Israel Has Problems at Top Brass, Pacifies Syria, Mounts Anti-Hezbollah Rhetoric

Israel Has Problems at Top Brass, Pacifies Syria, Mounts Anti-Hezbollah Rhetoric

12/05/2010 Conditions in Israel are not normal, Israeli media suggested Wednesday, citing “challenges” facing the army and the defense establishments on the one hand, and the specter of war whether with Lebanon, Syria or Iran.

“There is no doubt that under normal conditions, the establishment and its top brass would be able to address developments on the ground and decision-making processes from now until the end of the year; however, these are not normal conditions,” Yedioth Aharonoth’s Ron Ben-Yishai warned.

News of ‘major confrontations” between army chief of Staff Gabi Ashkenazi and Defense Minister Ehud Barak continue to percolate thus “jeopardizing their ability  to effectively deal with the various missions faced by the army.” “What started as a conflict between bureaus recently escalated to the point of growing personal hostility,” Ben-Yishai suggests.

Barak insists on choosing his candidate for next army chief in two or three months. This plan provokes anger among Major-General Ashkenazi’s close associates. The army chief will complete his term only in February 2011, so choosing his successor and making major appointments seven months before that will turn Ashkenazi into a “lame duck,” undermining his ability to manage the army effectively.

“The fact that senior US officials have met with Ashkenazi en masse in an effort to curb an Iran strike also undermines the relationship between the two figures,” Ben-Yishai says. However he adds that “despite their poor relationship, Barak and Ashkenazi manage to jointly take level-headed decisions on major issues.”

In the meantime, Israel is seeking to pacify Syria although it is maintaining its aggressive rhetoric against Iran and Hezbollah.

A Haaretz report cites “a synopsis of declarations” made in the past 48 hours to point at “a conflagration” on the northern front.
“The prime minister accused Iran of trying to provoke war between Syria and Israel; the minister for strategic affairs reiterated that a military option exists against Iran’s nuclear program; Iran’s parliamentary speaker threatened a “final and decisive war” against Israel; Lebanon’s prime minister expressed support for Hezbollah’s right to have Scud missiles in its arsenal; Syria’s president warned of “the demise of the peace process”; and Russia’s president, visiting Damascus, said he fears a catastrophe in the region.”

Haaretz believes that developments on the Iranian front depend on the results of Washington’s initiative to impose tougher sanctions – expected to be discussed at the UN Security Council next month. The paper also believes that Hezbollah’s “attempts to exact revenge for the 2008 killing of commander Imad Moghniyeh have failed,” thus leaving the main reason for conflagration in the near future on the alleged transfer of Scud and M-600 missiles from Syria to Hezbollah.

In a bid to pacify Syria, the Israeli army sought Tuesday to explain that PM Benjamin Netanyahu’s visit to a reservist training center in Northern Command to observe exercises was well planned in advance, as if urging Damascus not to conclude the opposite.

Strong diplomatic activity in the region, recently Russian President Dimitry Medvedev’s visit to Syria, indicates a serious situation in the Middle East.
Iran, Syria, and Hezbollah have said they have no interest in war, but also expressed readiness to confront Israel should it wage war on either party. The picture taken in Damascus a few months ago – joining Presidents Bashar Assad, Mahmoud Ahmadinejad, and Hezbollah S.G. Sayyed Hasan Nasrallah – was a clear message to Israel in this regard.

Apparently Israel is not ready to wage war on Lebanon at the present time; its army and defense establishments have their differences; they have the problem of shelters for settlers mainly in the north, they have the problem of being engaged in war on two, three, and maybe four fronts, and they have the problem of not knowing what to expect from Hezbollah during the course of the war. However it should be taken into consideration that Israel takes action when least expected, and based on speeches by Hezbollah’s S.G. and other senior officials, it can be concluded that “least expected” is no longer present in the resistance’s book of warfare.

India Can’t Handle the Truth About Hemant Karkare’s Murder

SC rejects plea for probe into Karkare’s killing


NEW DELHI: The Supreme Court on Wednesday dismissed a petition for a probe into the killing of Hemant Karkare, head of Maharashtra Police’s anti-terrorist squad (ATS), during the 2008 Mumbai terror attack.

