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Getting creative: Reducing opioid use for returning warriors

Airmen of the 174th Attack Wing participate in a weekly yoga class. Classes are intended to present an alternative way for 174th members to build both mental and physical strength. Yoga is also a way to alleviate chronic pain in the body. (U.S. Air Force photo by Staff Sgt. Duane Morgan) Airmen of the 174th Attack Wing participate in a weekly yoga class. Classes are intended to present an alternative way for 174th members to build both mental and physical strength. Yoga is also a way to alleviate chronic pain in the body. (U.S. Air Force photo by Staff Sgt. Duane Morgan)

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When service members return from tour of duty with debilitating battlefield injuries, opioid prescriptions are common in their recovery process. Opioids are effective in reducing pain in patients but can be highly addictive as a pain treatment option. As a result, the Defense Health Agency is exploring alternate pain management techniques to decrease the number of opioid prescriptions in military hospitals.

The Centers for Disease Control and Prevention reported in 2017 that drug overdose deaths involving opioids skyrocketed from roughly 8,000 in 1999 to over 46,000 in 2017. Of these numbers, deaths involving prescribed opioids jumped from around 3,000 to almost 17,000. DHA’s response has been an integrated approach to health that combines prescriptions with nonpharmacological pain treatments. DHA published a procedural instruction in 2018 that promotes physical and behavioral treatment techniques like acupuncture, massage, and music therapy as alternativess to address acute pain and prevent it from becoming chronic. Opioids would then be prescribed only when indicated.

Dr. Chester Buckenmaier, a professor at the Uniformed Services University and a licensed acupuncturist, agrees that these other pain treatment techniques are key to the future of pain management. While Buckenmaier is an anesthesiologist by trade, he teaches students at USU to take alternate treatments into consideration as they study to be the health care providers of tomorrow.

“The Defense Health Agency and USU are aggressively educating the next generation to look at these other techniques as first line treatments for pain,” Buckenmaier said. “We’re teaching them today that this is medicine.”

Outside the classroom, practitioners like Dr. Bhagwan Bahroo from the Psychiatry Continuity Service program at Walter Reed use yoga to treat pain in military hospitals.

“A good yoga session not only improves muscle tone, adds strength, and improves flexibility of the joints, but also helps bring peace of mind, reduces anxiety, and improves mood,” Bahroo explained. He added this method relieves pain intensity and increases daily function, two factors essential to successful pain management.

Acupuncture and yoga are only a few examples of nonmedication pain management treatments. Health care providers across the military are also exploring other approaches such as meditation and nutrition to combat pain while maintaining healthy, daily function. Battlefield acupuncture, or auriculotherapy, is already available at certain military hospitals, and TRICARE is evaluating the clinical effectiveness of traditional acupuncture, which could become a covered service in the future. With the implementation of the updated Defense and Veterans Pain Rating Scale, DHA will have a way to measure these techniques and their effects on pain.

“This is a cultural change that we’re bringing not only to our patients, but also to ourselves as clinicians,” Buckenmaier said.

Service members and civilians dealing with both acute and chronic pain are encouraged to explore these other techniques with their health care providers when considering an opioid prescription. For more information on how to manage pain, visit the Military Health System’s Pain Management page.

Read Mr. Thomas McCaffery's memo officially recognizing November as Warrior Care Month.  

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