Veterans More Likely to Have Chronic Pain

By Pat Anson, Editor

Nearly one out of ten U.S. military veterans suffers from chronic severe pain, according to an extensive new survey that found the prevalence of pain higher in veterans than nonveterans, particularly in veterans who served during recent armed conflicts.

The survey by the National Institutes of Health provides the first national estimate of severe pain in both veterans and nonveterans.

The prevalence of severe pain – defined as pain that occurs "most days" or "every day" and bothers the individual "a lot" – was 9.1% for veterans and 6.4% for nonveterans.

“Our analysis showed that veterans were about 40 percent more likely to experience severe pain than nonveterans,” said Richard Nahin, PhD, lead author of the analysis.

“Younger veterans were substantially more likely to report suffering from severe pain than nonveterans, even after controlling for underlying demographic characteristics. These findings suggest that more attention should be paid to helping veterans manage the impact of severe pain and related disability on daily activities.”

The study is based on data from a survey of over 67,000 adults (6,647 veterans and 61,049 nonveterans) who responded to questions about the persistence and intensity of their pain. The vast majority of veterans were men (92%), while most of the nonveterans were women (56%). The survey did not identify any specific aspects of military service, including branch of the armed forces, years of service, or whether the veteran served in a combat role.

More veterans (65%) than nonveterans (56%) reported having some type of pain in the previous three months.  They were also more likely to have severe pain from back pain, joint pain, migraine, neck pain, sciatica and jaw pain.

Younger veterans (8%) were substantially more likely to suffer from severe pain than nonveterans (3%) of similar ages.

“These findings show that we still have much more to do to help our veterans who are suffering from pain,” said Josephine Briggs, MD, director of the National Center for Complementary and Integrative Health (NCCIH). “This new knowledge can help inform effective health care strategies for veterans of all ages. More research is needed to generate additional evidence-based options for veterans managing pain.”

Veterans Complain About VA Pain Care

The survey adds to the growing body of evidence that military veterans are more likely to suffer from physical and mental health issues, and that their problems are not being adequately addressed by the Veterans Administration, which provides health services to 6 million veterans and their families. According to a recent VA study, an average of 22 veterans commit suicide each day.

One of them was Peter Kaisen. In August, the 76-year old Navy veteran committed suicide outside a VA Medical Center in Northport, New York.  Kaisen’s widow told Newsday that her husband had chronic back pain, but VA doctors had told him there was nothing more they could do to ease his suffering.

According to a 2014 Inspector General’s study, more than half of the veterans being treated at the VA have chronic pain, as well as other conditions that contribute to it, such as depression and post-traumatic stress disorder.

In recent months, dozens of veterans have complained to Pain News Network that their treatment grew worse after the VA adopted the Centers for Disease Control and Prevention’s opioid prescribing guidelines, which discourage doctors from prescribing opioids for chronic pain.

“I am a Vietnam era veteran who has had testicular cancer, prostate cancer, hip joint cancer, and have been living with an inoperable spinal cord tumor,” wrote Tommy Garrett. “I cannot get the VA to prescribe OxyContin that civilian doctors have had me on for 17 years.”

“I received epidurals for 10 years and also I received pain medication for 6 years. The VA quit giving me epidurals and also took me off Vicodin,” said Mitch Kepner. “(Before) I was active and now I just lay around and do nothing wishing I was dead. I have no life, everything I do is a struggle. I don't want pity. I don't want compassion. I don't want (anything) from anybody. I just want Vicodin back so I can function.”

After several years of taking morphine to relieve pain from chronic arthritis, Vietnam veteran Ron Pence had his dosage cut in half by VA doctors – who want him to take Cymbalta, a non-opioid originally developed to treat anxiety. After reading about Cymbalta's side effects, Pence refused to take it.

“Why start something like that when what I was taking had no side effects for me and was working fine? I am sure the pills they are pushing will end in a lot more deaths and terrible disabilities and suffering,” wrote Pence in a PNN guest column.

“We are in one of the most advanced countries in the world medically, yet the doctors and politicians will not use that knowledge to ease pain and suffering. We have to find a solution.”

