Pain and Combat Injuries in Soldiers Returning from Operations Enduring Freedom and Iraqi Freedom: Implications for Research and Practice

By Clark, Michael E.; Bair, Matthew J. et al. | Journal of Rehabilitation Research & Development, March-April 2007 | Go to article overview

Pain and Combat Injuries in Soldiers Returning from Operations Enduring Freedom and Iraqi Freedom: Implications for Research and Practice


Clark, Michael E., Bair, Matthew J., Buckenmaier, Chester C.,, III, Gironda, Ronald J., Walker, Robyn L., Journal of Rehabilitation Research & Development


INTRODUCTION

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) commenced in October 2001 and May 2003, respectively, as part of the global war on terror. To date, more than 1 million military personnel have been deployed to Afghanistan or Iraq. Approximately 21,000 of those deployed have been wounded in combat, and about 46 percent of these casualties have been medically evacuated (http://www.icasualties.org). Blast-related injuries predominate; wounds from improvised explosive devices (IEDs), land mines, shrapnel, and other blast phenomena account for 65 percent of combat injuries [1]. Approximately 60 percent of these injured soldiers have symptoms of traumatic brain injury (TBI) (http://www.dvbic.org/). Nevertheless, despite the number of casualties and the wound severity, the U.S. military medical system has been remarkably successful in the management of combat trauma during these conflicts, as evidenced by the >90 percent survival rate following injury [2]. This success has been attributed to multiple factors, including improved body armor [3-4], surgical care deployed far forward on the battlefield [5], and rapid evacuation to major hospitals via military aircraft equipped with sophisticated medical equipment [6]. The advantages of these innovations for survival following combat trauma are clear, but this success has created other unforeseen medical challenges. One of the most significant has been the management of pain immediately following combat trauma, during subsequent acute medical treatment, and throughout initial rehabilitation efforts.

In this article, we introduce the subject of trauma-related pain and describe several innovative approaches for improving the pain care provided to OEF and OIF military personnel during acute stabilization, transport, medical-surgical treatment, and rehabilitation. Next, we identify some of the pain assessment, classification, and treatment challenges emerging from work with this population and, where possible, provide associated clinical practice suggestions. Finally, we close with a discussion of related research priorities. Throughout, we should note that empirical data in this area, while provocative, are limited. Therefore, the conclusions and implications we provide should be viewed as tentative and subject to modification as additional data become available.

PAIN AND TRAUMA

Because trauma patients are often seriously injured and have multiple body regions involved, they commonly experience significant levels of pain [7-8]. Since the initial care of the trauma patient involves stabilization of cardiovascular and respiratory status, employment of life-saving procedures (e.g., chest tube, endotracheal intubation), and assessment of multiple and severe injuries, pain may not be appropriately assessed and thus not adequately treated [9]. Compounding the problem of pain treatment in the trauma setting are provider concerns that opioids may lead to hypotension, respiratory depression, clouding of mental status, and obfuscation of changes in clinical status [7].

When adequate pain control is not achieved, individuals suffer unnecessarily, adding to concerns about their ability to recover and function normally after the trauma. Unfortunately, most trauma-care algorithms, even at major trauma centers, do not include a systematic approach to pain assessment. Furthermore, empirical studies of pain assessment in trauma patients are virtually nonexistent. This lack is unfortunate given that pain may be constantly present for trauma patients from the time of the initial injury through the acute treatment phase and may continue into rehabilitation and the return to the community [10].

Edwards has categorized the continuum of trauma care into three phases: (1) emergency, (2) acute or healing, and (3) rehabilitation [10]. The emergency phase begins at the time of injury and ends after resuscitation and emergency stabilization are complete. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Pain and Combat Injuries in Soldiers Returning from Operations Enduring Freedom and Iraqi Freedom: Implications for Research and Practice
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.