How To Help A Veteran In Pain

I have seen more than I can count of them, veterans with chronic pain symptoms.  Nobody who serves our nation should be left to suffer.

In my world – nobody at all should be left to suffer.

I’ve worked in the Veterans Affairs system in many cities in several states and in various positions.  I’ve been the doctor who sits in the office and sees them one by one, diagnosing them and prescribing treatment.  I’ve been the evaluator who examines them and decides what kind of pension or how much disability they get.  I’ve been the director of day treatment centers where we try to give these noble servants of the people everything from activities to fill up their days, to continuing therapy for problems such as PTSD, and even food and shelter.

I’ve also been in the hospitals where veterans are recovering from wounds, or being treated for conditions they contracted in the jungles of Viet Nam or the deserts of the Middle East.

In fact, my earliest exposure – while still a medical student – brought me into contact with veterans of both World Wars.

I know veterans – I have been around them. And I have the utmost love and respect for them.

Oh yes – and if you didn’t already know, I am a veteran myself.

I’m not here to wave the flag or to try to get compliments for myself.  I’m here to make you aware of how our veterans are too-often treated, and to try to get people interested in making changes for the better.

The primary complaint in the majority of veterans I’ve seen is pain.  And the doctors who take care of them – much like the doctors who take care of civilians in pain – are all too eager to take the quick and easy route and dish out addictive pain-killers.

Yes, it is important to alleviate pain. Especially on an acute basis.  When someone is injured, they need relief as quickly as possible.

But as a long-term strategy, addictive pain-killers are a poor choice.  Besides the obvious risk of addiction, most of these are dangerous and can kill.  Or – if the pain becomes too terrible – be used by a victim to end the suffering.

Suicide.

No doctor should want to be responsible for that.

But the medical care system is a machine.  It operates like clockwork.  The victim is given heavy drugs to take away the pain.  Other treatments are given, when necessary – surgery, stitches, bandages, prosthetics or whatever.

Somehow, the pain-killers never get removed or replaced.  Perhaps most doctors feel that if they take away the drugs, they will be perceived as doing less than what they should be doing.

Some will lower the dosage of medicine, perhaps even to sub-therapeutic levels.  Many will make comments about the dangers of addiction, and justify inadequate treatment of pain on that basis.

Meanwhile, it is difficult or impossible for the patient to live a normal life – unhindered by pain.  Mobility is lost or limited.  Interaction with others is more difficult.  Work is often impossible.

But the doctor has assured himself that nobody can accuse him of prescribing to an addict.

Besides their medical doctors, veterans are often assigned therapists to help try to accept lives that are somehow diminished, limited and to deal with the myriad issues they have.  Yet, the patients drop away one-by-one when they realize that a psychologist can’t prescribe anything.

It has taken me a long time, until now, to realize that everybody is wrong. 

In a recent issue of my private subscription-only newsletter – which anyone can request for a free subscription – I wrote about a research paper that revealed that soldiers who are injured in combat, do not ask for morphine at all.  It is when the return to the civilian life, when they have problems with families and work and Post Traumatic Stress Disorder that they need the pain-killers – and are then adding substance abuse to their problems.

People have been doing research for a long time, and they have lots of data.  I once thought I would spend my lifetime creating new and interesting data.

Now I think my greatest contribution is looking at existing data, making sense of it and spreading it to the general population.

I am about as antiwar as anybody.  When I left the military my Parents-of-Blessed-Memory actually did all they could to block me from joining any pacifist organizations.  

They did not want me to call attention to myself.

I listened to them then.

Now, I think if I do not call attention to myself, I may actually be doing something wrong.

People do not seem to have pains from their wounds when they are actually in combat.

So let’s recreate combat.

No, I do not mean killing people.

I was still on active duty at Fort Bragg when the movie “Platoon” was popular.  A LOT of guys who had been in Viet Nam were waiting to see that movie.  They told me various things.  It always seemed to amount to some kind of catharsis, some kind of relief.

We can create virtual combat.

At GameStop stores I have watched demonstrations of and stood behind soldiers in uniform buying combat games – called “Shooters” in the industry — and wondered why.   Call of Duty, Medal of Honor – these and other titles are more popular than movies and comprise a third of the entire videogame market.

Maybe, the better we can recreate the “high” of combat, the less pain people will feel.

Secondarily, we can make veterans feel measurably better by treating them like the war heroes they are, even if they did nothing but put their lives on the line by wearing the uniform.  Effusive praise and recognition – the type usually only seen on Veterans Day — is in order.  Veteran’s discounts at stores and restaurants help a participant feel proud.  Billboards thanking our nation’s veterans and memorials in parks are also therapeutic.

Just today, Nancy, a Vietnamese-born nail salon operator who gave me a manicure thanked me effusively for being in the U.S. military.  She was grateful to those service personnel who had helped her family many years ago by saving their lives and helping them get to America.

Fortunately, whatever pain I have is transient and attributable to the years I have struggled under the gravity of our planet and its effect on my bones and joints rather than resulting from combat. But I was elated by this lady’s spontaneous gratitude and I don’t think any wound I could have suffered would have bothered me for a good while after I left her salon.

Primarily, we can give veterans the opportunity of reliving the “High” that they got from combat without the risk of bullets and explosions.  Nobody would die in the kind of video game scenarios I would suggest.  Patients would be reminded of the importance of what they were doing when the realistic computer graphics and sound effects occupied their senses.

My bet is that the pain would go away.

Maybe not as long as with opiate drugs, but researchers can measure how long, and use that data to figure out how often this “virtual” experience has to be relived.

In the brain’s frontal lobe, fibers cross each other.  It has been known for a very long time that physical and emotional pains can become quite easily confounded.

One thing I believe we have to do is to get rid of the “stigma” associated with psychological problems.  It sounds to me like we are basically talking about a normal reaction to the horrible stimulus that is war.

Occasionally, we hear of programs telling to folks to shake the hand of a veteran and thank him (or her) for their service.  But these are short-term and short-lived.  I personally thank (and shake hands if allowed) any person who reveals a military past, whether it is a patient or a chance encounter in a grocery store.

Some are surprised – but most smile.  And that’s a great payback for very little effort on my part.

I thank everybody I have seen who has worn the U.S. uniform for any reason, ever since I figured out how much it could help.  Vets are very grateful that I do this.

But I’ve had to get used to one aspect of human nature.  Your congratulations probably won’t be reciprocated.

To my amazement, I can count on one hand the number of veterans who have thanked ME for serving.  Maybe they are just focused on their own pain, and I sure understand that.

Me?  Well peacetime service was not the Hell that war is said to be – but it was not all that much fun.  I just hope that nobody has any trouble believing that women do serve in the military, for lots of us do.

I don’t think our society has even digested the fact that women are physicians, and plenty of them.  So it might be a while to reassure people that there are and have been a lot of ladies in the armed forces.

Thanks, veterans.

We ought to make room along-side the drugs and psychotherapy to accept the fact that something so seemingly frivolous as playing a videogame could help our veterans in distress.

I get goosebumps just imagining all the smiles.