Addressing Addiction and Pain Management in Our Nation’s Military and Veteran Populations

November 06, 2019

Over the last two years, the U.S. Pain Management Best Practices Inter-Agency Task Force studied how pain is treated in the military and veteran populations to make recommendations to improve the treatment of acute and chronic pain. The Task Force issued its report earlier this summer, “Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations,” which highlights the barriers to optimal pain care and the reduction of opioid misuse among veterans and military personnel.

The Task Force report discusses the challenges in treating pain that are specific to the military and veteran populations. Delayed treatment for an injury can result in acute pain becoming a chronic pain issue. Additionally, service-related complications, such as post-traumatic stress disorder (PTSD) or traumatic brain injury, can add complexity to pain management. All these factors place the military and veteran populations at high risk of opioid addiction and misuse. The Task Force report also notes that veterans die by suicide at higher rates compared with civilians. Among veterans, pain conditions are associated with an increased risk of suicide.

One of the barriers to optimal pain care identified by the Task Force is the fragmented healthcare system that serves the military and veteran populations. The report discusses the lack of coordinated care and differing standards of care, such as the implementation of opioid risk-mitigation strategies, within the military community, the Military Health System (MHS), and the Veterans Health Administration (VHA). The Task Force recommends implementing strategies to streamline access to medical records and facilitate collaboration across systems to provide more timely and effective pain care.

Better coordination and collaboration across healthcare systems is critical and will help ensure members of the military and veterans receive high-quality care. Additional resources are also needed so clinicians in the local VHA medical centers can adopt standard of care, non-opioid alternative protocols for pain management using Ultrasound Guided Regional Anesthesia (USGRA).  These protocols, which include Alternative to Opioids in the Emergency Department (ALTO), Enhanced Recovery After Surgery (ERAS), and the Perioperative Surgical Medical Home have been tested in non-VHA hospitals and have been shown to contribute to lowering opioid prescription rates by as much as 30% to 50% percent in a given year. Once these protocols are more broadly adopted throughout the VHA, better coordination between VHA addiction treatment facilities and medical centers will ensure that when veterans need healthcare, such as a planned surgical procedure, they are sent to a medical center with opioid alternative/non-opioid pain control protocols involving USGRA in use. 

America is indebted to the members of the military and veterans who have sacrificed so much for our country. We owe it to our military and veteran populations to make the necessary investments so they have access to the same high-quality healthcare that is available to civilians.