain meds. The real casualties of this campaign will be wounded soldiers suffering from chronic pain.

It really bothers me to think that a guy who was wounded for his country but needs pain relief will now have to face the stigma of being looked at as a suspected drug abuser, in order to further the expansion of the war on drugs into places it does not belong, while fueling the leftie narrative that evil wars turn our troops into a bunch of drug addicts.

I guess it would be unreasonable to expect a story which fuels two narratives to be characterized by honest reporting and fact checking.

posted by Eric on 03.17.10 at 12:41 PM

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Comments

Any one in America who needs chronic pain relief is considered a suspect for drug abuse. In the eyes of the government they are all potential criminals.

Which is one of the reasons chronic pain is severely under treated in America.

The neglect is criminal.

M. Simon · March 17, 2010 02:55 PM

My daughter has a chronic back injury - a pinched nerve - sustained while she was on active duty and going through combat refresher training. She collided at a dead run with another Marine, both of them in full gear - and the other Marine was one of those foot-ball playing, 6 foot plus guys. It is usually not so bad that she needs pain meds. But the thing is, that a lot of what service members do as a matter of course is so physically challenging, that military service over time will eventually damage a body permanently (jumping from perfectly good airplanes, running miles in full gear, etc)- even if direct combat isn't involved.

Sgt. Mom · March 17, 2010 05:19 PM

Sgt. Mom, I'm sorry to hear about your daughter's injury and resultant pain, and I think the important thing to remember is that however it is treated is a matter between your daughter and her doctors.

I see this as a three-pronged assault against soldiers wounded or injured in the service of their country; against the rights of all patients to be pain-free; and against a doctor's sacrosanct obligation to practice medicine by looking out for the best interest of his patient.

I suspect we are going to see a lot more second-guessing of doctors by the government. My dad was a doctor and he's lucky he didn't live to see it.

Eric Scheie · March 17, 2010 05:29 PM

I have an extremely difficult time believing that one-quarter of Americans are in actual chronic pain. I do not have difficulty believing that one-quarter of veterans are, although even that does not seem to be the case. And while I agree with you wholeheartedly that what pain medications a patient needs should be between the patient and his or her doctor, I simply do not believe that all patients who allgedly experience chronic pain need chronic meds. Call me a doubting Thomas, but I kind of think Americans--not soldiers, who are probably likely to underreport chronic pain--are just whiners. If all the estimates of how many people are in chronic pain or suffer from the kind of mental problem--depression, ADHD, whatever--that "needs" medication were true, we would probably cease to function as a people, because we would all be disabled by our pain and suffering.

Admittedly, I also don't really think pain is inherently bad, and I don't think anyone has a "right" to be pain-free. I don't even know how such a right would be supportable. I'm all for giving soldiers anything and everything they need, but for normal office workers who get sciatica from sitting too much, man, just get up and walk. (for example...I KNOW that not everyone who "suffers from chronic pain" has sciatica)

Julie · March 17, 2010 07:10 PM

That's unbelievabile.
You're exactly right about the "against a doctor' sacrosanct obligation..." part, if they're counting prescriptions or doses and implying it's drug addiction, that's doctor approved drub abuse, he's calling them criminals.

Webb says, "I would really like to dig down in the data here and get their thoughts about what is driving this."

I'll field that one there Mr. Combat Expert Senator.
We keep so many more of our troops alive than we used to so many of them were mostly dead at some point and that takes a long time to fix, Miracle Max retired.

When they can sew your guts back together (with a few, damaged, pieces left over), reattach an arm, remove what's left of a leg and attach a prosthetic, set multiple fractures in any bone, including the pelvis, ribs and skull while taking out damaged pieces and bits of metal, uniform and whatnot and putting in and taking out pins, ribs, staples and whatever else they use, well, that's painfile and takes a long time.

Sir.

Veeshir · March 17, 2010 07:19 PM

The USA Today article referenced here is an example of agenda-driven journalism compounded by craven political opportunism. The underlining premise is that readers are mushy-minded dolts who will be seduced my this meme into knee jerk antipathy toward military physicians and compassionate empathy for drug addled victim soldiers. My how far we have sunk as a society.

TomA · March 17, 2010 07:28 PM

Julie -- while I do agree with you that there is no right to be pain free, it seems you think pain and suffering are GOOD and build character. At least that's what I'm getting from your comment.

And... that's bullshit.

I also suspect you have no idea what sciatica is or how it happens. If merely walking could cure it, how about allowing some pain medication to actually accomplish that walking?

One thing is for certain and that is that the military has much better data on who is being prescribed pain medication for what than is available from the general public.

And I can verify that they keep strict tabs on any medication that is considered addictive, from Lortab to Klonopin to Ambien. While the military will fill those prescriptions, I wish anyone (especially someone on active duty) good luck getting a prescription for them from a military physician.

