Four years and a lifetime ago, a new war began for Sgt. Shane Savage.
On Sept. 3, 2010, the armored truck he was commanding near Kandahar, Afghanistan, was blown apart by a roadside bomb. His head hit the ceiling so hard that his helmet cracked. His left foot was pinned against the dashboard, crushing 24 bones.
Sergeant Savage came home eight days later, at age 27, with the signature injuries of the conflicts in Iraq and Afghanistan: severe concussion, post-traumatic stress and chronic pain. Doctors at Fort Hood in Killeen, Tex., did what doctors across the nation do for millions of ordinary Americans: They prescribed powerful narcotic painkillers.
What followed was a familiar arc of abuse and dependence and despair. At one point, Sergeant Savage was so desperate that he went into the bathroom and began swallowing narcotic tablets. He would have died had his wife, Hilary, not burst through the door.
Today Sergeant Savage has survived, even prevailed, through grit, his family and a radical experiment in managing pain without narcotics. When off-duty, he pulls on cowboy boots and plays with his children, does charity work and, as part of a therapy program, rides horses. The only medication he takes for pain is Celebrex, a non-narcotic drug.
"You have to find alternative ways to get out and do stuff to stay active, to get your brain off the thought process of 'I'm in pain,' " said Sergeant Savage, whose ears push out from under a Texas A&M baseball cap.
The story of Sergeant Savage illuminates an effort by experts inside and outside the military to change how chronic, or long-term, pain is treated. By some estimates, tens of millions of Americans suffer from chronic pain, and the use of opioids — drugs like hydrocodone, methadone and oxycodone (the active ingredient in painkillers like OxyContin) — to treat such conditions has soared over the last decade.
This opioid boom was a result of a synchronized drumbeat sounded by pharmaceutical companies, pain experts and others who argued that the drugs could defeat pain with little risk of addiction. Insurers embraced opioids as a seemingly effective and relatively inexpensive solution to a complex problem that often involves psychological and emotional issues.
In recent years, sales of opioids have flattened because of their role in 16,000 overdose deaths annually in the United States, cases that often involve abuse of the drugs. But a growing number of specialists have sharply reduced or stopped their prescription of opioids for another reason: their belief that the drugs have led doctors to focus on the wrong goal in treating chronic pain.
Opioids blunt a patient's discomfort for a time. But the drugs can become a barrier to improving how well a patient functions physically and socially, goals that appear crucial in combating chronic pain, many experts say. As a result, specialists are returning to strategies that were popular before the opioid era, like physical therapy, behavior modification and psychological counseling. Others are exploring alternative treatments like acupunctureand yoga.
Many pain programs now use non-opioid drugs, including ones developed for conditions like epilepsy, that are also effective in relieving pain. "We have to change the paradigm and the culture," said Dr. Karen H. Seal, who specializes in pain treatment at the Veterans Affairs Medical Center in San Francisco and has studied the use of opioids and other drugs in combat veterans.