Don’t Let Them Stop the Stem Cell Movement

By A. Rahman Ford, Columnist

Somewhat lost in Donald Trump’s presidential victory was the resounding statement made by voters that medical marijuana is here to stay.  Those people-driven victories were monumental for millions suffering from painful and debilitating illnesses -- people who could achieve a life-saving benefit from marijuana or its derivatives. 

It’s only a matter of time before the DEA changes its ridiculous classification of marijuana as a Schedule I controlled substance. 

I believe that one of the next challenges in the wellness movement is the FDA’s control over your own stem cells, or as I call them, personal stem cells.  Quite frankly, the DEA’s position on marijuana is about as misplaced as the FDA’s position on you using the cells God gave you to heal yourself. 

Some scientists have been pushing quite a bit of manufactured controversy around the issue.  Those same scientists tried the same thing with marijuana.  But now the people know the truth.

Personal stem cells are simple to understand.  I’m not talking about embryos, umbilical cords or artificial cells grown by some scientist in a lab.  When I talk about personal stem cells, I’m talking about master cells cultivated from your own bone marrow or fat. 

Yes, you have stem cells in your own body that can heal you.  

In marijuana terms, it’s like you’re your own stem cell “grow house.”  Your own cells can be used to heal any number of physical ailments, including orthopedic issues.  Orthopedists have been using the procedure for years, and there is also evidence that stem cells can be used to heal autoimmune diseases. 

Like marijuana, we really have no idea how many ailments can be improved or even cured with personal stem cells.

If you’re wondering whether personal stem cells can actually heal, look no further than professional sports.  Recently, Bartolo Colon, currently the oldest major league baseball player at 43 years of age, signed a $12.5 million pitching contract with the Atlanta Braves.  How in the world is he able to be so productive at an age where most players are long retired?  You guessed it – his own stem cells.

What about NFL Hall of Famer and two-time Super Bowl winner Peyton Manning, who literally broke his neck playing the game he loved?  Yes, his own stem cells.  International athletes like tennis champion Rafael Nadal have benefitted as well.  In fact, hundreds of professional athletes have healed from serious injuries by using their own stem cells. 

Personal stem cells can work.

Unfortunately, many athletes have to go overseas to use their own God-given healing potential, because the FDA doesn’t allow certain techniques to expand your really strong (mesenchymal) stem cells.  But these wealthy, well-connected athletes who earn their living by being fit -- often enduring severe injuries and pain -- know the truth.  Your own stem cells can heal you.

Just think how many wounded combat veterans could benefit from their own cells!  A 2014 University of Michigan study found that 60 percent of U.S. Army soldiers who were unable to return to a military career after an Iraq deployment couldn’t do so because of a muscle, bone or joint injury. The strongest predictors of inability to serve were fractures and chronic knee, shoulder, spine and back pain. 

But it’s not just musculoskeletal conditions.  Our troops also have crippling brain injuries from IED and other bomb blasts.  According to the Pittsburgh Tribune Review, tens of thousands of combat veterans returning from Iraq and Afghanistan with undiagnosed brain injuries “often were ‘thrown into a canyon’ – falling deeper into despair and sometimes flirting with suicide or addiction.”

It gets worse.  To cope with the pain and depression of injury, many wounded warriors turn to addictive pharmaceutical painkillers or illegal street drugs.  A 2011 American Public Health Association report found that the overdose rate for veterans on opioid painkillers was twice the national average, and that they are more likely to become addicted to heroin. 

Opioid abuse is such an epidemic that, in a recent letter to physicians, the Surgeon General called it a crisis and launched the “Turn the Tide” campaign to raise awareness about the issue. 

Fortunately, many wounded warriors have already begun turning the tide by replacing their toxic pills with medical marijuana.  Now, we owe it to our troops to help them turn the tide even further, by giving them another option – personal stem cells.

