">

Cooling

Soothing

Relaxing

Uplifting

Posts Tagged ‘ptsd’

Pain USA, PTSD with Military soldiers

Posted on: July 12th, 2013 |

 

 

On my Martial arts website, I wrote an article about research on joints.  (See Professor Vandry’s View Again the Racehorse theory for Joints! Collagen 1, 2, and 3, Vitamins and Minerals for the joints, Serrazyme Nattokinese (fibrinogen breakup), Lumen 90, and of course St. Jude’s Miracle Oil®!)1

From the article above, the SJMO refers to medical journals for limited references on how these oils work.  Regarding the title of this article, we refer to medical journals on each of our 9 oils in St. Jude’s Miracle Oil®2

Wintergreen acts as an anti-inflammatory agent (1-4).  The medicinal properties of peppermint oil are analgesic, anti-septic, anti-inflammatory, and antimicrobial, among others (5).  Lavender has anti-inflammatory and analgesic properties (6), and pain relief assessment (7).  Eucalyptus Blue has anti-inflammatory and analgesic properties (8), Clove bud has anti-infectious properties include: anti-viral, anti-bacterial, anti-fungal effects (9-10).  Geranium has shown temporary relief of neuralgia pain (11).  Clary Sage in pain relief on outpatients with primary dysmenorrhea (12).  Frankincense was used for symptomatic knee osteoarthritis. (13) Myrrh oil has anti-inflammatory and analgesic activity (14). 

As referenced on another website, Essential oils do not require FDA approval.  However, manufacturers are not allowed to claim that they prevent or treat illness. We do not make claims such as those, but oils in our product have been used separately in clinical trials in medical journals I have researched.  Our goal is to explore clinical trials with our oil regarding the above results from medical journals.  When we research inflammation, or infection, viral and others, many wonder who does this effect?  How many people in society can use this?  This is in my opinion a huge wakeup to developing alternative means to our standard system that has criticism.

Military veteran’s service connected disabilities…pain, pain, pain!

bva7

(Added photo: William Vandry lecturing research on pain, nutrition, diseases of legal blindness to VFW/BVA San Antonio 2014)

Nationally, according to the federal Veterans Benefits Administration, musculoskeletal conditions were the No. 1 service-connected disability for veterans every year from 2007 to 2011.

Overview of Pain in the United States and the Military Health System on pain statistics:

This basically translates into Pain is the most frequent reason patients seek physician care in the United States, and more than 50 million Americans suffer from chronic pain.  The annual cost of chronic pain in the U.S. is estimated at $100 billion, including health care expenses, lost income, and lost productivity.  Back pain alone is the leading cause of disability in Americans under 45 years of age. The failure to adequately address pain in the health care system continues to result in unnecessary suffering, exacerbation of other medical conditions, and huge financial and personnel costs. 

According to the American Academy of Pain Medicine, “pain medicine” is a relatively new medical specialty that is evolving along with its place in the medical hierarchy.  Although there are many treatment modalities for pain management, one of the major components for the treatment of pain continues to be the use of Over-The-Counter and prescription medications.

The use of medications is appropriate, required, and often an effective way to treat pain. However, the possible overreliance on medications to treat pain has other unintended consequences, such as the increased prevalence of prescription medication abuse and diversion throughout the United States.  According to the Office of National Drug Control Policy, prescription opioid analgesics are the most commonly abused prescription drugs in the U.S., with the highest rate of abuse occurring among those ages 18-25.

For patients interested in treatments other than, or in addition to, medication, Complementary Alternative Medicine (CAM) is a popular option.

Though CAM is increasing in popularity among patients, this popularity has yet to result in a parallel increase in acceptance and use within traditional medicine.

There is a wide range of these therapies and treatments, such as acupuncture and yoga therapy, that have proven valuable in reducing an overreliance on use of medications to treat pain.  Many of the Military Health System’s (MHS) challenges with pain management are very similar to those faced by other medical systems, but the MHS also faces some unique issues because of its distinctive mission, structure and patient population.

The Pain Management Task Force developed 109 recommendations that lead to a comprehensive pain management strategy that is holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain. 