The petition wanted an independent fact-finding committee, headed by a sitting or a retired judge of the apex court, to look into the events before Karkare’s killing.

A bench of Justice B. Sudershan Reddy and Justice Surinder Singh Nijjar rejected Radhakant Yadav’s public interest litigation (PIL) but gave him the liberty to move the high court.

Since Yadav, a three-time Bihar legislator, had moved the Supreme Court under Article 32 of the constitution that deals with citizens’ rights, the apex court questioned him on how his fundamental rights had been encroached upon.

Under Article 32 a citizen of India can knock the doors of the apex court for protection of his rights, including the fundamental rights.

The petition “submitted that there was an abject failure of the state of unparalleled magnitude in protecting the citizens of the country from terrorists, including the death of officers like ATS chief Karkare”.

The petitioner contended that the entire Mumbai terror attack should not be seen as single episode but two different attacks.

The petitioner pointed to the book “Who Killed Hemant Karkare”, authored by former Maharashtra Police chief S.M. Mushrif, which said the government explanation given for the ATS chief’s death was not logical and not believable.

He said the R.D. Pradhan Committee, headed by a former senior bureaucrat, was set up by the state government to give a report on various aspects of the Mumbai attack but it did not receive cooperation from various authorities.

Yadav said that Karkare investigated and exposed the plot of “right wing terror groups” who were responsible for several blasts between 2003 and 2008.

Karkare came to know about the involvement of political and religious leaders and was “only inches away from arresting some of them” before his killing, the petitioner claimed.

The petitioner also claimed that the Research and Analysis Wing, India’s external intelligence agency, had sent the Intelligence Bureau precise and actionable information about the Mumbai attack but it was not passed on to Maharashtra police.

Swat From Staged Drama To the Real Thing–When Is Final Act?

Locating the Swat operation

By Zubair Torwali

Officially known as Operation Rah-e-Rast, the military offensive in Swat has now completed a full year. It is indeed this offensive that earned credibility for the powerful army chief of Pakistan, and – to some extent – for the democratic government as well. The applause aside, let us locate the offensive with the people of Swat.

When asked about the effectiveness of the offensive, Mukhtar Yousafzai – head of the independent Swat ‘qaumi jirga’ and a seasoned political activist — analyses the situation as follows: “In Swat, it was the state agencies that groomed, promoted and protected the terrorists. They were given full liberty to use modern means of propaganda and power such as FM radios [and] sophisticated weapons and had full backing. It was designed to make Swat another Afghanistan. The local leadership was either killed or demoralised. Journalism was banned and free voices were choked. Swat was made a safe haven and, in the end, it was handed over to the Taliban to establish their writ in the way they liked. Swat thus became a paradise turned into hell. But the brave people of Swat did not surrender.”

Continuing, Yousafzai says, “They spread out … organised demonstrations, appealing to the civil society within [the country] and the world outside by demonstrating in Washington, Toronto, London and New York. They circulated memorandums to the embassies of all the nations. Indigenous writers came out and used the might of their pens to bring into the limelight the plight of the people of Swat. Owing to the efforts of the people of Swat, the army decided to launch a third offensive against the Taliban.” He says the two phases of the offensive before Operation Rah-e-Rast were “merely war games”.

“They were never aimed at eliminating militancy from the valley. It is this third phase, known as Rah-e-Rast, that has some credibility.”

Asked to elaborate Yousafzai’s statement on credibility, Mukhtar Lala says, “The Taliban are on the run, their strongholds have been dismantled to a great extent, their leadership and network stand afflicted with remarkable harm and they are now isolated.”

However, Mukhtar is extremely worried about the recent wave of target killings that have targeted some important figures of civil society, such as members of the Swat qaumi jirga and other peace committees. “The peace in Swat is too fragile to rely on … it is suspicious and vulnerable. The blowing up of CD shops and the circulation of threatening letters by the Taliban have again frightened the people, who consider these latest developments as the beginning of a new rising in the valley,” he says.

