[Mslday]

On the Front Lines, Nuerolgy Now
Neurology Now:Volume 4(2)March/April 2008p 33-34

Lieutenant Colonel Trip Buckenmaier III, M.D., chief of the Army's Regional Anesthesia and Pain Management Initiative, says that virtually every soldier injured gets some type of pain management-from Motrin to an epidural block to a low dose infusion of the anesthetic ketamine-and, of course, morphine, which has been used since the Civil War to manage pain.

But Dr. Buckenmaier and his colleagues are revamping the way the military practices medicine. They are trying hard to avoid soldier's disease, which occurs when war-injured troops get hooked on morphine. When you just use one drug to manage pain, people can get into trouble, the physician explains. Until this war, pain management stopped at morphine.

The modern military's medicine cabinet is designed to treat pain not as a symptom but as a disease of the central nervous system. We look at pain not as a symptom of disease but as a disease in and of itself, says Dr. Buckenmaier. The nervous system becomes overwhelmed and develops maladaptive pathways that lead to chronic pain, he explains. We want to stop this process during the acute pain phase, with hopes of preventing chronic pain problems.

Some of you are familiar with the treatment I had in Germany last year following a surgery to my RSD limb. I have always called it a continuous peridural nerve block and realize after reading this article that the term "peridural" means the same as peripheral block as described here in this article. I realize now that my terminology was simply a matter of a translation issue. What I had in Germany is the same as described in this article, see the excerpt below.

They are also using peripheral nerve stimulators to insert pumps that deliver regional doses of anesthesia for days to weeks. These peripheral nerve blocks have been used successfully on wounded soldiers in Iraq since 2003. Dr. Buckenmaier says there is growing evidence that anesthesia can be delivered close to the nerves surrounding the wounded area in order to block pain signals before they are transmitted to the brain. (See illustration on page 33.) The anesthesia, because it is localized, can be continuous and causes no sleepiness. The soldiers often report feeling no pain.

The fact that these doctors are recognizing pain as a disease in and of itself is a huge step forward for all of us, newly diagnosed or not. I benefited from this procedure in Germany despite all odds being against me for having had RSD for 6 odd years. I think this is very important information for any of us here who have to face surgery.

http://www.neurologynow.com/pt/re/ne...!1243308592244

MsL