Wednesday, January 16, 2013

Interview: Col. Kevin Galloway, U.S. Army Pain Management Task Force | Defense Media Network

Pain. It's a four-letter word with powerful implications for those suffering from long-term, chronic medical conditions. Today the single most common reason patients seek medical care in the United States is for treatment for pain.

Pain for military personnel has its own unique set of issues, including the reality that their duties are much more likely to cause injury than the jobs of their civilian counterparts. The realities of military life in the early 21st century have only highlighted that fact. Along with the dangers of being wounded or killed on the battlefields of the world since 9/11, there are the physical consequences of getting ready for multiple deployments to some of the most rugged places on the planet.

High-impact physical activities repeated daily for months at a time take a toll on joints and muscles, and with ever increasing loads being carried, back injuries are becoming more common all the time. Trauma caused by wounds and accidents are also generating their share of pain, as are the effects of stress, improvised explosive devices (IEDs), and even vehicle accidents. There is physical pain as a result of stress, depression, and, of course, the concussions that are among the signature wounds of America's present conflicts overseas.

This is why the U.S. Army Pain Management Task Force was chartered to recommend some solutions to the pain problem. One of the members of the Pain Management Task Force was Col. Kevin T. Galloway of the U.S. Army Nursing Corps. A lifetime Army medical professional, he is well qualified to talk about the task force, along with some of the discoveries and conclusions from their final report.

The Year in Veterans Affairs & Military Medicine: Can you tell us a little about your project?

Col. Kevin Galloway: All right. Be careful what you ask for. I can tell you this is a very exciting thing. This is a very proactive initiative on behalf of the Army and DoD [Department of Defense]. It started … a couple of years ago when the Office of the Surgeon General, the Army surgeon general, began to connect the dots of several issues that were out there that affect military medicine, but more importantly, these are things that are out there in what I call the big "M": civilian medicine.

Pain was something that started to pop up on the radar. It's the primary reason that Americans seek appointments with medial providers. It affects more Americans than several diseases that everybody's familiar with – diabetes, heart disease, and cancer – combined. There are issues globally with abuse and diversion of prescription pain medicine, as well as poly pharmacy shopping, that are indicative of just the way our medical model delivers care and pain care in particular – the "pill for every ill" approach – and specifically to the military health model. I mean, we certainly are a subset of medicine. And to complicate things for the Army and military medicine, we've got similar challenges but some heightened things that focus it for us.

We've got the number of severely injured soldiers that are returning from operational theaters in Iraq and Afghanistan and have been coming in for years. We're concerned about the reports of prescription drug diversion and abuse in our own force, and asking ourselves some very tough questions. Is our treatment and structure minimizing and mitigating these issues that, like I said, are not limited to the military? What are we doing differently based on the fact we have a specific population of patients? We have a moral and ethical obligation to take care of the soldiers that we put in harm's way and the nation has entrusted to us for their medical care. I think that our surgeon general has taken it very seriously, and … event after event came up, whether it was issues of diversion in the news or questions that he couldn't answer when he talked about the increases of soldier suicides. What is the pain component of that? And he asked his staff to look at it, because we didn't have the kinds of information that we would have liked to bring to him, which was a comprehensive pain strategy in place. He then decided to take a very serious step for an organization like the U.S. Army, and chartered a task force to look at the problem of pain.

Now, when we talk "pain," we're not just talking about pain from wounds, but about twisted ankles, orthopedic injuries, bad backs, and all sorts of other things?

That is correct. You know, the actual wounded population, size-wise, is a relatively small part of the pain problem for Department of Defense medicine. The majority of the people medically evacuated from theater are not wounded. They are injured. They have back pain. They have ankle injuries, almost sports medicine types of issues. And so the things that plague us pain-wise … are a tremendous workload on our system. The real challenge that we have is for the folks that have chronic pain conditions that are not combat related.

Does this include the pains from stress and other mental problems?

Well, there's something emerging called P3 Syndrome, which is a combination of the symptom overlap between post-traumatic stress [PTS], post-concussive brain injury [TBI], and pain. And so, there's so much symptom overlap between these three conditions, which are prevalent with the high operations tempos in theater, and, you know, the war going on for eight years, that it's really hard sometimes to separate just what is what. Several of the treatments are very similar, and so we've taken a hard look at ourselves, and we're going to start really looking at the whole patient as opposed to dividing them up into individual symptoms or diagnoses. A patient is a patient, and we are all about patient-centered care. Whether it's pain or TBI or PTS, it's very much related, and so it's going to take an integrated team approach, and I think that that's the conclusion the pain task force came to.

There's a huge issue that we are looking at. I mean, we look at the pain continuum from "no pain" to "resolution" to folks that end up living with some level of chronic pain. It's a huge group that we're looking at, and there's a huge continuum of initiatives that need to focus on prevention, early identification, and treatment that need to be integrated into our entire medical care system. This is a huge effort! This is something that, when I did my research in the beginning of this effort with the other members of the pain task force, we saw long-term failure. We've seen organizations, both inside and outside the military, in medicine with "the big M" look at this, begin to address it and back off occasionally because it was always in the "too hard to do" box. It is a very complex problem, but I think for us, we don't see an alternative to looking at it dead in the face and attacking the problem.

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