PENTAGOn—The Army’s top doctor says leaders are embarking on efforts to standardize pain management across the Army.

In May, a pain task force appointed by Lt Gen Army Surgeon General Eric Schoomaker, MD, released a report that found that MEDCOM and MHS lacked a comprehensive pain management strategy.

The report stated that in MHS there is “no widely disseminated pain management philosophy” in place and that specialty care services, personnel, and treatment modalities are not standardized or “predictable” across MTFs. Currently, patients may find different treatment modalities available at different facilities.

The report suggests that the military should expand the availability of pain management therapies available to patients to reduce overmedication, including complementary and alternative therapies such as acupuncture, meditation, yoga, biofeedback, and others. “We do recognize that both within the military, Army, and the rest of the nation there is an overreliance on medications to treat pain and that overreliance can sometimes have unintended consequences,” Schoomaker.

The Pain Management Task Force was chartered by the Army, but included members from the Navy, Air Force, and Veterans Health Administration. Members of the group conducted visits to VA and DoD medical facilities and asked the leadership and staff to assess pain management capabilities.

The task force developed 109 recommendations to improve pain management for patients and standardize care between DoD and VHA.

Schoomaker underscored the importance of the pain management review given the number of severely injured soldiers and the reports of medication abuse and suicides in which pain may have played a factor. Prescription drug abuse among troops in general has been a concern among congressional lawmakers who held a hearing on the topic earlier this year.

The task force was already conducting its evaluation of pain management when the 2010 NDAA tasked DoD with developing and implementing a comprehensive policy on pain management by March 31, 2011.

The Report’s Pain Findings

The report stated that in the US healthcare system there is a wide variability in pain management practice and that the topic of pain management is often “poorly presented and inadequately developed in the curricula” of many medical, nursing, and pharmacy schools.

The MHS’s challenges with pain management are similar to those faced by other systems, but the MHS also has challenges associated with its unique mission and patient population. The report pointed out, for example, that continuity of care is a challenge in military medicine because of the transient nature of the military population. The report also noted that military culture praises selflessness and a “willingness to accept pain,” which can result in servicemembers delaying seeking treatment when they are in pain.

The report stated that the task force observed that there was a general feeling among medical providers that they were “ill prepared to manage the full continuum of pain management responsibilities for their patients.” Many providers felt they did not have the necessary training, time, support staff, modalities, or consultative services in their “pain toolkit.”

Most primary care providers indicated that they could provide adequate pain care for acute patients, but that the available therapies to them were limited to medication and possibly physical therapy. The report recommends that a uniform approach to pain care with common tools and capabilities be available across DoD and VHA.

Pain management on the battlefield was also addressed in the report, which noted that currently the Joint Theater Trauma Registry does not collect information on casualty pain. This type of information would help in addressing pain care on the battlefield. The task force recommended adding a joint trauma registry module to capture, define, and characterize pain issues throughout the care continuum starting from the battlefield.

Dealing with Pain

Col Kevin Galloway, chief of staff for the Pain Management Task Force, explained that the task force found pockets of best practices in dealing with pain across the system, but that there was not always consistency across the system.

Galloway said that there are pain management practices being used that need to be made a part of a larger strategy so they can be replicated in the Army and across DoD. In addition to conventional approaches, this includes the ability to employ all modes of therapies to help patients, including complementary and alternative therapy. “We want to make sure that there is something other than medication to be used for pain. There is nothing wrong with medication. There is a time and place for it, but frequently you can complement it and minimize its uses with other modalities …. ”

Army officials said that they are now beginning anArmy campaign to implement the report’s recommendations.

Schoomaker said that the military is currently in compliance with national standards when it comes to pain management, but is aiming to “set the bar higher” by implementing the report’s recommendations. “There is nothing in this report that says that we are doing something improperly or harming patients today. What we feel we need to do is, do it better than we have been doing.”

One problem both in civilian and the military medicine is the interaction among multiple medications that a patient may be taking. Col Jonathan Jaffin, MD, director of heath policy and services in the Army office of the surgeon general, said that a new poly-pharmacy program and policy has been developed to examine how to better manage patients taking multiple medications.

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