Caring for Those with Chronic Pain

Family Caregiving, Military Families November 19, 2012 Print Friendly and PDF

Pain is one of the symptoms most frequently reported by service members returning from military deployment. As a caregiver, understanding and managing the physical and psychological pain of your wounded warrior can play an important role in his or her rehabilitation and reintegration process.

Chronic pain has the potential to significantly affect your warrior during the recovery phase. According to the American Chronic Pain Association, chronic pain is pain that continues beyond an expected healing period of an injury. The pain can linger even if your warrior is no longer ill or injured and, in some cases, even if no illness or injury exists.

Chronic pain can come from normal wear and tear on the body or from aging. During military operations, however, chronic pain may come from combat-related injuries or day-to-day military activities. Many service members who sustain less traumatic wounds return home with back problems, joint immobility, or other ailments.

Potential Dangers of Untreated Chronic Pain

There can be consequences if your service member does not seek immediate attention for his or her chronic pain. Potential consequences include the following issues:

  • suicide
  • substance abuse
  • depression
  • physical deconditioning or loss of physical fitness
  • sleep disturbance
  • reduced sexual activity
  • lower self-esteem
  • irritability
  • impaired ability to work

Signs of Chronic Pain

People perceive and react to pain in different ways. Those who suffer from chronic pain are less likely to be able to perform simple day-to-day activities, such as walking, sitting, standing, lifting, or even touching objects. Be aware of signs indicating that your warrior may be in pain. Such signs include the following indicators:

  • distressed facial expressions, such as grimacing
  • heavy breathing
  • unusual body movements, such as limping
  • behavioral changes, such as not wanting to eat or sleep
  • emotional changes, such as irritability or crying

Chronic Pain Combined with Other Disorders

Chronic pain can occur along with another health problem. In such cases, efforts to address the chronic pain can be more complicated. Among service members, it is not uncommon for chronic pain to accompany posttraumatic stress disorder (PTSD) or amputation.

Chronic Pain and PTSD

Coping with chronic pain can be difficult on both the body and mind of your service member. Coping can be even more difficult if the cause of the pain involves some form of trauma. If your service member has PTSD, he or she also may be experiencing some form of chronic pain.

To improve your service member’s quality of life and decrease his or her disability in cases of comorbidity, or the presence of one or more disorders, it is important to address both chronic pain and PTSD at the same time. In essence, treating the pain alone will not cure your wounded warrior’s PTSD symptoms; rather, it could worsen those symptoms.

The National Pain Foundation suggests that you have your service member talk to a doctor or nurse case manager about how his or her pain may serve as a trigger or reminder of the trauma, resulting in increased pain and disability.

Chronic Pain and Amputation

If your service member had a limb or limbs amputated, he or she may experience phantom limb pain, a form of chronic pain that is perceived as pain present in the missing limb.

Military amputees may perceive phantom limb pain as a real, relentless pain experience involving the limb that is no longer there. According to the journal Pain Factor, phantom pain may be caused by sensations generated from the central nervous system, which includes the spinal cord and brain. Nerve endings at the amputation site can send signals to the brain that are perceived as pain, making your wounded warrior think that pain is present in the area of the missing limb or that the missing limb is still intact.

To determine whether your loved one is experiencing phantom limb pain, talk to your warrior about the amputation site. Ask the following questions:

  • Does he or she feel as though the amputated limb is still present?
  • Is there an itching, tingling, pinching, burning, or throbbing sensation from the amputation site?
  • Is he or she sensing pain coming from areas of the missing limb farthest from the body (for example, from the fingers or hand of a missing arm)?

If your wounded warrior answered yes to any of these questions, he or she may be experiencing phantom limb pain.

Treatment Options

Talk to your wounded service member's doctor about treatments available for chronic pain. Treatment varies among patients, depending on their specific chronic pain conditions. Potential treatment options for those struggling with pain include acupuncture, massage, physical therapy, medication, mirroring, and nerve blockers.

  • Acupuncture is designed to stimulate the body through the use of thin needles manipulated by hand or electronically and strategically placed on the body.
  • Massage is a technique used to enhance the healing process of muscles and tissues and to provide overall relaxation.
  • Physical therapy encompasses an array of movements to increase strength and flexibility of the body and to alleviate pain.
  • Pain medications are a common method of pain relief for the treatment of chronic pain. Pain medications are not compatible with everyone, and people respond differently to any given medication.
  • Mirroring is a procedure used for amputee patients exhibiting phantom limb pain who feel as though their limb is still present. Mirroring involves holding a mirror to the amputated area to fool the brain into “seeing” the amputated area.
  • Nerve blockers are injections given along the nerve to prevent pain signals from passing through the brain, stopping signals to the brain that cause the patient to perceive pain.