An internationally recognised researcher on Swat, Dr Sultan-e-Rome says of the operation, “A failure … the fresh wave of target killings right under the nose of the army is a testament … [the decision to] force civilians to form lashkars and be their own watchmen during the night, an increase in the number of army posts and frequent checking and curfews are other testaments.”

However, Rohul Amin, a lecturer in Swat, says. “There is marked improvement in the Swat situation, but there is [still] a sense of fear and insecurity among the people after the new spate of target killings of peace committee members. These attacks will scare tourists away during this season as well. Apart from this, business is picking up and schools and colleges are open. There is the writ of the government. People are satisfied with the success of the operation,” says

Ihsanul Haq Haqqani, a senior journalist from Swat, aptly says, “No doubt, the operation was a success, but the post-operation policy is enough to convert the success into a horrible failure. The civil administration and the political leadership are happy to keep the army engaged in the aftershocks. The army should conclude its job at the earliest.”

Even after a year, one wonders how the trust of the people can be reinforced. Mukhtar Lala has a remedy. “The target killings and the bomb blasts are a result of security lapses. The army is Swat has forgotten its core concern – the security – and is now involved in other rehabilitation activities, which are not their responsibility.” He says, “The military should design measures that would improve its credibility by dealing in a people-friendly manner with civilians. It should be open to criticism and counselling by the civil society of Swat. The media must not be controlled through the ISPR. The Maliks and Khans of Swat should gather on a single platform above party affiliations and unite for the sake of over 1.6 million people of Swat.” He says the Swat qaumi jirga would be organised in each village and at the union council level.

Whether the elimination of militancy from Swat is possible or not, the people of this scenic valley are determined to assist the military in their fight against the militants if the army performs its duty wholeheartedly and builds a better relationship with the people. Unnecessary measures and humiliation of the general public by security personnel would be counterproductive. While the people of Swat have not surrendered to the Taliban, the state is prompting the population of the valley to lose trust.

On the current situation, Ziauddin Yousafzai, the spokesman for the Swat qaumi jirga says, “Over the last year, security forces have been successful in restoring the writ of the government. The prevailing peace is borrowed and temporary. It is tranquillity in the shadows of guns. Peace without guns is our dream and aim. That needs a clear vision and good intentions on the part of the state institutions and the people.”

Zubair Torwali is a freelance analyst and activist based in Swat where he heads Centre for Education and Development. He can be reached at,

Ukrainian opposition attack pro-Russia policies

Ukrainian opposition attack pro-Russia policies

Wednesday, May 12, 2010
KIEV: Hundreds of supporters of President Viktor Yanukovich threw a cordon around the Ukrainian parliament on Tuesday as opposition politicians and demonstrators angrily accused the leadership of selling out the country to Russia.

The ex-Soviet republic is hosting a visit by Kremlin leader Dmitry Medvedev on May 17-18 and tension is high after riots in parliament on April 27.

On Tuesday, several hundred members of the pro-Yanukovich Regions Party formed a barrier to the entrance to the parliament building, while police kept back about 3,000 supporters of former prime minister Yulia Tymoshenko from drawing near. Tymoshenko, who has seized on the Black Sea fleet issue to reinvigorate the opposition, declared: “Everything that happened over Crimea and Black Sea fleet was directed at belittling our independence.”

Rehman Malik’s past being whitewashed

[SEE: Mossad And India Spy Agency Team Up, Target Pakistan]

Rehman Malik’s past being whitewashed

Wednesday, May 12, 2010
Record goes missing, officials punished; Victims come out in the open to complain; source close to PPP terms cases against Malik bogus, politically motivated

By Umar Cheema

ISLAMABAD: The official record of the 1996 cases against interior Minister Rehman Malik has started to disappear and FIA officials who arrested and handled him back in 1996 are now facing his wrath. Meanwhile, A private party has suddenly withdrawn its 15-year old FIR against Mr Malik for illegally grabbing 12 acres of land.

A director of FIA in Peshawar confirmed to The News that the record relating to the minister had been misplaced and it is being reconstructed but he denied they had tampered with the previous record.

