Veteran experiences of living with chronic pain in the context of VA care and an opioid 'epidemic'
Koenders, Sedona L.
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While chronic pain is an increasingly prevalent condition in the United States, it is twice as common among the military veteran population. As many Vietnam War era veterans are aging and experiencing comorbid medical conditions, their chronic pain is becoming increasingly complex. Policies enacted in response to the ‘opioid epidemic’ have in some ways made treatment of pain safer, but have also left remaining questions regarding how to properly provide care. There are three fields of complexity that interact within this topic: patients with a clear need for care and pain management, providers committed to helping patients, and structural barriers that unintentionally interfere with the provision of care. The lived experience of chronic pain and receiving care through the VA healthcare system combined with a common military culture exemplifies a lifeworld centered on pain—which I call a ‘painworld.’ This painworld is seen in the illness narratives of older, white, male veterans with chronic pain. Examining the way a single VA site provides pain care shows the providers are dedicated to treating veteran patients and offer a large number of treatment options. While the need for pain management services is clear from both the patient and provider perspectives, translating the lived experience of these veterans and their medical needs into a hierarchical bureaucratic structure is difficult. Furthermore, the bureaucratic nature of a large federal organization creates gaps in the healthcare system. This leads to the creation of informal systems through systems-correcting praxis to fill the gaps and attempt to prevent siloing and slippage throughout. Together, these fields of complexity are organized into three chapters, building the argument that the convergence of veteran painworlds, pain care, and bureaucracy can contribute to miscommunication, leading to unintended slippage through the system and inadequate care, despite good intentions of staff. Furthermore, the VA system and structure of providing pain care both influences and is part of the painworld, as are the interactions that occur between veteran patients and staff.