Four years and a lifetime ago, a new war began for Sgt. Shane Savage.
On Sept. 3, 2010, the armored truck he was commanding near Kandahar, Afghanistan, was blown apart by a roadside bomb. His head hit the ceiling so hard that his helmet cracked. His left foot was pinned against the dashboard, crushing 24 bones. Sergeant Savage came home eight days later, at age 27, with the signature injuries of the conflicts in Iraq and Afghanistan: severe concussion, post-traumatic stress and chronic pain. Doctors at Fort Hood in Killeen, Tex., did what doctors across the nation do for millions of ordinary Americans: They prescribed powerful narcotic painkillers.
What followed was a familiar arc of abuse and dependence and despair. Today Sergeant Savage has survived, even prevailed, through grit, his family and a radical experiment in managing pain without narcotics.
“You have to find alternative ways to get out and do stuff to stay active, to get your brain off the thought process of ‘I’m in pain,’ ” said Sergeant Savage, whose ears push out from under a Texas A&M baseball cap.
The story of Sergeant Savage illuminates an effort by experts inside and outside the military to change how chronic, or long-term, pain is treated. By some estimates, tens of millions of Americans suffer from chronic pain, and the use of opioids — drugs like hydrocodone, methadone and oxycodone (the active ingredient in painkillers like OxyContin) — to treat such conditions has soared over the last decade.
This opioid boom was a result of a synchronized drumbeat sounded by pharmaceutical companies, pain experts and others who argued that the drugs could defeat pain with little risk of addiction.
In recent years, sales of opioids have flattened because of their role in 16,000 overdose deaths annually in the United States, cases that often involve abuse of the drugs. But a growing number of specialists have sharply reduced or stopped their prescription of opioids for another reason: their belief that the drugs have led doctors to focus on the wrong goal in treating chronic pain.
Opioids blunt a patient’s discomfort for a time. But the drugs can become a barrier to improving how well a patient functions physically and socially, goals that appear crucial in combating chronic pain. As a result, specialists are returning to strategies that were popular before the opioid era, like physical therapy, behavior modification and psychological counseling. Others are exploring alternative treatments like acupuncture and yoga.
Many pain programs now use non-opioid drugs. We have to change the paradigm and the culture.
Five years ago, approximately 80% of the injured soldiers treated at Walter Reed Army Medical Center in Washington were prescribed opioids. That figure has since plummeted to 10%, and many patients are benefiting from the change.
The implications go far beyond the military because most patients at Walter Reed in recent years have not been suffering from serious battlefield injuries but from problems many civilians face, like back injuries.
The important issue in the treatment of chronic pain is recognizing patients with chronic and acute pain are different and require different approaches. Employing a drug alone is unlikely to lead to a successful outcome.”
A 2008 study by the Mayo Clinic found that patients who were weaned off opioids and put through a non-drug-based program experienced less pain than while on opioids and also significantly improved in function. Other studies have had similar findings.
Whatever the case, physicians treating soldiers or veterans are free of insurance industry dictates. And a growing number of doctors are largely abandoning opioids because the drugs do not seem to help many with chronic pain.