The recommendations rely heavily on an education and communication plan that crosses DoD and VHA medical staff and patients. The Task Force also placed an emphasis on linking to existing Service and MHS initiatives (e.g. Patient Centered Medical Home, Comprehensive Soldier Fitness) that support the pain management strategy. The requirement to synchronize both effort and approach to pain management across the MHS and VHA is an essentialfirst step in combating the variability that plagues pain management across the MHS. This requirement was the driving force behind many of the other TF recommendations.

 Pain Management Task Force Final Report:

• One study reported 48% of veterans experienced pain regularly and expressed concern over their pain. Use of outpatient medical services in these veterans was significantly higher than those that did not report chronic pain.1

• A separate study of veterans found that the most common chronic pain conditions were joint pain, back pain, headaches, limb pain, and abdominal pain.  Women had a significantly higher prevalence of headache, abdominal, and limb pain than men, and men had a significantly higher prevalence of back pain and joint pain than women. Chronic chest pain was similar in both samples. Among the  women, 82.5% met the sample criteria for a single pain site, and 17.5% had multiple pain sites. In comparison, 86.7% of men met the sample criteria for a single pain site, and 13.3% had multiple pain sites.2

• In recent years, the Afghan and Iraq Wars have increased the prevalence of migraines and headaches in veterans returning to theUnited States.

In one study of 3,621U.S.soldiers screened within 90 days of returning from a one-year combat tour in Iraq, soldiers were shown to have two to four times the incidence rate of migraine as compared to the general population.3

•   Chronic pain and PTSD are often found together (co-morbid). In one study of veterans with PTSD, 66% had chronic pain diagnoses at pretreatment. Patients with more pain before treatment reported reductions in pain over the course of PTSD treatment and in the four months following treatment.4

•  One study found that Gulf War deployment was associated with higher prevalence of Chronic Widespread Pain (CWP) than deployment elsewhere. Both deployed and non-deployed veterans with CWP reported more health care utilization and co-morbidities and lower health-related quality of life scores than veterans without CWP. Deployed veterans were more likely to have CWP than non-deployed veterans, and CWP was associated with poor health outcomes.5

•   Among the Gulf War veterans evaluated in a separate study, family history, pre-deployment symptoms, and the level of perceived stress during the war were associated with subsequent development of CWP.6

•   An estimated 17.6% of veterans with Gulf War syndrome have also shown an association with fibromyalgia.7

(NOTE:  If you are a vet reading this or someone who has fibromyalgia, refer to the article on my other website on joints and the MD research on nattokinese)

• The most common reasons for medical evacuation of military personnel from war zones in Iraq and Afghanistan in recent years have been fractures, tendonitis and other musculoskeletal and connective tissue disorders, not combat injuries, according to results of a Johns Hopkins study.8

•   Military personnel evacuated out of Iraq and Afghanistan because of back pain are unlikely to return to the line of duty regardless of the treatment they receive, according to research led by a Johns Hopkins pain management specialist.  Researchers found that just 13% of service members who left their units with back pain as their primary diagnosis eventually returned to duty in the field.

Women, officers, those deployed in Afghanistan and those with previous back pain had better outcomes, but only marginally. Aside from combat injuries sustained during battle, the return-to-duty rate for spinal pain and other musculoskeletal disorders is lower than for any other disease or non-combat injury category except for psychiatric illness, the researchers said.9

• Research has found that being female, enlisted rank groups, service in the Army, Navy, or Air Force, age greater than 40 years, and a marital status of married were all risk factors for low back pain among active-duty military. Each service, when compared with the Marines as the referent category, had a significantly increased incidence rate ratio of low back pain:10

– Army: 2.19

– Navy: 1.02

– Air Force: 1.54

• One study of racial differences among active-duty military with low-back pain.

• A survey of VA primary care providers (PCPs) found:19 – 77% of respondents identified pain control among the top three treatment priorities.

