22 APRIL 2021

“Mental health problems and post-traumatic stress in particular, are underpinned by a pain condition that becomes chronic and disastrous if not well managed”

Peter Rudland, Chronic Pain Champion

I’ve heard it said that it can be more difficult to rule yourself than to rule a city.  This statement speaks to the fact that the battles that we face in the world are sometimes simpler, less opaque, than those that live within our minds.  When we fight our enemies, we assess their strengths, tendencies and vulnerabilities and can make a plan to overcome them.  But what if that enemy is our mind and it makes us believe that we are allies and that we don’t need help?

The stereotype of the stoic soldier who can live through any challenge without seeking help creates barriers to getting support for pain and associated mental health issues.   We need to better understand the mental health support needs of our veterans and the role that chronic pain plays as a contributing factor to poor mental health.

According to the Australian Institute of Health and Welfare, between 2002–2017 the age-adjusted rate of suicide in ex-serving men was 18% higher than among Australian men. Many factors are associated with the higher suicide risk for suicide in veterans - with chronic pain an often overlooked one. A US study found that moderate and severe pain over the course of a year increased the risk of a suicide attempt in veterans, even after considering other risk factors.

On Monday, 19 April, the Prime Minister announced a Royal Commission Into Death by Suicide for Veterans. The Commission will have a mandate to examine systemic issues, any common themes and past deaths by suicide of Australian Defence Force members and veterans.

Painaustralia is privileged to have the support, experience and insight provided by our National Patron, Air Chief Marshal Sir Angus Houston AK, AFC (Ret’d) and Painaustralia’s Champion, Veteran and Invictus Games competitor who survived a 2010 Blackhawk helicopter crash, Peter Rudland.

As Chief of our Defence Forces for many years, Sir Angus Houston witnessed the impact of pain on hundreds of personnel and saw first-hand its significant role in changing the life trajectory of many young people in the military – imposing disability and a life of ongoing challenge to function and participate in society and community.

As a veteran and chronic pain champion, Peter Rudland knows how important it is to address the chronic pain and mental health of veterans and the disastrous effects it can have if it’s not well managed. Now, with this Commission, we hope veterans’ mental health will receive the attention it deserves and that the extent to which mental health problems and post-traumatic stress in particular, can be underpinned by poorly managed.

We know that a significant number of Veterans live with pain from injuries caused by improvised explosive devices and weapons that inflict severe impacts on heads, necks, spines and limbs. Pain is also common in Veterans who have experienced several injuries, and it is often accompanied by post-traumatic stress disorder (PTSD).  One such potential outcome from service is musculoskeletal pain, which is one of the most common reasons for medical discharge from the armed forces. It is the number one reason for discharge from the British Armed Forces, while in the US a survey of Veterans who served in Iraq and Afghanistan found that almost 57% now have compromised musculoskeletal systems.[1]

While a multidisciplinary approach is recommended for addressing chronic pain, often the only treatment apparent and available to many of these veterans is medication and there is some evidence suggesting over-use of medications by Veterans. For some pain related medicines (e.g. opioid medicines such as codeine, morphine or oxycodone), there is no evidence that they will help in the long-term. For many people, medicines can actually-make pain worse and have many serious side effects. 

The Veterans community is a special community with its own set of values and social mores.  Painaustralia knows from our work with DVA and groups like Soldier On that simply telling former defence personnel that there are services available to help in managing pain may not be sufficient to ensure Veterans have access to appropriate pain management options.

Understanding both the needs and the barriers to best practice pain management for Veterans is not a straight-forward issue.  Understanding how best to address Veteran needs requires careful exploration of the current situation including veterans health programs, the active engagement of supportive Veterans groups, Veterans themselves and pain management specialists.

These barriers may include awareness of how best to manage pain, a perceived lack of confidentiality in seeking treatment and various forms of stigma around help seeking behaviour by Veterans.  The consequences of this lack of uptake to treatment may be an increased risk of suicide, drug dependence and other harmful outcomes. 

Painaustralia supports the aims of the Royal Commission as there is a need to take a more strategic national approach. We hope its outcomes result in helping our Veterans move towards a future with improved mental health, well-managed chronic pain and a mindset that helps them to live well rather than an enemy in the fight.

Are you a Veteran or current serving ADF member?  Painaustralia will be providing a submission into the Royal Commission and we’d love to hear your story about how you manage your pain.