Chronic Pain and Co-Morbid Brain Injury From IED Trauma
by Mordecai N. Potash, MD
 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…
Please refer to the June 2007 issue for the complete text. In the event you need to order a back issue, please click here.
— June 2007
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
|