– primary care physicians who did not choose pain control were more likely to indicate that chronic pain patients should see a specialist (54% vs. 35%)

– of the respondents, 86% reported psychology or mental health clinics were available at their clinic site; 71%, physical therapy; and 20%, multidisciplinary pain clinics most PCPs (74%) were satisfied with the quality of care they provide for patients with chronic pain but only 30% were satisfied with access to pain specialty services

• In the first study to look at sex-specific pain prevalence in Operation Enduring Freedom/ Operation Iraqi Freedom (OEF/OIF) Veterans, researchers from the VA Connecticut Healthcare System and the Yale University School of Medicine found women veterans had a lower prevalence of pain than male counterparts returning from the conflicts.11

– Results indicate that of those veterans evaluated for pain, 43.3% reported any pain, 63.2% of those with pain reported moderate-severe pain, and over 20% of those with pain scores recorded over three months’ time reported persistent pain.

– According to the study, female veterans were less likely to report any pain (38.1% vs. 44.0%). In veterans with any pain, researchers found female veterans were 6% more likely to report moderate-severe pain (68.0% vs. 62.6%) and less likely to report having persistent pain (18.0% vs. 21.2%) than male colleagues.12

• One study of veterans with chronic non-cancer pain found that more than 80% reported previously trying CAM, and almost all reported a willingness to try one or more of the four CAM modalities being studied (massage, acupuncture, chiropractic, herbal medicine).

– Veterans in the study who had already tried CAM treatments differed little from veterans who had not, suggesting that many veterans experiencing chronic pain may be interested in CAM treatment options for chronic pain. The results of this study support the VA’s increasing movement toward offering CAM modalities as treatment options for pain.13

• Based on a large, nationally representative sample, a recent publication reported that military veterans were twice as likely to commit suicide as nonveterans.

Chronic pain and depression – two conditions not uncommon in VA medical settings – are leading contributing factors in deaths by suicide.

A systematic literature review of pain and suicide, suicide attempts and thoughts of suicide revealed that patients with chronic pain had a 2-fold risk of death by suicide, a 14% prevalence of suicide attempts (compared with 5% without chronic pain), and a 20% prevalence of suicide ideation.

 Solutions?

In researching pain, I have found injuries along with inflammation seems to be the main problem.  In other words, when we develop an injury, inflammation is consistent, and our needs for NSAIDS and other pain medications are the primary source of relief.  What seems to be a lack of knowledge is handling pain in society, and especially for our military.  I found that over the recent years, the military has looked at alternative pain therapy, and one  shows the  new approach to pain management at Dwight D. Eisenhower Army Medical Center is setting the tone for the rest of the Army:

“The recently launched interdisciplinary pain center focuses on replacing pain medication with alternative remedies such as acupuncture, along with teaching soldiers coping mechanisms for pain. It’s an important resource in an active duty force where muscular skeletal issues make up about 80 percent of medical board evaluations, said Maj. Jeffrey Tiede, the chairman of Eisenhower’s Department of Pain Management.”

Issues with essential oil

I am aware of many critical opinions on essential oils, but there are two issues:

1.  There are those who are excited about selling oils or health products, supplements, etc. and run into the same problems as many other health products, the ‘cure-all’ claims, or a claim that has no evidence, whether scientific or anecdotal. 

2. I have read opinions on skeptical websites with statements such as: “Why doesn’t Harvard fund research?”, and the implications are a misunderstood assessment or theory that there is no evidence is really a lack of information. 

We have references on this website to many medical journals we researched and found on essential oils, particularly the oils in our product.  There are benefits to essential oils that can be argued on a clinical level, although there definitely is a thirst for more thoroughly examined and funded research.  For example, medical journals generally show a very positive view on oils:

Psychological Response to Treatment

“Psychological responses to treatment were assessed as changes in anxiety and depression according to the STAI and SDS results.  State anxiety scores from the STAI were significantly reduced after both aromatherapy massage and control massage compared with the baseline obtained before the massage.”5

I feel the more important point would be a desire to fund more research instead of criticizing a subject without evidence.  Here is a  great article on PTSD and essential oils tackling this argument on PTSD:

Post-traumatic stress –can essential oils help?

Concerned that essential oils are often recommended for post-traumatic stress disorder with little supporting evidence, Susan Rands carried out a systematic literature review.

