America’s veterans and the crisis of chronic pain

America’s veterans and the crisis of chronic pain

Since the Civil War, there have been seventy-four wars and conflicts America has fought in. But as bad as previous wars had been, there has never been anything in American history like the Iraq and Afghanistan wars. While America’s direct intervention against Germany and Japan lasted less than five years, the war on terror went on for decades. Extended time in extreme circumstances will cause extreme adaptations in the human body and mind, and many of these are not conducive to life at peace. Then there was radioactive dust suspended in the air and inhaled by our troops as they advanced past tanks taken out by spent uranium rounds, burning toxic chemical pits that somehow no one realized was bad to inhale, etc. Besides the usual bullets, bombs, and IEDs, these factors generated an enormous number of veterans who suffered from debilitating conditions that primary care doctors were ill-equipped to treat.

Of the approximately 697,000 American fighters that were sent to the first Gulf War, about 250,000 of them were plagued by strange rashes, fatigue, cognitive problems, insomnia, and, of course, pain. The worst kind of pain as far as treatment goes. If you are suffering from cancer, you go into a special category according to the Center for Disease Control’s misguidance. As if, somehow, pain caused by burned toxins damaging your nerves and making them constantly fire pain signals is different than radiation treatment damaging your nerves and making them constantly fire pain signals. Why? I think the answer is simple. Money. If you have cancer, most states provide some type of insurance that covers your treatment. If you are a veteran with pain, you will be at the mercy of the Veterans Administration, which politicians’ control.

Politicians will line up to salute you as you march out the door, but far fewer of them will stand in the rain as your flag-draped coffin comes back, and almost none of them will come to the hospital for more than a photo shoot as you try to smile with the stump of your leg burning with phantom pain signals. And while the trauma to your body is horrendous, it is nothing compared to the trauma to your mind. The psychological pain of living with traumatic memories dramatically compounds our perception of pain. Why do you think car accidents cause so much severe chronic pain? The mind tries to constantly remind us not to let THAT happen again by making us acutely aware of any related pain.

No one knows how to cure these problems or even treat them effectively. What we do know is that untreated severe chronic pain shortens our lives, further damages our minds, and leaves us often susceptible to drug addiction, unemployable, and on the street. Of the twenty million Americans right now who have been disabled by military service, those with severe chronic pain know how hard it is to get treatment that allows any quality of life and, perhaps, a good night’s sleep, but at least it was possible before 2016. Then, the CDC came out with their non-evidence-based guidelines, and things took a sharp turn for the worse. I’ll tell you a secret. Doctors don’t like to prescribe pain or anxiety medications. There are several reasons for this, but one of the greatest is that people are judged by their ability to “take the pain,” “man up,” and “deal with it.” It is considered shameful in our society to admit that your suffering is too much to ask for help.

Plus, there is no benefit to the physician to treat pain, addiction, or anxiety/PTSD these days. We get paid the same to give you something that we know won’t work if it’s safer for us. The party line these days is that NSAIDs and perhaps gabapentin are enough. Those of us on the frontline of the pain war know that this is simply not true. Opiate medications have been used for pain for thousands of years for a simple reason: they work. Yes, they increase your risk of death by addiction and overdose, but less than leaving the pain untreated. And that’s the critical point. The DEA and federal prosecutors act like simply not treating with opiates makes the problem go away. It does not. It leaves our patients with nowhere to turn to ease their suffering. For every pain and addiction doctor destroyed by the blindness of our system, thousands of patients are left without effective medical care. And they are dying by the thousands.

The recent targeting of physicians who treat pain, addiction, and anxiety has dramatically reduced private access to these therapies and has given the VA cover to deny veterans effective treatment. When you do not adequately treat someone’s pain, you abandon them to the streets, where they WILL find fentanyl-laced fake medications and die. And worse yet, doctors can be prosecuted for treating veterans. Let me tell you a story. A physician, a veteran himself, received a patient who had moved to the area. This physician practiced at the corner of four states, making the treatment of “out of state” patients unavoidable. But still a “red flag” to the DEA’s algorithms.

The veteran had suffered a sports injury while on duty but had recovered enough to continue duty until there was an accident while driving a large military truck. The veteran was thrown around the vehicle, causing some spinal fractures and lots of soft tissue injuries. These won’t always show up on basic X-rays and CT scans. In fact, a person can be beaten to death with no obvious fractures visible to either of the modalities. However, this veteran had MRIs, and his injuries were well documented; he was discharged on partial disability and had to file a claim to increase the level from around 10 percent to 40 percent or so. While navigating these obstacles, he looked for work.

It is important for the injured to stay productive. Not working or contributing to your family will kill most faster than heart disease. The veteran found a job working as a civilian at an Army depot that outfitted military vehicles with armor. Starting off, he would need to operate a forklift, and the jostling was very hard on his spine. The physician learned all this on the first visit and, being a veteran himself, was motivated to help. The man had received treatment at the VA with oxycodone and later methadone for his pain. As most veterans know, methadone is often used for severe chronic pain by the VA because it is cheap. It also has the highest rate of unintentional overdose by delayed respiratory depression, but that is somewhat ignored. On discharge, he had tried to find a PCP in a different city but could not locate one willing to treat his problems, but had put him on buprenorphine for his pain until he could find someone who would.

This is not uncommon also. Buprenorphine, either as a pure tablet or in patches and films, can be used for this purpose, though most of us know that it is also used for addiction treatment. The doctor first prescribed a Butrans patch, which is buprenorphine and lasts a week. His insurance company denied this medication. Not wanting to prescribe methadone for the above reasons, the doctor wrote a prescription for oxycodone, which worked well. The veteran was able to keep his job and continue working. A happy ending, right? Wrong. The doctor came under scrutiny by the DEA, and with their vast trove of medical knowledge, they decided that the previous use of methadone and buprenorphine by this patient meant that he had an addiction, and despite the CDC and DHHS saying you CAN treat patients for pain if they have addiction, they don’t go on to tell you that the DEA absolutely WILL try to send you to prison for this.

In this case, a medical “expert” took the stand for the DEA, telling the jury that the MRI had been read wrong by the radiologist and that he, the expert, could tell by looking at the MRI that this man did not have severe pain. The prosecutor told the jury that the use of methadone and buprenorphine proved addiction and that the doctor’s use of oxycodone placed the patient “at risk of addiction and overdose” by continuing treatment. She said that the first prescription the doctor wrote was a crime, as he was willfully blind to these “facts.” The veteran took the stand in the doctor’s defense, saying that the physician had been compassionate and caring in his treatment. Reducing medications when he thought it appropriate, but it did not matter; the “expert” opinion had carried too much weight. The doctor was convicted for treating this patient and one other. I don’t know how much time the former Marine and Air Force officer physician will get, but if at all possible, I’ll let you know after they sentence me.

L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues. 

He can be reached on LinkedIn and YouTube.



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