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Getting creative: Reducing opioid use for returning warriors

Image of Airmen of the 174th Attack Wing participate in a weekly yoga class. Classes are intended to present an alternative way for 174th members to build both mental and physical strength. Yoga is also a way to alleviate chronic pain in the body. (U.S. Air Force photo by Staff Sgt. Duane Morgan). Airmen of the 174th Attack Wing participate in a weekly yoga class. Classes are intended to present an alternative way for 174th members to build both mental and physical strength. Yoga is also a way to alleviate chronic pain in the body. (U.S. Air Force photo by Staff Sgt. Duane Morgan)

When service members return from tour of duty with debilitating battlefield injuries, opioid prescriptions are common in their recovery process. Opioids are effective in reducing pain in patients but can be highly addictive as a pain treatment option. As a result, the Defense Health Agency is exploring alternate pain management techniques to decrease the number of opioid prescriptions in military hospitals.

The Centers for Disease Control and Prevention reported in 2017 that drug overdose deaths involving opioids skyrocketed from roughly 8,000 in 1999 to over 46,000 in 2017. Of these numbers, deaths involving prescribed opioids jumped from around 3,000 to almost 17,000. DHA’s response has been an integrated approach to health that combines prescriptions with nonpharmacological pain treatments. DHA published a procedural instruction in 2018 that promotes physical and behavioral treatment techniques like acupuncture, massage, and music therapy as alternativess to address acute pain and prevent it from becoming chronic. Opioids would then be prescribed only when indicated.

Dr. Chester Buckenmaier, a professor at the Uniformed Services University and a licensed acupuncturist, agrees that these other pain treatment techniques are key to the future of pain management. While Buckenmaier is an anesthesiologist by trade, he teaches students at USU to take alternate treatments into consideration as they study to be the health care providers of tomorrow.

“The Defense Health Agency and USU are aggressively educating the next generation to look at these other techniques as first line treatments for pain,” Buckenmaier said. “We’re teaching them today that this is medicine.”

Outside the classroom, practitioners like Dr. Bhagwan Bahroo from the Psychiatry Continuity Service program at Walter Reed use yoga to treat pain in military hospitals.

“A good yoga session not only improves muscle tone, adds strength, and improves flexibility of the joints, but also helps bring peace of mind, reduces anxiety, and improves mood,” Bahroo explained. He added this method relieves pain intensity and increases daily function, two factors essential to successful pain management.

Acupuncture and yoga are only a few examples of nonmedication pain management treatments. Health care providers across the military are also exploring other approaches such as meditation and nutrition to combat pain while maintaining healthy, daily function. Battlefield acupuncture, or auriculotherapy, is already available at certain military hospitals, and TRICARE is evaluating the clinical effectiveness of traditional acupuncture, which could become a covered service in the future. With the implementation of the updated Defense and Veterans Pain Rating Scale, DHA will have a way to measure these techniques and their effects on pain.

“This is a cultural change that we’re bringing not only to our patients, but also to ourselves as clinicians,” Buckenmaier said.

Service members and civilians dealing with both acute and chronic pain are encouraged to explore these other techniques with their health care providers when considering an opioid prescription. For more information on how to manage pain, visit the Military Health System’s Pain Management page.

Read Mr. Thomas McCaffery's memo officially recognizing November as Warrior Care Month.  

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“While rest is an important component to recovering from injuries and reducing your pain, sometimes you can reduce sensitivity and prevent chronic pain through physical activity. Talk to your doctor for more personalized advice and start retraining your brain with these resources: www.tricare.mil/PainManagement #Painmanagement #PainParadigm”

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“When it comes to treating pain, we all wish for a fast fix. However, treating pain requires a holistic, gradual approach to restore patients to a higher level of function and return service members to full duty status. https://tricare.mil/HealthWellness/Featured-Health-Topic #Painmanagement #PainParadigm”

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“Opioids are a useful tool to manage extreme pain but can be extremely dangerous if misused. Talk to your doctor about how to SAFELY use opioids to temporarily manage pain and to develop a collaborative plan to taper you off opioids as soon as it is appropriate. You can learn more about MHS efforts to lower the risks of opioid misuse here: https:/ ...

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“DOD and VA developed a Stepped Care Model of pain management that utilizes evidence-based treatments to manage pain and seeks to prevent acute pain from becoming chronic. Learn more here: www.tricare.mil/painmanagement #Painmanagement #PainParadigm”

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“Common prescription opioids like Hydrocodone, Oxycodone, and Morphine are highly addictive and can be extremely dangerous if misused. Pay attention to these signs of abuse and seek help immediately if they present themselves. Learn more about opioid safety here: https://www.tricare.mil/opioidsafety #Painmanagement #PainParadigm”

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“Opioids are serious medications. Ensure you’re prepared to use them safely before going home with a prescription. Check out these tips and click on the link below to find helpful resources and learn more: https://www.tricare.mil/opioidsafety #Painmanagement #PainParadigm”

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“Learn the names of common prescription opioids so you can stay vigilant about your pain management medications. These medications are highly addictive, so talk to your doctor about the risks of use early to minimize complications. https://www.tricare.mil/opioidsafety #Painmanagement #PainParadigm”

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“Acute and chronic pain often require different treatments, so it’s important to understand their fundamental differences. Learn more about pain management here: www.tricare.mil/painmanagement #PainParadigm”

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“No one should have to live with pain. If you experience chronic pain, see your health care provider immediately to find and start the right treatment. Remember, there is hope for pain relief and you’re not alone. Learn how to assess your pain at: https://health.mil/News/Articles/2021/09/17/DVPRS-pain-scale #Painmanagement #PainParadigm”

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“Everyone experiences and responds to pain differently, so there’s no “one-size-fits-all” approach to treating it. Your medical provider will work with you to find the best treatments for you. Learn more here: https://health.mil/Military-Health-Topics/Conditions-and-Treatments/Pain-Management #Painmanagement #PainParadigm”

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“Understanding where pain comes from and why it happens is crucial to treatment. Treating pain often starts with retraining your brain through lifestyle changes in sleep, diet, or exercise. Learn some ways service members can manage their pain: https://health.mil/News/Articles/2021/09/30/Five-ways-to-manage-chronic-pain-for-military-wellness ...

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“Your mental and emotional state has more physical effects than you might suspect. You can start to reduce your chronic pain by reducing the stress you feel in your daily life. Learn more here: https://www.tricare.mil/painmanagement #PainParadigm”

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Invisible Wounds, Invisible Care

Invisible Wounds, Visible Care: A Road to Care and Recovery. 1. Seek Care: Are yo or someone you know showing symptoms of an invisible wound? Seek care early and often. Many resources are available to support you and your family. 2. Receive Care: Connect with medical and non-medical services that will assist you throughout the care process, help you build a care management team, and support your recovery. 3. Continued Care: Continue recovery while reintegrating into your unit or transitioning into civilian life.

This infographic outlines the Air Force Invisible Wounds Initiative and offers a list of resources for wounded warriors and their families.

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Last Updated: July 11, 2023
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