Noncombat-related acute and recurrent chronic pain is
the leading cause of soldier attrition in
modern war, with the return-to-duty rate as low as 2
percent when these soldiers are treated outside
the theaters of operation. However, that rate jumps to 95
percent when troops and officers are
treated and managed for pain in the field, according to a
new study from a Johns Hopkins
"The main factor seems to be rapid diagnosis and
treatment of pain syndromes," said study co-
author Col. Steven Cohen, of the
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine.
"Establishing pain treatment centers in combat areas
gets care to soldiers fast and could
dramatically increase the military's ability to maintain
troop levels and succeed militarily in places like
Iraq," Cohen said.
The report, appearing in the December issue of
Anesthesiology, shows that 107 of 113 soldiers
suffering from noncombat-related pain were able to return
to duty after being treated in Baghdad at
the Ibna Sina Hospital between October 2005 and September
2006. In contrast, a previous study by
Cohen and colleagues showed that of 162 soldiers with
similar kinds of pain evacuated from Iraq for
treatment at Walter Reed Army Medical Center in Washington,
D.C., or the Landstuhl Regional
Medical Center in Germany between April 2003 and July 2004,
only three returned to active duty.
Noncombat pain was defined in both studies as
conditions resulting from such things as physical
training, sports and accidents.
Among those patients treated in the field, sciatica
(leg pain and/or tingling, numbness or
weakness that travels from the low back through the buttock
and down the large sciatic nerve in the
back of the leg) accounted for 55.7 percent of the cases;
noncardiac chest pain, 11.5 percent; arm pain
from a herniated disc in the neck, 7.1 percent; groin pain,
7.1 percent; leg pain, 7.1 percent; low back
pain without leg symptoms, 6.2 percent; arm pain unrelated
to a herniated disc, 1.8 percent; and neck
pain/headache, 1.8 percent. All the patients were seen
within 72 hours of their initial complaints by
anesthesiologists who are pain specialists.
In the first study done in soldiers who were evacuated
for treatment, the most common
complaints were sciatica, low back pain, leg pain and arm
pain. The majority of these cases did not
receive definitive treatment until a few weeks after their
Treatments for both sets of patients were similar and
included epidural steroid injections,
trigger point injections, lumbar interarticular facet
blocks, groin blocks and corticosteroid injections,
as well as nonsteroidal anti-inflammatory drugs,
neuropathic pain drugs, muscle relaxants and opioids.
"Early intervention is almost always associated with
better outcomes," Cohen said. "The longer a
pain complaint goes untreated, the worse the prognosis."
Cohen said it is also more difficult to redeploy
soldiers once they are medically evacuated, for
both logistical and psychological reasons. "Soldiers who
stay with their units build on the strong ties
with those units and wish to remain. Those bonds weaken
when military personnel are stateside with
their families, making these soldiers even less amenable to
returning to the field," he said.
Cohen co-authored the study with Maj. Ron L. White, an
anesthesiologist at the Uniformed
Services University of the Health Sciences in Washington,
D.C. White serves in the United States
Army and Cohen in the United States Army Reserve.