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CAPTAIN Laura McGhee, a United States Army research biochemist by vocation, knows more than most about how much war can hurt.
Capt McGhee is chief of the battlefield pain management research programme at Fort Sam Houston in San Antonio, Texas. Her unit is part of the army’s Institute of Surgical Research (ISR) under the Medical Research and Materiel Command.
The ISR was established in 1943, initially focused on evaluating the role of newly discovered antibiotics in treating war wounds. Its mission later expanded to cover thermal and trauma injuries, and since 1996 the full spectrum of combat casualty care. Together with research activity, it provides specialised treatment as the army’s burn centre.
Research involves four main areas: bone regeneration and soft tissue, clinical trauma, damage control resuscitation, and pain management. There is also work done on trauma infomatics – the evaluation of what to measure and how to develop medical monitoring devices.
The US navy, air force and marines have similar operations but the army’s research budget is the biggest. This reflects the fact that it has in recent years been taking the largest number of combat casualties.
“Pain control on the battlefield actually became much more popular during the US Civil War, when they introduced morphine on the battlefield. But the research area has lagged behind,” said Capt McGhee. Later, I learn that some sources say that up to 400,000 people may have been saddled with morphine addiction because of its Civil War usage.
Morphine (and similar opioid alkaloids) is still the dominant painkiller for battlefield use, and it can still lead to addiction. However, one ISR researcher has recently developed an ultra-rapid opiate detoxification programme administered over 48 hours with the patient unconscious under general anaesthetic.
Pain cannot be measured quantitatively, and the US relies on a self-reporting system based on a scale of 0-10.
This is recorded on a database known as the Joint Theatre Trauma Registry, done when patients are admitted to the in-theatre emergency department.
Despite battlefield efforts, said Capt McGhee, about 70 per cent of casualties report moderate to severe pain.
“The problem with using intramuscular injection (of opiates) is that in cases of trauma... the body shuts down a lot of blood flow to the muscles so that the deposit of morphine is not absorbed into the bloodstream until the patient is in the hospital several hours later,” Capt McGhee explained.
Her team is consequently exploring intranasal and sublingual administration, where the medication is rapidly absorbed by membranes in the nose or under the tongue.
Other research involves investigating new painkilling drugs, such as ketamine and S-ketamine. Along with its potential use on the battlefield, ketamine may also be beneficial in relieving chronic pain that can linger for a lifetime.
Other research undertaken by Capt McGhee’s team may seem more exotic. “We’ve looked at the use of virtual reality for distraction therapy and pain control during dressing changes on burn patients,” she said, adding that this has already been applied effectively with an interactive virtual-reality video game called SnowWorld.
Aside from 21st century technology, the US army is also investigating alternative medicine therapies including acupuncture, meditation and behaviour modification. Basically, anything that might relieve suffering.
“The army tends to focus on transition-type research, making the transition from the bench to the bedside. That makes us a bit different from a basic science researcher, who is more focused on molecular mechanisms,” said Capt McGhee.
Do you aim to eliminate pain or reduce it, I asked her. “Realistically, it’s moving someone from an eight to a three (on the pain scale). I don’t think you can eliminate pain,” she responded.
And has there been any recent progress in dealing with battlefield pain? “The truthful answer is that there hasn’t been a whole lot of progress on the battlefield. Two hundred years later we’re still using morphine,” said Capt McGhee.
“With all the advances we’ve made in medicine, I keep thinking there’s got to be something better. And this frustrates us to no end.”
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