Mitigating Pain: From the Battlefield and Back Home

By David Loebsack Health.mil

Col. Chester Buckenmaier III initially became interested in regional anesthesia as a way to logistically improve the medical response for anesthesiologists on the battlefield. But after successfully using it to treat wounded service members on the battlefield during his deployments to Iraq and Afghanistan, Buckenmaier realized that he could be holding the keys to a new era of pain management.

It began during his 2003 deployment with the 21st Combat Support Hospital in Iraq, where he applied the first successful continuous peripheral nerve block to a soldier in Iraq who had sustained a severe shrapnel injury. He kept the patient pain free – through an international evacuation process, five surgeries and an amputation – for a period of 16 days.

Normally, a patient with such severe injuries would have been given intense doses of morphine, resulting in a number of unwanted side effects and leaving the patient largely unconscious. Buckenmaier, however, proved that other options were available to mitigate pain and allow patients to remain cognizant and free of side effects.

Since his experience in theater, the 45-year-old Army anesthesiologist has championed a movement in the medical community to shift away from traditional reliance on opioids like morphine, toward a more comprehensive and multimodal approach where acute and chronic pain needs are addressed.

The problem, Buckenmaier said, is not with opioids – which he sees as an important part of pain management – but with the way that the medical community views and deals with pain.

“Opioid use is not bad,” said Buckenmaier. “But opioids are such easy tools to use that we can be lulled into the idea that they are a magic bullet that will just take care of pain.”

Instead, he says, pain should be treated like a fifth vital sign, of equal importance to temperature, blood pressure, pulse and respiratory rate.

“Pain is a disease process and that, in and of itself, is a new idea – that pain is not just a symptom, but that it impacts every aspect of the patient’s rehab and recovery,” said Buckenmaier.

Now, thanks to the dedication and hard work of his research team at the Defense and Veterans Pain Management Initiative – formerly known as the Military Advanced Regional Anesthesia and Analgesia Initiative – Buckenmaier has been able to gain the attention of national leadership.

For starters, the new National Defense Authorization Act for 2010 includes a requirement for the Military Health System to develop a “comprehensive policy on pain management.”

In addition, the Army Surgeon General has chosen Buckenmaier, along with 25 of his colleagues in the medical field, to form a military pain task force that will reevaluate the way pain is treated.

Buckenmaier can sense the tide turning, and anticipates his team’s final recommendations will be completed by March. He says he is excited about the implications this will have on the future of medicine.

“I’ve been working on this for at least half of my career,” said Buckenmaier. “I am more encouraged and enthusiastic now than I’ve ever been. The medical community is finally starting to see that there is an 800-pound gorilla in the room, and its name is pain.”