State of the science review: Advances in pain management in wounded service members over a decade at war

ABSTRACT: The pain conditions and comorbidities experienced by injured service members and the challenge of pain management by the military medical system offer a unique opportunity to inform pain management and medical research. In this article, acute and chronic pain issues, current treatment options and limitations, as well as novel approaches to pain management are discussed within the context of combat casualty care, from the battlefield to hospitalization and rehabilitation. This review will also highlight the current pain management limitations that need to be addressed in future clinical and basic science research to improve care for our nation’s injured service members. (J Trauma Acute Care Surg. 2014;77: S228 S236. Copyright * 2014 by Lippincott Williams & Wilkins) During the last 12 years, during the span of OperationEnduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF), advances in battlefield medical tech-niques,1 protective armor,2 and rapid evacuation3 have led to an impressive greater than 90 % survival rate.4 Of the injuries incurred on the battlefield to date, approximately 52,022 ser-vice members have been wounded in action, while 5,346 have sustained fatal injuries.5 While this is a major improvement in survival, this substantially increases the number of patients needing treatment for significant pain