title: Presentation, diagnoses, mechanisms of injury, and treatment of soldiers injured in Operation Iraqi Freedom: an epidemiological study conducted at two military pain management centers.
abstract: In recent military conflicts the major source of soldier attrition has not been battle injuries but more mundane causes similar to those encountered in civilian life. In an effort to determine the pain conditions affecting soldiers during wartime, we conducted an observational study among 162 soldiers medically evacuated from Operation Iraqi Freedom who were referred to 2 large pain treatment centers located outside the theaters of combat. Fifty-three percent of soldiers presented with either radicular (n = 49) or axial (n = 37) low back pain, with lumbar herniated disk being the most frequently diagnosed condition (24%). The two most implicated etiologies were exacerbation of a previous pain condition treated with surgery (15%) and motor vehicle accidents(12%). Only 17% of patients were injured during battle. Seventy-two percent of soldiers received at least one nerve block/injection, the most common of which was lumbar epidural steroid administration (22%). Nonsteroidal antiinflammatory drugs were prescribed to 56% of patients, opioids to 49%, and some form of alternative therapy to 17%. Among the 49 patients in whom data were available, only 2% returned to combat duty in Iraq. With the exception of battle-related injuries, the pain conditions suffered during modern warfare seem to be similar to those encountered in civilian pain clinics. To improve the return-to-duty rate, better preventive measures and more aggressive treatment conducted in forward-deployed medical units are recommended.
  
  
  CONCLUSIONS
  We conducted an observational study at two large military pain treatment centers among soldiers injured in Operation Iraqi Freedom. Fifty-three percent of soldiers presented with low back pain, with lumbar herniated disk being the most common diagnosis. Only 2% of patients returned to combat duty in Iraq. To improve the return-to-duty rate, better preventive measures and more aggressive treatment in forward-deployed medical units are recommended.
authors.affiliation: *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore; †Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ‡Department of Anesthesiology, Walter Reed Army Medical Center, Washington, DC; §Pain Management Center, Landstuhl Regional Army Medical Center, Landstuhl, Germany; and ¶John Jay College of Criminal Justice of the City University of New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Scott
authors.initials: S
authors.lastname: Griffith
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Larkin
authors.forename: Felipe
authors.initials: F
authors.lastname: Villena
authors.forename: Ralph
authors.initials: R
authors.lastname: Larkin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D018710:Pain Clinics; D059408:Pain Management; D012017:Referral and Consultation; D016896:Treatment Outcome; D014857:Warfare