Conclusion:

“The results of this systematic review indicate that of the original 45 essential oils that were recommended for treating or managing PTSD only four – lavender, lemon, roman chamomile and ylang ylang – may be effective in treating some of the symptoms of PTSD such as anxiety, depression, insomnia, re-experiencing and anger. Currently, there is not sufficient evidence arising from blinded RCTs to support the use of the remaining 41 oils.” 

(My insert here.  On the website I saw a very thorough research study on the limited essential oils study.)

The potential for using essential oils in the treatment of PTSD needs to be researched further since their value may lie in providing safe alternatives or complements to anxiolytic and antidepressant medications in order to improve PTSD sufferers’ sense of well-being.  Of the 525 papers found in the first search only two investigated the use of essential oils in the treatment of PTSD. 

One looked at the use of essential oils in conjunction with hypnosis, but it was the hypnosis that was the focus of the study (Abramovitz, 2009).

The other (for which only an abstract was found) discussed aromatherapy and physiotherapy as precursors to counselling (Kinchin, 1997). 

The second stage of the search located 1228 peer reviewed papers of which 28 complied with the inclusion/exclusion criteria. The third stage of the search located 959 papers of which 32 were selected for potential inclusion in the systematic review.  Of the 60 papers with potential for inclusion, 25 could only be located as abstracts, four were excluded because they were animal rather than human studies, and one paper was excluded because it studied the effect of ingestion.

The remaining 30 papers were scrutinised for scientific rigour of methodology in accordance with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria.6

Evidence?  Response to the “Where are the Harvard studies?”

I believe the issues above show a very low effort to give scientific evidence on essential oils is directed to the point of the study.  Going back to just pain (since this is the subject regarding people in general and the military) , referring to the oils in our product, we need to reiterate some scientific research on pain and oils.  Reference above to our oils are evidence, but specifically and briefly here are studies on some of our essential oils for pain:

Lavender has  pain relief assessment. 

Geranium has shown temporary relief of neuralgia pain. 

Clary Sage in pain relief on outpatients with primary dysmenorrhea.

Now going back to inflammation, essential oils in our product have anti inflammatory effects, which are keys to pain.  Athletes need ice, then the RICE method (rest, ice, elevation, compression) but what does it do?  It reduces inflammation, circulates blood, lowers swelling, etc.. You cannot recover from an injury until you reduce the inflammation.  This demands more scientific study on the effects on inflammation and pain relief. 

Are there more specific references to trials with essential oils and pain?  YES!

1. Aromatherapy has major effects on decreasing pain and depression levels, and can be a useful nursing intervention for arthritis patients.  The essential oils used were lavender, marjoram, eucalyptus, rosemary, and peppermint

Collegeof Nursing, The Catholic University of Korea, Korea, Taehan Kanho Hakhoe Chi. 2005 Feb;35(1):186-94. 

(The effects of aromatherapy on pain, depression, and life satisfaction of arthritis patients)

2. Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial.  Essential oils blended with lavender (Lavandula officinalis), clary sage (Salvia sclarea) and marjoram (Origanum majorana) 

Department of Applied Cosmetology, Hungkuang University, Taichung, Taiwan.  J Obstet Gynaecol Res. 2012 May;38(5):817-22. doi: 10.1111/j.1447-0756.2011.01802.x. Epub  2012 Mar 22

3. Menthol, the cooling natural product of peppermint, is widely used in medicinal preparations for the relief of acute and inflammatory pain in sports injuries, arthritis an Pain

Department of Pharmacology, Yale University School of Medicine, 333 Cedar St., New Haven,CT06520.                                                                                                                                             2013 Jun 29. pii: S0304-3959(13)00364-3. doi: 10.1016/j.pain.2013.06d other painful conditions

4.  The chemical composition and biological activity of clove essential oil, Eugenia caryophyllata (Syzigium aromaticum L. Myrtaceae): a short review  (The essential oil extracted from the dried flower buds of clove, Eugenia caryophyllata L. Merr. & Perry (Myrtaceae), is used as a topical application to relieve pain and to promote healing)  Laboratoire d’Analyses, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, rue Avicenne 5000 Monastir, Tunisie. Phytother Res. 2007 Jun;21(6):501-6.