We celebrate our troops with parades and salutes on Veteran’s Day, Memorial Day and during just about every major sporting event, and justifiably so.  But maybe the best way to celebrate them is to allow them to heal themselves with their own cells so that they can once again be the parents, siblings and children we love.  Our government has a moral and ethical obligation to do so, and we the people have an ethical and moral obligation to make them do it.

Stem Cell Therapy Not FDA Approved

I want to be clear: clinical use of adult, embryonic and umbilical cord stem cells are not FDA approved, and any determination as to their safety or efficacy requires further research (although, in the interest of full disclosure, I have had umbilical cord stem cells in China and the therapy helped me greatly with no negative effects). These stem cells are properly under the domain of the FDA because they are biological agents that are taken from one person and injected into another person and intended to treat a disease. 

What I’m talking about are cells that go from YOU into YOU.  Personal stem cells are as natural as marijuana, and the federal government should acknowledge that your use of your own cells should be a transaction between you and a licensed physician, and regulated at the state level.

States like Colorado and Washington have already proven how safe and healing – not to mention lucrative – marijuana can be, despite what all of the “experts” were saying.  Your own stem cells are no different.

Right now, personal stem cells are technically legal, but the future regulatory landscape is so uncertain that few physicians offer it and few Americans can afford it.  Rather than expanding access to personal stem cells, the FDA has recently tried to restrict their use.

The proposed action by the FDA is wrong.  Unfortunately, it seems like the agency is refusing to hear the cries of persons with disabilities (like myself) and wounded warriors who come home crippled after serving abroad -- so that the children of federal agency bureaucrats can be safe here at home.

I believe marijuana legalization gives personal stem cell advocates hope.  The legalization movement succeeded despite federal intransigence because of the success of direct democracy. People voted at the state level in referendums, without elected officials operating as self-interested intermediaries. 

Given the important nature of this issue, and the apparent ineffectiveness of federal government lobbying and litigation alone, the personal stem cell movement may need to add a referendum component as well.  It may be difficult, but it can be done. 

Educate yourself, and then educate others.  Human beings are not drugs.  We need to keep it that way.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor in Chief of the Howard Law Journal. He earned his PhD at the University of Pennsylvania.

Dr. Ford is not affiliated with any stem cell treatment provider. He suffers from chronic inflammation in his digestive tract and is unable to eat solid food.

Pain News Network invites other readers to share their stories with us.  Send them to:  editor@PainNewsNetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Did Untreated Pain Lead Veteran to Commit Suicide?

By Pat Anson, Editor

Two congressmen are asking for an investigation into the apparent suicide of a Navy veteran suffering from chronic back pain outside a veteran’s hospital in New York.

76-year old Peter Kaisen of Islip was found dead inside his car in a parking lot Sunday at the Veterans Affairs Medical Center in Northport. He suffered a fatal gunshot wound to the head.

Kaisen’s wife told Newsday that he suffered from back pain and was unable to sit for more than a few minutes. She said doctors at the VA hospital told her husband there was nothing more they could do to ease his suffering.

The VA this year implemented the Centers for Disease Control and Prevention’s opioid guidelines, which discourage doctors from prescribing opioid pain medication for chronic pain. Since those guidelines were adopted, several veterans have complained to Pain News Network that their opioid doses have been reduced or stopped altogether. It's not clear if that's what happened to Kaisen.

The VA provides health services to 6 million veterans and their families. Over half of the veterans treated by the VA have chronic pain.   

A longtime friend and fellow veteran told the Associated Press that Kaisen visited the VA hospital once or twice a month. He lives about 30 miles away.

"We all think there is probably some depression," said Tom Farley said. "Maybe he wanted meds. Maybe he wanted to sit and talk. I don't know. None of the family knows."

A spokesman for the hospital declined to discuss Kaisen's medical history, but said the hospital had no evidence that he sought treatment at the emergency room on the day he died.

"The Northport VA stands ready to cooperate with any investigative body that believes more information is needed," the hospital's director, Philip Moschitta, said in a statement. "At no point did the staff in this facility fail to do the right thing by our patients."

PETER KAIsEN

But two hospital employees told The New York Times that Kaisen had been frustrated he could not see a doctor in the emergency room, where he went to seek help related to his mental health.