The officials have been punished and harassed so much that they have now come on record to publicly complain that they are being targeted by the all-powerful interior minister.

A deputy director of FIA, Tariq Malik, who had reported that Rehman Malik as the then additional DG FIA received two cars as illegal gratification, has been demoted twice and transferred to a far-flung area in Quetta.

Likewise, Sardar Azam, another assistant director, now retired, who had arrested Rehman Malik the day FIR No 14/96 was registered against him, has stated on record to The News that his pension is being delayed as punishment.

An FIR No. 12/97 lodged against the interior minister in 1997 in Faisalabad, for grabbing 12 acres of private land has also been quashed as the complainant, the private party, has suddenly withdrawn it after FIA officials approached it for a compromise.

Tariq Malik, the FIA officer who has been demoted, told The News he would record his statement in case he was summoned by any court or any other authority.

Sardar Azam, who retired in January this year, confirmed to The News that he was the man who arrested and investigated Rehman Malik in 1996 but now his pension benefits were being blocked.

He said he had recorded statements of two Toyota dealers namely Saleem Godiyal and Rafique Godiyal who had admitted giving illegal gratification in the form of two Honda cars to Rehman Malik and these cars were later also recovered by the FIA.

He said the interior ministry was delaying his benefits for no reason and was asking time and again for production of different documents that had been repeatedly submitted but every time a new demand comes up.

Jhang resident Barkhurdar son of Raja Sarang and Tassawar Abbas who lodged an FIR No. 12/97 against the minister in Faisalabad, were approached by FIA officials for a compromise and they have surrendered.

Their surrender even turned out to be surprising for the judge of the special court hearing the case on February 18, 2010 as he called the complainants separately, inquiring about the reason of their surrender and the family head told the judge: “he had become too ill to contest legal battles any further.”

The minister was facing charges of registering false cases against private individuals from Jhang, for pressuring them to quit possession of more than 12 acres of land purchased by them in 1992, as the same land was subsequently got allotted by the minister in the name of his real sister, Noor Begum.

The minister’s staff officer again played an instrumental role as the complainant party submitted to his wishes when strings were pulled.

The petitioner Barkhurdar, a resident of Jhang, confirmed to The News they had withdrawn the case upon the intervention of “some common friend”. He also confirmed the judge hearing the case was curious about the withdrawal decision and he had told him that being a diabetic patient, he couldn’t afford legal battle like this.

Tasarruf Shah, Deputy Director FIA, Faisalabad, when contacted by The News denied playing any role in this case.

Tariq Malik, FIA’s deputy director, who has twice been demoted after he refused to temper with the record about charge-sheeting of the minister, has now been transferred to Quetta from Islamabad. But he told The News he would speak about it in a court of law.

Tariq being an FIA inspector had filed a source report in 1996 that led to the registration of an FIR No. 14/96 against Rehman Malik alleging that he received two Honda cars as bribe from Toyota Company.

The minister’s staff officer summoned Tahir Malik in the interior ministry six weeks ago and interrogated him on how he came to know about the cars and how was it a bribe. The staff officer then demanded of Tariq Malik to alter his statement to help Rehman Malik get acquitted from the court.

As Tariq refused he was told that times had changed. “I know times have changed and also know it is changing very fast,” he is said to have replied. However Malik had to pay for his defiance as he was demoted one down to an assistant director, a notification which was cancelled later by the secretary interior.

But in a space of two weeks, he was not only demoted again but also transferred to Quetta, a station that is seeing the pullout of all Punjabi FIA staffers after some of them were murdered there.

All these cases against Rehman Malik stand reopened after the revocation of the NRO but since the FIA is the executing agency it is lending crucial support to cover up the past cases against their current boss.

The News talked to many FIA officials for their versions in all these issues. The minister’s staff officer, Sajjad Haider, who has been accused of using strong arm tactics to temper record, remove it or facilitate compromises between parties disconnected the call when he was asked the question.

He was later sent a message stating his version is required and that he should attend the call but he did not. The minister’s phone also remained un-attended and message sent expressing the intention of the caller was not responded to.

