It might not be the first thing that comes to mind when you think of wounded warriors, but back pain is a prevalent problem that actually leads to a large number of evacuations from downrange. Specifically, musculoskeletal pain and spine pain syndromes are the most common cause, accounting for between 30 to 35 percent of evacuations from Iraq and Afghanistan.

In a recent issue of The Spine Journal, editor-in-chief Eugene J. Carragee, MD, of the Stanford University School of Medicine, explores this trend among troops and offers suggestions as to how the issue can be handled.

This is a topic that Carragee was able to address from both a clinical and personal perspective, having served 27 years in the Army and retired in 2010 as an O-5. His co-author, Ronald A. Lehman Jr, MD, of the Walter Reed National Military Medical Center, still serves on active duty.

"Unlike any previous period in our nation's history, we have documented many of the challenges faced by spine providers in taking care of the unique injuries sustained in combat operations in Iraq and Afghanistan," said Dr. Lehman, who has treated hundreds of soldiers with non?battle and combat?related spine injuries.

Most of the injuries resulting from today's conflicts are unlike any previously reported in Vietnam or Korea, many of which stem from the strain of body armor or the danger of IED explosions. Unfortunately, many of these complaints are not a result of distinct injuries like fractures or disc issues, making it even harder to diagnose and treat. The research reports that there have been 10 times as many long-term spinal pain casualties unrelated to the physical injuries of battle reported in these recent conflicts.

An earlier study, conducted in 2009 by the John P. Murtha Neuroscience and Pain Institute, U.S. Army and by the Army Regional Anesthesia & Pain Medicine Initiative, revealed that Soldiers who left combat areas with low back pain complaints had just a 13.3 percent chance of returning to their units.

Though three years have passed, little improvement has been made to those statistics. According to Carragee's current research, if a Servicemember is diagnosed with pneumonia downrange, he or she is 80 percent likely to return to duty; however, if they are evacuated due to back pain, those numbers go down to an 18 to 20 percent likelihood of returning.

"We repeatedly send young people into combat to experience the worst psychological stressors possible, push them beyond endurance, and yet on the home front there is little to no collective understanding of the wars they fought or the experiences of deployment and combat," said Carragee. "Veterans seeking care for spine problems at home are shown to have continued serious psychological distress, associated with exposure to combat. This is a serious public health issue that will continue for many years."

Carragee and Lehman hope that an awareness of the situation can help clinicians to better care for veterans both at home and abroad.

"Doctors cannot treat these guys for just the back injury," Carragee explained. "The care must be more comprehensive, especially when dealing with these combat veterans."

The Spinal Journal reports cites that 60 percent of veterans seeking care for spine problems have serious continued psychological distress. That distress can seriously hinder recovery, even after specific treatments and surgical measures.  Carragee said that the doctors and surgeons treating these veterans need to view their recovery potential differently from the beginning.

"People with the long-term injuries and complaints need to be taken care of long-term by someone with complex spinal knowledge," he added. "That is the level of care that we need our Soldiers and veterans receive."