“He went to the E.R. and was denied service,” one employee said. “And then he went to his car and shot himself."

“Someone dropped the ball. They should not have turned him away,” another worker said.

Congressmen Peter King and Steve Israel sent a letter to the FBI and the Department of Veterans Affairs on Thursday asking for a "transparent" investigation into Kaisen’s death.

"It is critical that our nation's veterans feel they can trust the services provided by their VA medical facilities, and that their health and wellbeing is of the upmost priority," they wrote.

Kaisen’s wife told Newsday her husband served on a Navy supply ship, the USS Denebola, from 1958 to 1962.

According to a 2014 Inspector General’s study, more than half of the veterans being treated at the VA have chronic pain, as well as other conditions that contribute to it, such as post-traumatic stress disorder.

Because veterans are at high risk of opioid abuse and overdose, the VA implemented an Opioid Safety Initiative in 2013 to discourage its doctors from prescribing the drugs. The number of veterans prescribed opioids fell by 110,000, but alarms were raised when some vets turned to street drugs or suicide to stop their pain.

According to a VA study released in July, an average of 22 veterans commit suicide each day.

Prescribed Opioids Not Linked to Veterans’ Heroin Use

By Pat Anson, Editor

A new study of U.S. military veterans found a strong link between heroin use and the abuse of opioid pain medication, but with an important caveat:  the heroin use was associated with the non-medical use of opioid painkillers.

Having chronic pain was also not found to be a significant risk factor for heroin use.

The ten-year study by researchers at Brown and Yale Universities followed nearly 3,400 veterans at nine Veterans Affairs facilities who were participating in the Veterans Aging Cohort Study (VACS).

Of the 500 veterans who started using heroin during the study, 386 of them also began using prescription painkillers non-medically.

"Our findings demonstrate a pattern of transitioning from non-medical use of prescription opioids to heroin use that has only been demonstrated in select populations," said study co-author David Fiellin, a Yale public health and medical professor and director of the VACS study.

"Our findings are unique in that our sample of individuals consisted of patients who were receiving routine medical care for common medical conditions."

Even after statistically accounting for other risks -- such as race, income, use of other drugs, post-traumatic stress disorder (PTSD) and depression -- researchers found that veterans who began misusing painkillers were 5.4 times more likely to begin using heroin. Other major risk factors for heroin use include being male (2.6 times greater risk) and abusing stimulant drugs (2.1 times greater risk).

Veterans who received a short-term prescription for an opioid medication had a 1.7 times greater risk of starting heroin. But having a long-term prescription for opioids was not found to be a significant risk factor. And neither was having chronic pain.

“In our final model, pain interference in daily life was not a significant predictor of heroin initiation,” said lead author Brandon Marshall, an assistant professor in the Brown University School of Public Health.

Despite those findings, researchers recommend that all veterans should be screened for painkiller abuse, including those with legal prescriptions.

"This paper shows that, as a general clinical practice, particularly for this population which does experience a lot of chronic pain and other risks for substance use including PTSD, screening for non-medical painkiller use, whether you are prescribing an opioid or not, may be effective to prevent even more harmful transitions to heroin or other drugs," said Marshall, adding that veterans have a "constellation of risks" for substance abuse.

The study, published in the journal Addiction, did not identify the source of the opioids that were used non-medically. The National Institutes of Health and the U.S. Department of Veterans Affairs supported the study.

Under a federal spending bill passed by Congress and signed into law last year by President Obama, the Veteran’s Administration is required to follow the CDC's “voluntary” opioid guidelines, which discourage opioid prescribing for chronic pain. Since those guidelines were adopted, many veterans have complained to Pain News Network that their opioid doses have been reduced and they live in daily pain.

“They just cut my meds to one oxycodone every 12 hours, which gives me absolutely no relief,” wrote Harvey Williams, a Vietnam vet. “There must be something that the Veterans Administration can do to treat severe pain in the Vets. It's not fair for us to be sprayed with Agent Orange, return back to the United States, develop diabetes and in turn have severe neuropathy and pain for the rest of our lives and not be treated.”

