Military veteran living with chronic pain for a decade says he had to learn to 'push through'

Paul Roos has been living with chronic pain for the last 10 years — a direct result of injuries he sustained while serving as an infantry officer in the Canadian Armed Forces.

Roos, also the director of operations with the Chronic Pain Centre of Excellence for Canadian Veterans in Hamilton, says chronic pain is a condition affecting roughly 20 per cent of Canadians. The pain persists longer than three months after an injury.

"When I served in the Canadian Armed Forces, I had a couple of injuries, and some of them have some lingering problems, including chronic pain," Roos told CBC Hamilton. 

"In the Canadian Armed Forces, we found that veterans are suffering from chronic pain at twice the rates of Canadians, so it's a rate of about 40 per cent of veterans actually suffering from chronic pain."

Roos served for nine years in the Canadian Armed Forces starting in 2008, and his chronic pain began in 2012 while he was still in active service.

He said he suffered "an overuse injury" in his left leg and his right arm, "and a couple of problems" with his back as well. 

'A barrier to being active'

While his injuries weren't "catastrophic … or something that happened in a war zone," Roos said his ability to do normal day-to-day activities, including regular exercise, has been greatly affected.

"For myself, my injuries were always induced by activity, so I would always have a lower level of pain in my neck and my back, but if I tried to be more active, then the pain levels would go up, so it would act as a barrier to being active on a usual basis," he said.

"It really does act as a barrier because if you stop exercising, your injuries will typically get worse because you're not using your body anymore. But if you do exercise, you have to face a certain level of pain, and you've got to figure out if that pain is actually making things worse or if it's a manageable level of pain. 

"So, over time, there was a number of years where I stopped exercising just because it would cause pain," Roos added.

Roos said he eventually met a chiropractor in a pain clinic who was able to reduce the pain levels, and walked him through "what is an acceptable level of pain that you should push through and what you shouldn't push through."

The federal government launched the Chronic Pain Centre of Excellence for Canadian Veterans — a national research institution that works with veterans and their families — at McMaster University's Faculty of Health Sciences in May 2020.

Its mandate is to "build a knowledge system and develop evidence-based pain management therapies that will shape the future of veteran-first chronic pain management."

"Equipped with this research, the Centre of Excellence will provide training and education to care teams across the country," a news release announcing the centre said.  "This will allow veterans access to evidence-based, high-quality pain management services closer to home."

Chronic pain can be highly debilitating, particularly for veterans whose pain is often compounded by a myriad of factors like mental and emotional health after service.- Tom Hoppe, military veteran and chair of CPCoE

In the 2019 budget, the federal government announced $20.1 million in funding over five years from Veterans Affairs Canada, with $5 million annually per year ongoing to establish the centre at McMaster University in order to conduct research into innovative pain management therapies.

Tom Hoppe, military veteran and chair of the Centre of Excellence Advisory Council of Veterans (CPCoE) says chronic pain involves a complex set of physical, cognitive, emotional, social, and environmental factors. 

"Chronic pain can be highly debilitating, particularly for veterans whose pain is often compounded by a myriad of factors like mental and emotional health after service," Hoppe said. 

"For some veterans, a better understanding of how chronic pain impacts their life will allow them to make changes to improve their well-being and to use their treatment benefits to better manage their pain. For other veterans, a higher level of care is required."

Recent government of Canada research found that veterans are twice as likely to suffer from chronic pain compared to others in the Canadian population. Furthermore, 50 per cent of female veterans suffer from chronic pain and 63 per cent of veterans diagnosed with chronic pain have associated mental health conditions.

"Our work at the CPCoE is about coming alongside veterans living with chronic pain and offering resources and education but also community and encouragement to keep persevering," Hoppe said.

Veterans Affairs Canada (VAC) also provides coverage for a variety of services for veterans with chronic pain, although the extent of the coverage depends on a number of factors, VAC told CBC Hamilton. 

Once approved for a condition related to chronic pain, VAC says, a veteran could be entitled to the department's Treatment Benefits Program or could be covered for ambulance services, health-related travel, injections, medications, massage, osteopathic, chiropractic and mental health services.

Dr. Norm Buckley, medical director of the DeGroote Pain Clinic at Hamilton Health Sciences, says they see about 70 veterans per year in their intensive program, and about 20,000 patient-visits yearly, which translates to about 4,000 unique patients.

"The bulk of the patients come from our referral area, where as a tertiary care referral pain clinic, our referral area extends from Niagara Falls up to north of Guelph, and we get some from a little further afield," Buckley told CBC Hamilton. 

"The veterans referred into the intensive program actually come from all across the country."

People who have chronic pain and start to become restricted in their activities may experience breakdown of social relationships.- Dr. Norm Buckley, medical director, DeGroote Pain Clinic

Buckley says there are psychological and social aspects to pain, both of which must be addressed to ensure success for patients.

"The psychological part has to do with the way people learn, the way people recover from illnesses," he said.

"The social piece, people who have chronic pain and start to become restricted in their activities may experience breakdown of social relationships. There may be inability to go to work, inability to, you know, indulge in leisure activities. They may, because they feel lousy all the time … stop interacting with people and then your social relationships break down."

Meanwhile, Buckley says validating pain is part of the process. 

"One of the challenges of pain is that it's not measurable … [and] some patients find themselves feeling as though nobody believes them, and so part of the process is validating their pain experience," he said.

Buckley, also scientific director at Michael G. DeGroote Institute for Pain Research and Care, said in their intensive pain management program, success looks like regaining a significant amount of function. 

"One of our veterans talks about being able to take his kids to Canada's Wonderland, pace himself throughout the day, rest appropriately, but also benefit from the fact that as he reactivated he developed more endurance and so is much more aware of  the implications of his chronic pain problems, but able to resume a more functional, social and personal life," he said.

"So, frequently, success looks like people understanding what's going on, developing some sort of stable regimen of medication and or activities and at least not deteriorating any further and perhaps having improved mood and improved quality of life."

Bringing awareness to issue of chronic pain

Last month, Roos joined other veterans in a hike to bring awareness to the issue of chronic pain.

The first-ever Military Veterans Alpine Challenge — a seven-kilometre hike accessed by helicopter — took place in Whistler, B.C., on Aug. 27. 

Roos said the hike focused on the ideas of hope, comradeship, achievement, and challenge, adding that these themes resonate with veterans and help create parallels between life during and after service, ultimately providing a strategy for living life with a renewed sense of purpose. 

"The Alpine Challenge provided individual participants with a goal to work for and a reason to challenge themselves," Roos said.

"The highlight, along with my experience, was the renewed sense of camaraderie among everyone who participated."