Director General of FIA, Zafrullah Khan, when contacted to inquire about Tariq’s demotion said the interior secretary was the competent authority to do this. About his transfer to Quetta the DG said it was a routine matter. Secretary interior was not available for comments.

About the manipulation of record by FIA Peshawar office, DG FIA Zafrullah Khan referred this correspondent to speak to Inam Ghani, the director posted there. When contacted Director Inam confirmed that the record relating to the minister had been misplaced and it is being reconstructed but denied if they had tempered with the previous record.

The misplaced record is about a case in the Peshawar’s Court alleging Rehman Malik of fleeing abroad in 1998 while being on ECL. Sources say it is being manipulated though officially it has been misplaced. An FIR No. 62/98 was registered against the minister under the Exit from Pakistan (Control) Ordinance. The minister’s staff officer went to Peshawar for securing FIA’s help, official sources confided to The News.

An assistant director of the Passport Circle, refused to entertain his request. Then an inspector level investigator was assigned the task and he prepared a diary dated February 6, 2010, a report stating that the accusations against the minister were fabricated and that the minister was not informed that he was on the ECL.

As the court took up the case on February 10, 2010 and the case diary was presented, the court asked for the old record but it was told it has been misplaced. A deputy director (law) appeared before the court taking up the minister’s bail matter, instead of resisting the bail application, suggested to the court that he should be granted bail as denying this would amount to his humiliation, officials privy to development said.

In the case in which Rehman Malik continues to be a Proclaimed Offender, The News contacted Shuja Naveed, an FIA deputy director heading Special Investigative Unit (Islamabad). This case was instituted against the minister under FIR No.12/97 for registering a false case against one Dr. Mooeni, in which the minister had allegedly demanded Rs500000 through a journalist, named Dawood Ahmed Khawaja, Chief Editor Nai Roshni of Multan, whose affidavit dated 5/12/96 is on judicial record.

Shuja Naveed confirmed the court of special judge had sought details about what action has been taken against the accused and it has been informed that the record relating to the minister was shifted to NAB in 2004, hence they’re not responsible for any action.

Upon non-appearance, the minister was declared a Proclaimed Offender. Now when the court of a special judge has directed the FIA to intimate what action has been taken against the PO, the FIA has opted to remain silent.

A source close to the PPP, when contacted, declared all the cases against Interior Minister A Rehman Malik as bogus and politically motivated. He said at that time officials of FIA and other departments were forced to fabricate cases against Malik. These cases could not be further investigated because they had no foundation and were very weak.

He said the allegations about misplacement and tempering of the record by FIA officials had no truth. He said the staff had been asked to complete files with honesty. They had also been ordered to make investigations without any fear or favour.

Afghanistan, Iraq And Next Pakistan?

[The author in the following asks the question–why {has} the US urged Pakistan to launch a military offensive in the northern areas?

Understanding why the US wants Pakistan to launch major military operations in northern Pakistan should be clear to all readers of this site, the United States is really interested in southern Pakistan, Balochistan, to be more precise.  They want all Army and air resources tied-up fighting against the ISI’s militants, while they sweep into the south from the forces being built-up at Kandahar and Helmand.

SEE: ‘Final Solution’ Frenzy – Part Four: Final Solution for Pakistan ]

Afghanistan, Iraq And Next Pakistan?

By Gulam A. Mitha

10 May, 2010 –

Does it have to be that an entire country and it’s innocent civilians have to be punished after the failed New York Times Square bomb attempt by one person? It seems to be that way. Maybe another false flag operation was planned to issue stern warnings to Pakistan that should there be a successful attack next, there might even be a “boots-on-the ground” US presence on Pakistan as reported by the New York Times, a Zionist mouthpiece, on Saturday May 9, 2010 ( After the unsuccessful bomb attack by US citizen Faisal Shehzad who was captured by US authorities on board a flight to Pakistan via Dubai, the US administration has started issuing threats to Pakistan.

