I am the manager of a large civilian rehab center. Without a VA center in our area, we are starting to see a large number of returning soldiers for chronic pain problems. What can be done to prevent this painful suffering or at least manage it for our returning soldiers?

Pain relieving medications are the first line of treatment. Sometimes more than one drug is used in combination called multimodal pharmacology. Tylenol still remains a very effective nonnarcotic pain reliever.

Nonsteroidal antiinflammatory drugs (NSAIDs), antineuropathic (nerve pain) medications, antidepressants, along with opioids (narcotics) are available tools used for pain control. The idea of getting early control over pain is to prevent chronic pain from imprinting nerve pathways with a permanent pain signal.

Other management tools for chronic pain in this group of combat casualties can include physical and occupational therapy, biofeedback therapy, relaxation training, and counseling. Complex regional pain syndrome has its own treatment protocol prescribed and supervised by the physical therapist.

Various methods are used in an effort to stop the pain signals at the level of the nerve. Injections of numbing agents and steroids may be helpful. Nerve blocks, pulsed radio waves to the nerve plexus (place where nerves converge together), and various types of electrical stimulation have been used with varying levels of success.

Many times it takes a concentrated effort of many team members to help suffering soldiers find the right mix of medications and management techniques to gain control of their pain. This type of program is referred to as a comprehensive interdisciplinary pain protocol.

More and more health care professionals are training in some of the treatment techniques referred to as energy medicine. Craniosacral therapy, myofascial release, Reiki, BodyTalk, Touch for Healing, the Rosen or Alexander techniques are just a few of these therapies. Finding alternative ways to address pain is one approach that may prove very helpful.