Veterans know that being in the military can be hazardous to their health. The risk of facing the enemy and putting their life on the line is something soldiers face regularly. It's the nature of "going to war." Yet, there are numerous other unknown risks that are not apparent until later in life. Many veterans have symptoms which do not fit into a well-defined taxonomy of a specific disorder. Such ill-defined symptoms include headaches, memory loss, concentration difficulties, chronic fatigue, unexpected weight changes, sleep problems, joint and back pain, skin rash, diarrhea, respiration problems, dizziness, blackouts, and digestive problems.
These symptoms have been commonly represented among veterans as far back as the Civil War. In fact, after every war a number of veterans experience what is known as medically unexplained physical symptoms (MUPS). These days the Department of Veteran Affairs (VA), follows The International Classification of Diseases (ICD-9) manual placing them in the category of Symptoms, Signs and Ill-defined Conditions (SSID). From a treatment perspective the symptoms are the body's manifestations of the veteran's experiences. The body is in a sense speaking for them.
Today, MUPS/SSID is one of the three most common health issues treated in the VA medical system (along with musculoskeletal and mental health problems). Since they are medically unexplained, treatment is focused on the symptom; the cause is unknown and therefore remains untreated. The vagueness of any cause does not mean there is not a cause, it just means the cause remains unknown. In the past a pattern of symptoms was used as a means of classifying the disorder. Studies reviewing these symptoms have noted one element which has remained a common factor: Veterans have been exposed to an exceptional set of life-threatening experiences. The unprocessed memories of those experiences that are stored in the brain contain images, beliefs, emotions, and body sensations. All aspects contribute to the body's expression of those events. Comorbid expressions of depression and anxiety often accompany the experiences.
Gastrointestinal problems are common. The number of nerve cells in the visceral area -- the gut -- is second only to the brain itself. The body's ability to monitor neurological activity in the gut is significant. When we feel threatened our gut tightens. Anxiety can contribute to a sensation of nausea or upset stomach. Veterans who are emotionally numb due to their combat trauma have difficulty sensing what the visceral part of their body is feeling, but the neurological activity produces numerous unexplained symptoms. After effective therapy that reprocesses the memories of the war experiences, those various symptoms generally disappear.
Many veterans report chronic pain after a combat deployment. Chronic physical and emotional pain can be one of the most overwhelming problems a person faces. This pain often fails to respond to normally effective treatments such as counseling or medication. Neuroscience has discovered that aspects of physical and emotional pain are stored in the brain. The brain scans of chronic pain sufferers reveal specific patterns of neurological firing in areas of the brain associated with perception, emotion and motivation. These areas of the brain are associated with emotional stress, including PTSD. The physical aspects of pain activate feelings which become a part of the pain experience. The brain's ability to change (neuroplasticity) and compensate for dysfunctional areas offers hope.
What are effective treatments for chronic pain? Due to the multi-dimensional aspects of pain, a number of treatment approaches have been used. They take into account the cognitive, affective, behavioral, social, and physical aspects of pain. Cognitive-behavioral therapy (CBT), hypnosis, acupuncture, and biofeedback training have all been used. While EMDR therapy was originally utilized in the treatment of PTSD the neurobiological similarities with PTSD patients and chronic pain disorders has led therapists to use EMDR in the treatment of a broad range of disorders including chronic pain, anger, anxiety, and depression (Silver, Rogers, & Russell, 2008). Studies have found EMDR effective in the treatment of chronic pain (Mazzola, Calcagno, Goicochea, Pueyrredon, Leston, & Salvat, 2009; Shapiro, 2012)
The use of EMDR in the treatment of phantom limb pain (PLP) has been researched in the U.S. and Europe with significant results (Russell, 2008; Schneider, Hofmann, Rost, Shapiro, 2008). While EMDR will not resolve a physical deficit, it does address the unprocessed memory that is very often the cause of the phantom pain. The phantom pain is pain that existed prior to the amputation. The memory of the pain before amputation remained locked in the nervous system. These patients deal with troubling pain that theoretically should not be there. Phantom limb pain is a clear example of a pain memory. The limb or organ is removed but the memory of the pain continues to exist. EMDR is effective approach in treating pain memories thus eliminating phantom limb pain in the patient. Dr. Francine Shapiro's book Getting Past Your Past contains detailed accounts of the EMDR treatment of chronic pain, as well as self-help techniques that many people have found successful.
At my office at Soldier Center we treat veterans with various presenting issues, PTSD, conversion disorder, traumatic brain injury (mild to moderate), dystonia (trauma related), pain (including PLP), and those ill-defined symptoms previously mentioned. First, and foremost, we provide a secure place were veterans are accepted, their presenting issues identified, and treatment coordinated with other resources the veteran has available. There are no simple answers to complicated issues, but there is effective treatment available. Make sure you and those you care about are receiving treatment that is making a difference and offering hope.
Up to 12 EMDR sessions and five family therapy sessions (as needed) are offered to veterans and their families at various locations in the U.S. at no cost due to a corporate grant in support of veterans. Contact Soldier Center at firstname.lastname@example.org or our website www.Soldier-Center.com for further information. Together we can make a difference.
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Mazzola, A., Calcagno, M., Goicochea, M, Pueyrredon, H., Leston, J., & Salvat, F. (2009). EMDR in the treatment of chronic pain. Journal of EMDR Practice and Research, 3(2), 66-79.
Russell, M. (2008). Treating traumatic amputation-related phantom limb pain: A case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
Schneider, J., Hofmann, A., Rost, C., Shapiro, F. (2008). EMDR in the treatment of chronic limb pain. Pain Medicine, 9(1), 76-82.
Shapiro, F. (2012). Getting past your past: Take control of your life with self-help techniques from EMDR therapy. New York: Rodale, Inc.
Silver, S., Rogers, S., & Russell, M. (2008). Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans. Journal of Clinical Psychology in Session, 64(8), 947-957
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