Citation

McCulloch Gallagher R, Sandbrink F. Am. J. Public Health 2018; ePub(ePub): e1-e5.

Affiliation

Rollin McCulloch Gallagher is with the Departments of Psychiatry and Anesthesiology, Perelman School of Medicine, University of Pennsylvania, and the Center for Health Equities Research and Programs, Michael J Crescenz Veterans Affairs Medical Center, Philadelphia. Friedhelm Sandbrink is with the Department of Neurology, Washington DC Veterans Affairs Medical Center, and the Department of Neurology, School of Medicine, George Washington University, Washington, DC.

Copyright

(Copyright © 2018, American Public Health Association)

DOI

10.2105/AJPH.2018.304744

PMID

30495989

Abstract

War's burden on the health and well-being of combatants, civilians, and societies is well documented. Although the examination of soldiers' injuries in modern combat is both detailed and comprehensive, less is known about war-related injuries to civilians and refugees, including victims of torture. The societal burden of war-related disabilities persists for decades in war's aftermath. The complex injuries of combat survivors, including multiple pain conditions and neuropsychiatric comorbidities, challenge health care systems to reorganize care to meet these survivors' special needs. We use the case study method to illustrate the change in pain management strategies for injured combat survivors in one national health system, the US Department of Veterans Affairs (VA). The care of veterans' disabling injuries suffered in Vietnam contrasts with the care resulting from the VA's congressional mandate to design and implement a pain management policy that provides effective pain management to veterans injured in the recent Middle East conflicts. The outcomes-driven, patient-centric Stepped Care Model of biopsychosocial pain management requires system-wide patient education, clinician training, social networking, and administrative monitoring. Societies are encouraged to develop their health care system's capacity to effectively respond to the victims of warfare, including combatants and refugees. (Am J Public Health. Published online ahead of print November 29, 2018: e1-e5. doi:10.2105/AJPH.2018.304744).

Language: en