What is truly sad is that sometimes pain becomes chronic pain because it is not treated when it is acute. There's this Puritanesque thinking (as noted above) that one should just suffer through it and furthermore that they will be a "better" person if they do.

Perhaps it is a fine line, but there is a difference between needing something and being addicted to something.

Since the post pissed me off in one direction and Julie's comment pissed me off in another, it's quite likely this comment of mine makes no sense.

But hey... what the hell.

Donna B. · March 17, 2010 09:12 PM

Well, Donna--I don't know what to tell you except you're reading things into my comment that aren't there.

And I do know what sciatica is. I even know where the sciatic nerve is. I've had sciatica. It comes back once in a while if I'm not getting enough exercise. Rather than take medication, I move my ass. Sometimes it takes a few days for the pain to subside. I take Motrin if it hurts so bad that I have trouble walking. It doesn't "build character" but why use a bomb when a bullet will do? I suspect that if the American lifestyle weren't so completely effed, we'd have a lot fewer people suffering from "chronic pain" and "depression," not to mention diabetes (sometimes a source of acute-on-chronic and chronic pain). That doesn't have much to do with soldiers, who take a lot of risks but lack of exercise is usually not one of them.

I shall repeat: I understand that not all chronic pain is due to sciatica (or any other easily cured condition) and I fully support giving whatever medication soldiers need to get well, and I also agree that the government should not be interfering in what goes down between doctors and patients. As for what you read into what I posted earlier, I don't really know where you got most of that.

Julie · March 18, 2010 04:31 AM

What is in the first comment and further explained in the second, is that you are basing your view of chronic pain on pain that you experience.

Whether you intend to intend to or not, what you are implying about people you don't "believe" are really suffering pain, is that whatever they suffer is their own fault.

That thinking is closely related to the thinking that maladies are God's punishment for sins. It's based on a serious misunderstanding of the actual causes of diseases like diabetes -- which can result from several combinations of lots of things, being overweight is only one. Being inactive is another. Both of those things are associated with hypoglycemia also.

Donna B. · March 18, 2010 05:19 AM

Julie,

Would you perhaps explain why you appear to believe that everyone except you is such a drug-addicted hypochondriac that they shouldn't have access to pain medication? ("Call me a doubting Thomas, but I kind of think Americans--not soldiers, who are probably likely to underreport chronic pain--are just whiners.")

On precisely what basis do you make this judgment? Your own virtue in getting up and moving around when you're in pain? Other people not doing what you believe they should be doing?

As for diseases like diabetes, let me add in a few data points. There is evidence that adult-onset is in part auto-immune. Yes, that's right. For some people diabetes is not a "lifestyle disease". Obesity also has many causes. Narcolepsy, for one - something I happen to know personally - is also an auto-immune disorder, and almost always causes obesity, depression, and often diabetes. Multiple sclerosis is another auto-immune disorder, that - gosh! - can cause chronic pain. All of these are "invisible" if well controlled or in the early stages, and all of them can cause chronic pain.

How about instead of just assuming that most of the people who take painkillers on any kind of regular basis are "whiners" you consider the possibility that maybe, just maybe, these are people who DO have chronic pain issues and are just like you in preferring not to use the painkilling drugs unless they absolutely have to.

Kate · March 18, 2010 11:29 AM

OK, I don't believe in any "right" to be free from pain in the legal sense, so perhaps I shouldn't have used the word. Besides, being "pain free" is impossible. However, patients as consumers of medical care have a moral right to expect that their doctors will ameliorate their pain to the best of their abilities. Just as if you go to a hair stylist, you have the "right" to expect a decent haircut.

What just galls me is that idea that outside limits are being placed on the doctor-patient relationship which would limit the amount of pain relief based not on the patient's symptoms or doctor's judgment, but on a statistical public policy determination that cutting back on certain medications will decrease drug abuse.

In other words, because some people abuse drugs, some patients won't receive adequate pain relief!

It's unconscionable and outrageous.

Whether I suffer from pain, and how much pain I should have to endure are personal medical questions between me and my doctor. There are psychological and perhaps moral issues as well; some people are "weaker" than others. So what? For the government to enter into the equation is tyranny.

Eric Scheie · March 18, 2010 11:40 AM

Not only are they comparing the wrong things, they are comparing doses in 2001 - when we were not involved in any large scale conflict - and prescriptions now.

This is just like the NYT hit-piece in '05 I think that said violence among veterans back home is increasing, even though the NYT's own research showed that per capital violence was still much much lower than the general population, they did not tell you that though.

What makes me even angier is these peices are carefully written to sound like they are "sympathetic to the plight" of veterans and combat soldiers. They are basically saying "it's not their fault they are psychotic violent drug abusers."

plutosdad · March 18, 2010 03:32 PM