Photo of couple talking with physician.

Working Together to Battle Pain

While coping with chronic pain may seem overwhelming at times, military personnel and their caregivers can learn ways to manage chronic pain and restore more productivity and meaningfulness to their lives. Working together, your service member and you can get through the treatment process.

Your warrior can take the following actions:

  • Develop a comprehensive treatment plan with his or her doctor or nurse case manager.
  • Speak up to his or her healthcare provider, describing the pain and any activities that lessen or increase the pain.
  • Participate in the treatment process early on.
  • Talk to his or her doctor or nurse care manager about support groups for warriors in similar chronic pain situations.
  • Write down any questions or concerns he or she may have before each medical appointment.
  • Track his or her pain episodes, writing down how long the pain lasts, the severity of the pain, and activities that may have brought about the pain.
  • Set realistic goals with his or her healthcare provider concerning a treatment plan.
  • Know his or her limitations when it comes to overexertion.
  • Maintain regular sleep schedules.
  • Eat healthfully, and exercise regularly.
  • Realize that there will be good and bad days.
  • Learn to relax. Relaxation exercises are one way of reclaiming control over the body.
  • Find ways to distract himself or herself from the pain, such as by listening to music, reading, and so on.

You can take the following actions:

  • Keep a folder of your wounded warrior's medical information, and bring it to each medical appointment.
  • Report any major change you observe in your warrior's symptoms, mood, abilities, or daily activities.
  • Communicate with your warrior. Talk about issues and concerns as they arise.
  • Join a support group for caregivers in similar wounded warrior situations.
  • Attend medical visits with your wounded warrior.
  • Believe your warrior’s report of pain (validation).
  • Talk with your warrior about hopes you each have for the future.
  • Acknowledge the difficulty your wounded warrior may have in accepting new limitations.
  • Talk to your warrior's doctor or nurse case manager if the pain begins to disrupt his or her sleep.
  • Take care of your own health.
  • Be patient. Understand when to help and when to encourage self-help.
  • Learn about and introduce to your warrior relaxation techniques, such as meditation, muscle relaxation, and breathing techniques.
  • Look for humor in caregiving moments. It’s important to be able to laugh, even when moments can be heartbreaking.

Caregiver Resources

Your caregiving journey can be physically and mentally challenging, especially if you are caring for a wounded warrior who has chronic pain. Learning as much as you can about this condition will help you better serve your service member during this difficult time. And remember…never give up! Staying positive will keep your warrior optimistic and help him or her stay motivated during the rehabilitation process.

For more information regarding chronic pain and service members, visit the American Pain Foundation. The site features specific information regarding the military and veterans faced with this condition. Also, learn ways that your service member can successfully manage his or her chronic pain by going to the Real Warriors website.

Contact your local Army installation’s Soldier and Family Assistance Center (SFAC) for support groups and caregiver support services.


Sources

Black, I., & McManus, J. (2008). Pain Management in Current Combat Operations. Military Medicine, 223-227.

“Caregiver Cornerstones: A resource for family caregivers caring for people living with pain.” Partners Against Pain. Web. 14 Dec 2011.

Carmichael, Mary. 2007. The Changing Science of Pain. Newsweek, 149, 40-43.

“Chronic Pain and PTSD: A Guide for Patients.” National Center for PTSD. United States Department of Veterans Affairs. Web. 14 Dec 2011.

“Fast Facts on Amputation/Phantom Limb Pain.” American Pain Foundation. Web. 14 Dec 2011.

Gregor, K., Hardway, C., & Otis, J. (2010). An Examination of the Co-Morbidity Between Chronic Pain and Posttraumatic Stress Disorder on U.S. Veterans. Psychological Services, 7, 126-135.

McGinnis, D., & Braun, S. (2009). Exit Wounds: A Survival Guide to Pain Management for Returning Veterans and Their Families. Waterford Life Sciences, American Pain Foundation.

Murdough, B. 2008. Phantom Limb Pain: The Invisible Thief. The Pain Factor, 18, 15-16.

Muse, M. 1985. Stress-related, posttraumatic chronic pain syndrome: Criteria for diagnosis, and preliminary report on prevalence. Pain, 23, 295-300.

Townsend, Cynthia. “PTSD and Chronic Pain.” National Pain Foundation. Web. 14 Dec 2011.

 

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