5.  Effects of aroma hand massage on pain, state anxiety and depression in hospice patients with terminal cancer.  (Aroma hand massage had a positive effect on pain and depression in hospice patients with terminal cancer.) 

Department of Nursing, KeimyungUniversity, Jung-gu, Daegu, Korea.  Taehan Kanho Hakhoe Chi. 2008 Aug;38(4):493-502.

I found some disturbing numbers on PTSD and suffering of our military soldiers:

Up to 37% of the over two million service members who have deployed to Iraq or Afghanistan are struggling with serious mental health problems including post-traumatic stress disorder (PTSD), major depression, and traumatic brain injury.[1]

These mental health conditions result in debilitating pain and suffering and are associated with additional problems including addiction, difficulties maintaining work, and homelessness.[2]

These mental health issues can lead to tragic consequences, as illustrated by increasing military suicide rates.

Active duty suicides reached epidemic levels in 2010 with one active duty service member committing suicide every 36 hours.

Our Veterans are killing themselves at twice the rate of other Americans.[3]-[4]

Fortunately, there are effective treatments for these mental health problems and a great number of clinicians dedicated to helping our nations heroes.  Unfortunately, even when provided with the best evidence-based treatments, non-response rates can be as high as 50%.[7]

In addition, access to these treatments may be obstructed by an array of institutional and diagnosis-related barriers.

 I literally could research on and on, but the point is a large demand for more research.  Chronic pain with the general public and especially our military veterans relate with inflammation, insomnia, stress, nutrition and other areas.  We need to develop funding for more projects that involve our military with PTSD, pain, inflammation, and even the secondary effects such as anxiety, depression and hopefully to regain their peace of mind in society.  God bless our military soldiers.  I pray for your speedy recovery.

bva5

Photo: Blind Veterans San Antonio President Wally Guerra and William Vandry

William Vandry (Co-inventor SJMO product, researcher)

References

 

1. http://www.William Vandry.com/2013/04/28/professor-vandrys-view-again-the-racehorse-theory-for-joints-collagen-1-2-and-3-vitamins-and-minerals-for-the-joints-serrazyme-nattokinese-fibrinogen-breakup-lumen-90-and-of-course/

2. 9 essentil oils of SJMO

 

1. Methyl salicylate 2-O-β-D-lactoside, a novel salicylic acid analogue, acts as an anti-inflammatory agent on microglia and astrocytes.Lan X, Liu R, Sun L, Zhang T, Du G.J Neuroinflammation. 2011 Aug 11;8:98. doi: 10.1186/1742-2094-8-98.

2. A novel naturally occurring salicylic acid analogue acts as an anti-inflammatory agent by inhibiting nuclear factor-kappaB activity in RAW264.7 macrophages. Zhang T, Sun L, Liu R, Zhang D, Lan X, Huang C, Xin W, Wang C, Zhang D, Du G.Mol Pharm. 2012 Mar 5;9(3):671-7. doi: 10.1021/mp2003779. Epub 2012 Feb 15.

3. Anti-inflammatory activity of methyl salicylate glycosides isolated from Gaultheria yunnanensis (Franch.) Rehder.Zhang D, Liu R, Sun L, Huang C, Wang C, Zhang DM, Zhang TT, Du GH.  Molecules. 2011 May 9;16(5):3875-84. doi: 10.3390/molecules16053875

4. Evaluation of the new anti-inflammatory compound ethyl salicylate 2-O-β-d-glucoside and its possible mechanism of action.  Xin W, Huang C, Zhang X, Zhang G, Ma X, Sun L, Wang C, Zhang D, Zhang T, Du G.Int Immunopharmacol. 2012 Dec 4;15(2):303-308. doi:10.1016/j.intimp.2012.11.014.

5. Mullally BH, James JA,CoulterWA,LindenGJ. The efficacy of a herbal-based toothpaste on the control of plaque and gingivitis. J Clin Periodontol. 1995;22(9):686–9.

