Veterans and Pain

Dr Chow Chow

Dr Chow Chow

Key Issues:

  1. Veterans are now considered people who have any experience in the ADF including current, reserve and former (ex-serving) personnel.

  2. There are different challenges faced among the veterans in different age-groups, services and backgrounds.

  3. Trauma results in not only physical scars, but also psychological and social implications.

  4. Things to improve veteran’s pain conditions: increase healthcare providers competencies, better service design and planning, detailed biopsychosocial assessment and personalised treatments with ongoing symptoms monitoring.

Veterans? DVA? ADF?

Veterans are now considered people who have any experience in the ADF including current, reserve and former (ex-serving) personnel (Tehan 2017). In Australia, the Department of Veterans’ Affairs (DVA) support the healthcare needs for all eligible veterans and their families. While the Australian Defence Force (ADF) members are people who are currently serving or have previously served at least 1 day in a regular capacity or as a member of the active or inactive reserves.

The veterans are indeed a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. For many veterans, military service and operational deployment can also lead to a strong sense of identity and belonging. For many Defence members, a deployment is the pinnacle of their career, where years of preparation and training are put into action, either in war fighting, peacekeeping, peacemaking or humanitarian missions. Of notes, all deployments may involve high risks of exposure to trauma, as well as the threat of serious injury, death and loss.

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There are many high impact experiences will have occurred during times of extreme stress, in some cases during life-threatening situations. What is learned under these conditions can be resistant to change because it is associated with survival.

The significance of the Past and Present 

For World War II, Korean and Vietnam veterans, issues of ageing and chronic disease can be an important consideration. Depression, alcohol misuse and dependence and PTSD are the most common mental issues encountered in this group. Currently serving and recently discharged ADF personnel have engaged in a range of warlike, peacekeeping and peacemaking deployments, as well as disaster response and border protection operations. These younger, or ‘contemporary’ veterans are more likely to have experienced multiple, high tempo deployments. Many veterans describe the extraordinary demands of constantly facing the threat of death or serious injury.

Complex rules of engagement and lines of command within multinational forces can increase the level of stress on Defence members on deployment, particularly in peacekeeping and peacemaking operations, as can the conflict with personal belief systems in these and border protection operations. Apart from deployment cycles, frequent relocations within Australia can result in a sense of dislocation for contemporary veterans and their families, and combined with the often remote locations of ADF bases, this can limit consistent access to medical and mental health services.

Trauma – Physical, Psychological and Social

Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. The advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring.

Most veterans join the services as young adults, an important time in life for shaping values, beliefs and attitudes. Because they were socialised into military culture at a time when they were malleable, many will have adopted military values and ideals as their own. There are many high impact experiences will have occurred during times of extreme stress, in some cases during life-threatening situations. What is learned under these conditions can be resistant to change because it is associated with survival.

What can be done to improve the Veteran’s Pain Conditions?

  1. Improving healthcare providers competencies: the ability to anticipate and handle traumatic disclosure, and some knowledge of military ‘cultures’. Acknowledge the reality of the problem. In this way, the veteran will feel ‘heard’ and it will be acknowledged that his/her symptoms are not ‘put on’ or imagined.

  2. Service design and planning: establishment of multidisciplinary pain clinics, mixture of psychology, physiotherapy and occupational therapy, ability to assess for PTSD and alcohol problems. It is important to schedule regular review appointments rather than make appointments in response to the individual’s psychosomatic crises.

  3. Clinical and treatment issues: Take a detailed history with the veteran’s service history, trade, length of service, deployment, exposure to trauma, reason for and rank at discharge; family status; current contact and support from ex-services organisations. Conduct a routine medical assessment that includes a thorough physical examination. The veteran should be strongly encouraged and supported in maintaining or resuming daily routine and current roles (e.g. work, family). This is particularly important for veterans who have a lot of unstructured time. Reduce substance use when inappropriate use to deal with pain and other somatic symptoms.

  4. Monitor Symptoms to help identify psychosocial factors (e.g. times, situations and emotional states) which exacerbate their symptoms, emphasising the links between psychological factors and the experience of somatic symptoms. Then assist the veteran to manage these perpetuating factors through strategies that may include anxiety management, problem solving, facilitating engagement with social support etc

Need Help? Try these!

  1. Call the Australian Defence Force (ADF) All Hours Support Line on 1800 628 036 for 24-hour counselling and mental health support. This service is available to all ADF members and their families.

  2. Call the Open Arms – Veterans & Families Counselling Service on 1800 011 046 for confidential and free crisis counselling for war veterans and their families.

  3. Call the Defence Family Helpline on 1800 624 608 for 24-hour support, information and help in connecting with your local community.

Dr Chow Chow welcome all patients afflicted with ADF or DVA card holders. If you have any unanswered questions, feel free to contact me via the website. 

Reference:

  1. Olenick M, Flowers M, Diaz VJ. US veterans and their unique issues: enhancing health care professional awareness. Adv Med Educ Pract. 2015;6:635-639. Published 2015 Dec 1. doi:10.2147/AMEP.S89479

  2. Understanding the veteran experience. Open Arms. https://www.openarms.gov.au/health-professionals/about-veterans-and-their-families/understanding-veteran-experience. Accessed on 5 March 2021.

  3. Health of Veterans. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/australias-health/health-of-veterans. Accessed on 5 March 2021.

  4. Gauntlett-Gilbert J, Wilson S. Veterans and chronic pain. Br J Pain. 2013;7(2):79-84. doi:10.1177/2049463713482082

  5. National Centre For Veterans’ Healthcare. https://www.slhd.nsw.gov.au/concord/ncvh/default.html. Assessed on 5 March 2021.

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PO Box 415 MOSMAN NSW 2088
Phone 02 8866 1393
Fax 02 8088 7877
info@drchowchow.com
Healthlink: tzechowc

DR CHOW CHOW

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