APS Press Room
| For immediate release April 12, 2007 |
Contact: Chuck Weber (847) 705-1802 |
Iraq War Spawns New Kind of Military Medicine
WASHINGTON, DC, May 3, 2007—Better body armor and improved aeromedical evacuation enable American soldiers in Iraq to survive blasts that would have proved fatal in Vietnam or even the first Gulf War, but they pose a new challenge to military medicine—how to deal with the excruciating pain of injuries to arms and legs that body armor can’t protect against.
In fact U.S. military doctors call Iraq a war on human limbs — with injuries among the most painful known to medicine—and they have found new ways to cope with the kind of injuries soldiers now face.
These advances — which result in an unprecedented 90 percent survival rate — were reported at the annual meeting of the American Pain Society here today under the heading, “The Battlefield and Beyond: Pain among Returning ‘Operation Iraqi Freedom’ and ‘Operation Enduring Freedom’ (Afghanistan).”
The innovations start on the battlefield, where, in 2003, an Army anesthesiologist replaced the traditional general anesthesia, which suppresses the entire nervous system and leaves patients completely sedated, with a technique called “regional anesthesia.”
Lt. Col. Chester “Trip” Buckenmaier III, MD, of the Walter Reed Army Medical Center, was the first to use the technique on the battlefield in Iraq. Army Spc. Brian Wilhelm was suffering from a wound by a rocket-propelled grenade that blew off the hamstrings in the back of his leg. “I don’t care what you do, doc, just get rid of this pain,” Wilhelm pleaded.
“In previous wars, his pain would likely have been numbed by morphine, an addictive narcotic,” Buckenmaier said. “That’s 19th century medicine used in the American Civil War. Instead, I used an electric probe to pinpoint the exact nerve that transmits pain from the wound, then injected that nerve with a constant flow of non-addictive medicine from a microprocessor-controlled pump.”
“Just 120 seconds after his battlefield surgery, Wilhelm was wide awake, alert, pain free and having a good time with his buddies,” Buckenmaier beamed.
He explained that when a leg or an arm is injured, impulses from the damaged nerves are transmitted into the brain. Researchers theorize that if this process is not interrupted, the brain essentially memorizes the pain, leading to chronic pain long after the wound heals. Narcotics like morphine do not stop the signals, they simply prevent the patient from feeling them as pain.
“With regional anesthesia, we can stop most of those pain signals from reaching the brain, so the stress response, the stress hormone release and the depressions to the immune system — a whole host of things we know are detrimental — are turned down,” Buckenmaier explained.
The first 24-36 hours away from the battlefield, regional anesthesia makes the aeromedical evacuation of troops to Landstuhl, Regional Medical Center in Germany a lot less traumatic, Buckenmaier added. “After all, these patients are in an intensive care unit (ICU)—literally on the fly. In fact, by the time they get to Walter Reed, they’ve been in a 12,000-mile ICU, and often it’s a bumpy ride.”
After Walter Reed, severely injured soldiers are transferred to one of four Polytrauma Rehabilitation Centers in Tampa, Richmond, Palo Alto, or Minneapolis. Polytrauma basically means multiple injuries and/or locations — at least one of them life-threatening — that impact daily functioning, according to Robyn Walker, PhD, a psychologist at Tampa’s Haley Veteran’s Administration Hospital.
Since body armor does not protect the head, traumatic brain injuries are even more common than injuries to legs and arms, which add a cognitive impairment component to the rehabilitation of polytraumatic injuries.
“Simply assessing pain is difficult when only two-thirds of the patients can verbally communicate their pain intensity,” Walker said.