The first threat came on May 5, 2010 from Fareed Zakaria, author and host of CNN’s “Fareed Zakaria GPS” in which he reported that “Pakistan is the epicentre of Islamic terrorism” and that “’s worth noting that even the terrorism that’s often attributed to the war in Afghanistan tends to come out of Pakistan, to be planned by Pakistanis, to be funded from Pakistan or in some other way to be traced to Pakistan..”. Zakaria was a favored student of Dr. Huntington the celebrated author of “The Clash of Civilizations and the Remaking of the World Order”. Zakaria has also been noted to be involved with George Bush and Paul Wolfowitz in pushing for the war on Iraq.

Why would Zakaria use the words “Islamic Terrorism” rather than Muslim terrorism? In my article, The Winds of Change, published by Countercurrents on May 4, 2010 I’d written that since the war cannot be waged on Islam, the next best is to wage it on its adherents to weaken them. The strategy is working. The affluent group of Muslims are being weakened as they pursue materialistic objectives whereas the poorer Muslims are being intimidated through wars waged on them. One group fears the loss of wealth and the other fears loss of lives, not their own maybe but of their families.

On May 7, 2010, US military commander in Afghanistan General Stanley McChrystal met with Pakistan’s military commander General Ashfaq Kiyani in Islamabad to clearly issue a stern warning that Pakistan must immediately begin a military offensive against the Taliban and al-Qaeda in North Waziristan. US ambassador to Pakistan Anne Patterson also met with Pakistani president Asif Zardari and used “forceful” language to convey the American point that the Pakistanis had to move more assertively against the militants threaded through the society. As if that is not enough, pressure mounted from Hillary Clinton on May 7, 2010 that it faced “very severe consequences” if a terror plot like Times Square bombing were traced to Pakistan. US officials have even admitted that if there is a successful attack, the US will have to act. Maybe there is a successful attack being planned by the US either on its soil or on some European, Indian or Israeli soils. If the unsuccessful bomb attack is so politically successful, one would wonder how successful will be a successful bomb attack.

The answers to the question why US has urged Pakistan to launch a military offensive in the northern areas is very clear. It is to create more fear and terrorism, more suicide bombings, ensure more terrorists are bred, continue and further increase drone attacks and, demoralize and weaken the military through exhausting the hardware in its arsenal such that if a joint US-Indian-NATO attack is launched on Pakistan in the near future, it’ll not be able to sustain the war. Nuclear deterrence against an enemy already on its soil is pointless.

The one thing that most Muslim leaders severely lack is diplomacy and negotiation skills, more so a nuclear state like Pakistan than any of the others who’ve no strong and viable defences. Pakistan could easily retaliate to threats from US or India but being an indebted nation whose leaders are corrupt to the nth degree and who have families overseas, they’re unable to demonstrate diplomacy or use language that would remove threats so they submit to threats. Zardari is a known state criminal and the US has all the scoops on him to blackmail him should he not relent to US demands.

It is now obvious that the US has military intentions towards Pakistan. India and Israel but more so the latter would like to see Pakistan denuclearised. Pakistan is also of significant geo-political importance as it would serve as a corridor for land-locked Afghanistan and the former Soviet satellites . 9/11 led to the occupation of Afghanistan, WMDs led to the occupation of Iraq and its becoming obvious that the relentless pressure of terrorism might lead to Pakistan’s occupation and subsequent denuclearisation. The Zionists have mastered the art of fabrication without being challenged. They’ve not only fabricated 9/11, WMDs and other false flag operations but they’ve also fabricated an economic culture leading to rewards for the obedient servants and slavery for the masses throughout the world.

Much as the US, France, Germany and UK would like to bomb Iran to the rubble because of its oil and gas, Russia and China have not been supportive of actions against Iran in the United Nations. The next best target is therefore Pakistan as the US needs not secure UN, Russian or Chinese support for actions against it. The excuse of containing the epicentre of “Islamic terrorism” is sufficient. Pakistan is in the pressure cooker with the lid on and the stove flame on high.

Gulam Asgar Mitha

180 Citadel Crest Cir. NW

Calgary, AB, CANADA T3G 4G4

Trying To Make the Lives Saved Worth Living For Trauma-Scarred Servicemen

Multi-Symptom Pain Disorders Plague Returning Service Men and Women

Newswise — Nine in 10 Iraq and Afghanistan veterans return with some form of pain and about 60 percent have significant pain, mainly from the cumulative effect of exposure to recurring blasts which cause unimaginable injuries, according to prominent VA pain clinicians speaking at the American Pain Society’s annual scientific meeting.

