Electrical spinal cord stimulation (SCS) provides an option for military personnel with back pain and other chronic pain conditions to return to combat and other strenuous duties, according to a study in the July issue of Anesthesia & Analgesia.
“We present six cases that demonstrate SCS can be a viable option for motivated patients in a physically and mentally challenging environment,” the researchers wrote.
Spinal cord stimulation is an increasingly used option for patients with back pain or other pain problems of spinal origin that do not respond to standard treatments. Equipment is surgically implanted to generate electrical current to the spinal cord, disrupting the nerve signals responsible for perceived pain. Because of the need for implanted equipment, SCS has generally not been considered a good option for patients who are physically active.
However, the new report suggests that SCS may be useful in managing the unique medical challenges posed by pain problems in military personnel.
“Due to advances in medical science and the physical and mental fortitude of our soldiers, many previously career-ending and life-altering disabilities have been overcome,” lead author Anthony Dragovich, MD of Womack Army Medical Center, Ft. Bragg, N.C. and co-authors wrote. “Many soldiers desire to remain in military service, but unremitting pain is often the last standing hurdle.”
The report summarizes the use and outcomes of SCS to manage chronic pain problems in six military personnel. All patients had chronic pain conditions that were not adequately controlled by drugs or other treatment options. In each case, the pain problem threatened the patients’ ability to deploy with their units or return to work as a military contractor.
All six patients were able to be deployed or redeployed after implantation with SCS hardware and effective electrical stimulation programs. For example, one patient was able to return to duty with a special forces unit in Iraq. The authors note his ingenuity in modifying his uniform to accommodate his electrical stimulation programming unit. Another patient, having completed an overseas assignment without pain, was in the process of applying to dive school.
Just one patient, a military contractor, developed increasing pain after several deployments. The other five patients were all able to return to duty, remain with their units, or return to other assignments.
“A major dilemma faced by medical officers is how to control chronic pain in a motivated soldier who might otherwise be an asset to his unit,” the researchers wrote. Although SCS has been successfully used to treat war injuries, it is “widely acknowledged” that it makes a service member nondeployable.
That assumption may need to be re-evaluated, Dragovich and colleagues believe. They outline a list of criteria that should be fulfilled to consider deployment in soldiers with SCS — starting with the motivation and desire to remain deployable.
The authors acknowledge that SCS during deployment has some limitations, including the lack of medical support. However, most of the same limitations apply to the use of strong medications used to treat chronic pain. They conclude, “[W]ith appropriate selection criteria, SCS can be a life-altering therapy that enables soldiers and other patients to achieve their professional goals.”