“My VA doctors did not exam me prior to (cutting) my prescriptions,” wrote retired Army Capt. William Green, a Desert Storm veteran. “I asked how they decided to start reducing when I was reporting ongoing 6-8 on 10 pain scale. He didn't even consult with the doctor I do get ongoing treatment from. The doctor said, ‘We don’t care. We are following CDC guidelines.’”

The VA provides health services to 6 million veterans and their families. Over half of the veterans treated by the VA have chronic pain.   

Counseling and Behavioral Therapy Help Vets in Chronic Pain

By Pat Anson, Editor

An innovative two-step program that combines analgesics with deep breathing, relaxation techniques and counseling significantly reduced pain levels in U.S. military veterans who suffer from chronic pain, according to a new study at a VA Medical Center.

Researchers at the Roudebush VA Medical Center in Indianapolis, the Regenstrief Institute and the Indiana University School of Medicine studied 241 veterans who returned from deployments in Iraq and Afghanistan. Findings from the ESCAPE trial -- short for Evaluation of Stepped Care for Chronic Pain – are being published in JAMA Internal Medicine.

It is a critical health issue among veterans, many of whom had multiple, often lengthy deployments. Many have significant long-term pain. We know that medications alone are only modestly successful in helping them; current pain treatments haven't made much of a dent,” said Matthew Blair, MD, the study’s lead investigator and an associate professor of medicine at Indiana University.

A recent study found that nearly half of the American soldiers deployed to Iraq and Afghanistan return home to the U.S. in chronic pain, and about one in seven were using opioid pain relievers. Although pain is a common condition, researchers say no intervention studies had been conducted on the best ways to treat chronic pain in these veterans.

“The absence of studies is concerning because chronic pain may prove even more disabling in veterans of recent conflicts than in veterans of previous eras owing to the high combat intensity,” said Bair, who served for eight years as a U.S. Army physician.

The veterans in the ESCAPE study suffered from moderate to severe chronic pain in the back, knee, neck or shoulder for at least three months. Veterans with substance or abuse problems were excluded from the study, as were those with suicidal thoughts, active psychosis or schizophrenia.

In the first phase of ESCAPE, patients were given 12 weeks of pain medication, ranging from acetaminophen to opioids. Because analgesics may not relieve pain sufficiently when used alone, the veterans were educated about self-management strategies such as goal setting, problem solving, deep breathing and relaxation techniques. Patients were also encouraged to minimize bed rest, return to normal activities, and perform stretching and strengthening exercises.

Step two involved 12 weeks of cognitive behavioral therapy that included psychological counseling for both pain and depression. Nurse care managers consulted with veterans over the telephone, helping them counter negative thoughts – such as helping them understand that while they may not be able to perform the same physical activities they enjoyed before deployment, a substitute activity like swimming might be achievable and decrease their pain.

Those who received the two-step ESCAPE program saw improvement in their function and a decrease in pain severity and pain interference -- how pain interferes with their mood, physical activity, work, relationships, sleep and enjoyment of life.

“The decrease in pain severity and 30 percent improvement in pain-related disability we achieved in the ESCAPE study are clinically significant, and we found that improvement lasted for at least nine months," said Blair.

Researchers say the ESCAPE program could be duplicated to treat chronic pain at other VA medical centers and other large health care systems outside the VA. However, implementing the program in smaller community settings or in private settings may be challenging.

"This is an important, methodologically rigorous study that underscores the value of psychobehavioral treatment in chronic pain,” said Beth Darnall, PhD, a pain psychologist and author of Less Pain, Fewer Pills. “Cognitive-behavioral therapy and the use of relaxation strategies work exceedingly well within the context of a comprehensive pain management program, and when the techniques are used regularly.”

Darnall recommends the same techniques used in the VA study in her own private practice.

“It’s important for people to know that the results from psychobehavioral skills build over time.  In other words, use them daily and your results will unfold and strengthen over the course of weeks and months,” she wrote in an email to Pain News Network.