Treatment of Pain: General Information

As previously stated, pain is a universal symptom of the combat injured patient and must be managed early and effectively. Adequate early pain control has been shown to reduce post-traumatic stress disorder and ongoing pain control is an obligatory part of trauma care. Inadequate treatment results in undesirable consequences that delay or prevent a wounded warrior’s full rehabilitation and recovery.

Non-pharmacologic pain therapies should be considered first-line treatment for mild to moderate pain or an adjunct to opioid medications. This includes battlefield acupuncture when administered by an appropriately qualified clinician and supplies are available. (See Appendix F.)

With regards to specific opioid medications, any opioid available can be titrated to equal effectiveness for achieving desired pain control. This CPG is going to emphasize the use of Ketamine throughout the deployed continuum of care. Ketamine is a very effective analgesic either by itself or as an adjunct to opioid analgesia and can be used to reduce the total narcotic burden.19,20 Ketamine, in parenteral doses of 0.15-0.3 mg/kg, has been shown to reduce pain scores, total narcotic use, and need for rescue medication when used with morphine for acute pain control.20