Chronic Pain and Co-Morbid Brain Injury From IED Trauma
The case study described in this article presents several interesting and important issues in pain management. Some issues are found generally in the treatment of chronic pain but other issues discussed are more pertinent to veterans. Indeed, some of the issues specific to veterans may be even more specific to veterans injured during Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) than previous military conflicts.
One pain management issue that occurred with this injured veteran—and is likely specific to OIF/OEF veterans—is the co-morbidity of cognitive problems together with chronic pain complaints. Certainly, the pain management literature is replete with documentation of post-traumatic stress syndrome (PTSD), depression, and other mood and anxiety disorders arising out of chronic pain states. However, there is less information on cognitive issues co-morbid with chronic pain complaints.
Many veterans injured in OIF/OEF are injured by an improvised explosive device (IED). These devices cause a high rate of injury to the head and extremities, which are regions of the body less protected from body armor. These IEDs convert several types of potential energy into forces that injure or kill soldiers. The explosive itself , in synergy with the accelerant it is combined with, can produce intense heat that produces severe burn injuries. The explosive also forces out shrapnel at a high velocity that can penetrate the tissues and organs of its victims. Indeed, most IEDs now use nails and small metal shards because of the high velocity they achieve when expelled and the ease with which these small, hard metal objects can penetrate the body.
What is also being better appreciated are the injuries caused by intense changes in air pressure caused by the IED’s shock waves. The devastating effects of these changes in air pressure were recently described by Ronald Glasser in the Dallas Morning News:
“The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of very high pressure is followed closely by the ‘secondary wind’: a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front…
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