The Socioeconomic Burden of Pain From War

Abstract

War's burden on the health and well-being of combatants, civilians, and societies is well documented. Although the examination of soldiers' injuries in modern combat is both detailed and comprehensive, less is known about war-related injuries to civilians and refugees, including victims of torture. The societal burden of war-related disabilities persists for decades in war's aftermath. The complex injuries of combat survivors, including multiple pain conditions and neuropsychiatric comorbidities, challenge health care systems to reorganize care to meet these survivors' special needs.We use the case study method to illustrate the change in pain management strategies for injured combat survivors in one national health system, the US Department of Veterans Affairs (VA). The care of veterans' disabling injuries suffered in Vietnam contrasts with the care resulting from the VA's congressional mandate to design and implement a pain management policy that provides effective pain management to veterans injured in the recent Middle East conflicts.The outcomes-driven, patient-centric Stepped Care Model of biopsychosocial pain management requires system-wide patient education, clinician training, social networking, and administrative monitoring. Societies are encouraged to develop their health care system's capacity to effectively respond to the victims of warfare, including combatants and refugees.

FIGURE 1—

Estimated Surviving Population of War Veterans From Different US War Eras: 2014–2043 Source. Hunt SC, Hoge CW. Health care for military veterans. In: Jameson JL, Fauci AS, Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 20th ed. New York, NY: McGraw-Hill; 2018. Reprinted with permission.

FIGURE 2—

Numbers and Rates of Mental Health (MH) and Pain (Pain) Conditions in 24 578 Operation Iraqi Freedom–Operation Enduring Freedom Veterans With Traumatic Brain Injury (TBI) in the US Department of Veterans Affairs: 2009 Source. Taylor et al.