One of out every ten veterans alive today was physically injured during their military service, and approximately 75% of those injuries were sustained in combat. Nearly one-third of post-9/11 veterans have a service-connected disability, which may include psychological trauma. Having a service-related injury increases the chances for comorbidities such as chronic pain, PTSD, mental health disorders and substance use disorders, putting veterans with injuries at risk of homelessness, family strife, and unemployment. 

Common physical combat injuries may include: 

• Second and third-degree burns
• Broken bones
• Shrapnel wounds
• Limb Loss
• Traumatic brain injuries (TBI)
• Nerve damage and paralysis
• Loss of sight and hearing
• Toxic exposure from dust and burn pits 

Veteran physical injury is uniquely complex in that it often results in co-occurring issues and disorders. For example, 12-20 percent of noninjured veterans develop post-traumatic stress disorder (PTSD) whereas 32 percent of veterans with combat casualties develop PTSD. PTSD is strongly connected to substance use disorder, with more than 2-out-of-10 veterans suffering from co-occurring PTSD and substance misuse. Veterans with physical injury are also more likely to deal with chronic and severe pain.

Chronic and Severe Pain in Veterans

Physical injury in veterans often results in chronic and severe pain. Severe pain, defined as occurring most days or every day, is significantly higher in veterans than in civilians, with nine percent of vets reporting severe pain. This includes back pain, jaw pain, severe headaches or migraine and neck pain, with pain frequently interfering with everyday activities. Chronic and severe pain makes veterans vulnerable to prescription drug misuse and other substance use disorders.

Interestingly, it’s been found that using morphine in managed, immediate care after combat injury reduced the risk of developing PTSD, echoing the general findings that early intervention after a traumatic event, using psychological and emotional first-aid, greatly increases successful recovery.    

 Vets who do not receive early care intervention often manage their severe pain on their own without a support system in place, compounded by the often-difficult transition to life after service, resulting in substance use for pain and grief management.

While prescriptions for opioids in the veteran population have decreased, opioid overdoses in vets increased 21 percent from 2010 to 2016 and approximately 10% of veteran admissions to substance use treatment centers were for heroin and six percent were for cocaine use.

 The Relationship Between PTSD and Physical Injury

Studies have shown that PTSD symptoms may exacerbate chronic pain and, in turn, pain may exacerbate PTSD symptoms. PTSD is associated with negative outcomes among veterans with chronic pain, disability and sleep disturbances. Other research suggests a link between pain severity after combat injury and PTSD risk, with pain complaints being five times greater in veterans with PTSD. 

Increased risk of PTSD is associated with:

• Longer deployment time
• More severe combat exposure
• More severe physical injury
• Traumatic brain injury
• Low morale and poor social support within the unit
• Lack of familial/social support outside of service
• Family problems
• Prior trauma exposure

Nearly 1-out-of-3 Veterans seeking treatment for substance use disorder also have PTSD, and in the wars in Iraq and Afghanistan, about 1 in 10 returning veterans have a problem with alcohol or other drugs.

A traumatic brain injury (TBI) is uniquely associated with substance misuse. A TBI sustained in combat can contribute to higher rates of binge drinking, opioid misuse and suicide. Compared with the military population who did not sustain TBI, discharge rates for alcoholism or drug use were 2.6 times greater for mild TBI and 5.4 times greater for moderate TBI. The symptoms of TBI and PTSD often overlap, and it is possible to develop PTSD after a TBI.

Ultimately, PTSD can be “mutually maintaining” with physical injury, where pain serves as a reminder of the trauma, reducing activity levels, increasing pain perception and elevating anxiety.

Treatment and Recovery from Physical Injury

Physical injury is associated with the subsequent development of PTSD, depression, anxiety and substance use. For veterans living with physical pain and substance use, seeking treatment and establishing social support are vital steps to recovery. Pyramid Military Therapy & Recovery Programs use a clinically integrated approach to address underlying trauma, substance use disorders and co-occurring disorders. Our continuum of care includes early intervention, an individual treatment plan that uses a variety of treatment modalities and peer support that continues after initial treatment.

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