6. Hajhashemi, V., Ghannadi, A., & Sharif, B. (2003). Anti-inflammatory and analgesic properties of the leaf extracts and essential oil of lavandula angustifolia mill. Journal of Ethnopharmacology, 89(1), 67-71.(Lavender)

7. Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial.  Ou MC, Hsu TF, Lai AC, Lin YT, Lin CC.  SourceDepartment of Applied Cosmetology,HungkuangUniversity,Taichung,Taiwan

8. Phytochemical composition of Cymbopogon citratus and Eucalyptus citriodora essential oils and their anti-inflammatory and analgesic properties on Wistar rats.  Gbenou JD, Ahounou JF, Akakpo HB, Laleye A, Yayi E, Gbaguidi F, Baba-Moussa L, Darboux R, Dansou P, Moudachirou M, Kotchoni SO.  SourceLaboratoire de Pharmacognosie et des Huiles Essentielles, Faculté des Sciences de la Santé, Faculté des Sciences et Techniques, Université d’Abomey Calavi, 01 BP 918,Cotonou,Benin.

9. Antifungal activity of the clove essential oil from aromaticum on Candida, Aspergillus and dermatophyte species Euge´ nia Pinto,1 Luı´s Vale-Silva,1 Carlos Cavaleiro2 and Lı´gia Salgueiro2

10. Curr Med Chem. 2003 May;10(10):813-29.Antibacterial and antifungal properties of essential oils.  Kalemba D, Kunicka A.SourceInstitute of General Food Chemistry, TechnicalUniversity of Lodz,Poland.

11. 20Greenway, f, Frome & Engels, T. (2003). Temporary relief of postherpetic neuralgia pain with topical geranium oil. American J of Medicine, 115, 586-587.

12. Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: a randomized, double-blind clinical trial.  Ou MC, Hsu TF, Lai AC, Lin YT, Lin CC.  SourceDepartment of Applied Cosmetology, HungkuangUniversity, Taichung, Taiwan.

13. Rheumatology (Oxford). 2013 Jan 30. Ayurvedic medicine offers a good alternative to glucosamine and celecoxib in the treatment of symptomatic knee osteoarthritis: a randomized, double-blind, controlled equivalence drug trial.  Source Center for Rheumatic Diseases, Pune, School of Biomedical Sciences, Symbiosis International University, Pune, BJ Medical College, Pune, Department of Rheumatology, Nizam Institute of Medical Sciences, Hyderabad, Department of Medicine, All India Institute of Medical Sciences, Delhi, Interactive Research School for Health Affairs, Bharati Vidyapeeth Deemed University, Pune, SPARC Institute, Mumbai, Department of Medicine, KEM Hospital, Mumbai and Symbiosis International University, Pune, India

14. Anti-inflammatory and analgesic activity of different extracts of Commiphora myrrha.  Source:JiangsuKey Laboratory for TCM Formulae Research,NanjingUniversityof   Chinese Medicine,Nanjing210046, PR China.

3. References:

1. Kerns R, Otis J, Rosenburg R, Reid C. “Veterans’ reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system.” J Rehabil Res Dev. 2003 Sept-Oct;40(5):371–80.

2. Kaur S, Stechuchak K et al. “Gender differences in health care utilization among veterans with chronic pain.” J Gen Intern Med. 2007 Feb;22(2):228–233.

3. Nati

4. Shipherd JC, Keyes M, Jovanovic T, Ready DJ, Baltzell D, Worley V, Gordon-Brown V, Hayslett C, Duncan E. “Veterans seeking treatment for posttraumatic stress disorder: what about comorbid chronic pain?” J Rehabil Res Dev. 2007;44(2):153-66.

5. Forman-Hoffman VL, Peloso PM, Black DW, Woolson RF, Letuchy EM, Doebbeling BN. “Chronic widespread pain in veterans of the first Gulf War: impact of deployment status and associated health effects.” J Pain. 2007 Dec;8(12):954-61.

