Pain Management

Dr. Buckenmaier, III, is Chief of the Army Regional Anesthesia and Pain Management Initiative (ARAPMI) at the Walter Reed Army Medical Center in Washington, DC. This program has been on the front lines of pain research over the past several years. Medscape.com interviewed Dr. Buckenmaier concerning the program's research and practical application. ARAPMI has been around since 2000, but really took off at the start of the War on Iraq in 2003. Its' primary responsibility is to enhance the ability to manage the pain of battlefield casualties, emphasizing the multimodal approach to pain management. In short, this means that the method of treating each patients' pain is best suited to their situation.

Dr. Buckenmaier describes pain as a disease process, and like all diseases can be appropriately treated. Such methods include patient-controlled dosage, which allows the patient to administer a dose of painkillers as they need it. This may sound dangerous, but the system is a safety within itself; should the patient become over-sedated, he or she will not be able to press the button for additional doses. Also, another example is the pill pack carried by Special Forces that contains a painkiller, an anti-inflammatory, and different anti-biotics that are to be taken when a soldier is initially injured. This is a great first step to the treatment of not only pain, but the injury itself. Another point that Dr. Buckenmaier touches on is the idea of having, at the least, a clinician dedicated to the pain management of casualties. Studies show injured soldiers having very high levels of pain prior to their arrival at definitive care, suggesting the need for better pain management of these patients before transport.