6. Ang DC, Peloso PM, Woolson RF, Kroenke K, Doebbeling BN. “Predictors of incident chronic widespread pain among veterans following the first Gulf War.” Clin J Pain. 2006 Jul-Aug;22(6):554-63.

7. Yunus M, “The Prevalence of Fibromyalgia in Other Chronic Pain Conditions.” Pain Res and Treatment. 2012:1-8.

8. Cohen S, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels S. “Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom: a prospective cohort study.” Lancet. 2010 Jan;375:301-309.

9. Aldington D. “Back pain: the silent military threat.” Arch Internal Med. 2009 Nov;169(20):1923-24.

10. Knox J, Orchowski J, Scher DL, Owens BD, Burks R, BelmontPJ. “The incidence of low back pain in active duty United States military service members.” Spine. 2011 Aug 15;36(18):1492-500.onal Headache Foundation. War Veterans Health Resource Initiative. http://www.headaches.org/warveterans/index.html. Accessed June 27, 2012.

11. Kaur S, Stec

12. Haskell S, Brandt C, Krebs E, Skanderson M, Kerns R, Goulet J. “Pain among veterans of Operations Enduring Freedom and Iraqi Freedom: do women and men differ?” Pain Med. 2009 Oct;10(7):1167.

13. Denneson L, Corson K, Dobscha S. “Complementary and alternative medicine use among veterans with chronic non cancer pain.” J Rehab Res Dev. 2011;48(9)1119:1128.huchak K et al. “Gender differences in health care utilization among veterans with chronic pain.” J Gen Intern Med. 2007 Feb;22(2):228–233.

4. (The role of pain management in recovery following trauma and orthopaedic surgery.  J Am Acad Orthop Surg. 2012;20 Suppl 1:S35-8. doi: 10.5435/JAAOS-20-08-S35.  Walter Reed Army Medical Center, Washington, DC, USA.)

5. Immunological and Psychological Benefits of Aromatherapy Massage  (Evid Based Complement Alternat Med. 2005 June; 2(2): 179–184. )

6. References:

Abramovitz, E.G. and Lichtenberg, P. (2009) Hypnotherapeutic olfactory conditioning (HOC): case studies of needle phobia, panic disorder and combat-induced PTSD. International Journal of Clinical and Experimental Hypnosis. 57 (2) pp.184-197.

Anon, (1998) Practice Parameters for the Assessment and Treatment of Children and Adolescents With Post Traumatic Stress Disorder. Journal of the American Academy of Child & Adolescent Psychiatry  37 (10) pp.4S-26S.  Braden, R., Reichow, S. and Halm, M. A. (2009) The Use of the Essential Oil Lavandin to Reduce Preoperative Anxiety in Surgical Patients. Journal of PeriAnesthesia Nursing. 26

(6) pp.348-355. Dileo, J. F., Brewer, W. J., Hopwood, M., Anderson, V. and Creamer, M. (2008) Olfactory

7. PTSD and suffering of our military soldiers References:

1] Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008. Am J Public Health. September 1, 2009 2009;99(9):1651-1658.

[2]Karney BR, Ramchand R, Osilla KC, Calderone LB, Burns RM. Predicting the Immediate and Long-Term Consequences of Post-Traumatic Stress Disorder, Depression, and Traumatic Brain Injury in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom. In: Tanielian TL, Jaycox LH, eds. Invisible Wounds of War: Psychological and cognitive injures, their consequences, and services to assist recovery. Santa Monica, CA: Rand Corporation; 2008.

[3] McFarland BH, Kaplan MS, Huguet N. Datapoints: Self-Inflicted Deaths Among Women With U.S. Military Service: A Hidden Epidemic? Psychiatr Serv. December 1, 2010;61(12):1177.

[4] Kaplan MS, Huguet N, McFarland BH, Newsom JT. Suicide Among Male Veterans: A Prospective Population-based Study. Journal of Epidemiology and Community Health. July 1, 2007 2007;61(7):619-624.

[7] Schottenbauer MA, Glass CR, Arnkoff DB, Tendick V, Gray SH. Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations. Psychiatry:recoveries, all of you. Interpersonal & Biological Processes. 2008;71(2):134-168.