“We are talking about a complicated set of problems involving cognitive issues, deep emotional impacts, and acute and chronic pain that have serious, long-term implications for our veterans and make effective pain treatment outcomes far more difficult to achieve,” said Michael E. Clark, Ph.D., clinical director of the Veteran Administration’s largest and most comprehensive pain management and rehabilitation program in Tampa, and associate professor, department of psychology, University of South Florida. “The pain constellation exhibited by returning service members is the most complex situation I have ever seen in my 30 years of practice and calls for a revolutionary new approach to simultaneously address the spectrum of shared, common symptoms across these severe disorders.”

“These Middle East conflicts, with their very high level of blast injury survivors, call for the military, the VA and the civilian health system to treat post-injury pain as a priority after military discharge to prevent pathophysiology, with a focus of providing effective pain control and rapid restoration of function and social networks to prevent disability and secondary negative health and personal consequences of chronic pain,” said Rollin M. Gallagher, M.D. MPH, deputy national program director for pain management for the VA and clinical professor of psychiatry and anesthesiology, Penn Pain Medicine, University of Pennsylvania

Dr. Clark added that the severity and breadth of the problem has been aggravated by the prevalence of multiple tours of duty for many service members, including weekend National Guardsmen who can be older with families and jobs, a situation not seen in previous U.S. conflicts.

Dr. Gallagher further noted the VA’s pain care challenge is magnified by a 90 percent injury survivor rate from these conflicts compared with only 40 percent in the Vietnam War. VA clinicians are now challenged to manage pain in blast survivors with one or several other consequences of blast, such as head injuries causing mild to severe TBI, physical disfigurement and social stigma, emotional trauma, and often post traumatic stress disorder (PTSD).

“The evidence is compelling that the symptoms of these comorbidities, as well as others such as substance abuse, depression and sleep problems, overlap significantly,” Dr. Clark explained, “and there is ample reason to believe they will not respond as favorably to traditional interdisciplinary pain treatment when compared to other groups of former soldiers.”

“The need is for a fully integrated, system-wide and evidenced-based continuum of pain management from the battlefield to military hospitals to our community care facilities with increased pain care access, state-of-the art treatment protocols, high competence levels for care providers, and the integration of pain education into professional training,” said Dr. Gallagher.

Dr. Gallagher pointed out that earlier and more aggressive acute pain treatment intervention closer to the battlefield may help to prevent or lessen longer-term disabilities and secondary consequences of chronic pain. “Present research will tell us definitely what we know from our clinical experience – that early blockage of neurological pain impulses to the spinal cord and brain close to the site of injury using peri-neural catheters and nerve blocks , along with more aggressive analgesic treatment, is proving more effective than the traditional method of just morphine injections,” he said. “And the soldiers appreciate the earlier intervention.”

VA’s Integrated Pain Care Approach
The overlapping disorders of pain, mild traumatic brain injury (TBI), and post-traumatic stress (PTSD) among returning soldiers is leading to new initiatives at the VA.

“The VHA has directed a new pain management strategy with a stepped-care model that offers a comprehensive continuum of treatment from acute pain at injury to longitudinal management of chronic pain, and this approach is now being considered by the Department of Defense in collaboration with the VHA,” Dr. Gallagher said. “The goal is to reduce pain and suffering and improve the quality of life for our returning Iraq and Afghanistan service men and women suffering acute and chronic pain.”

“The use of silo treatment pathways in chronic pain treatment is insufficient, less effective and less efficient,” Dr Clark said, “because they typically focus solely or primarily on pain-related symptoms and either exclude those with concurrent PTSD and/or TBI symptoms or occasionally refer them to relevant specialty programs for simultaneous but independent treatment.”

As an example of the VA’s health care system refocus, Dr. Clark reviewed current work at the Tampa VA facility using a single team approach and a post-deployment behavioral health program with specialties in behavioral medicine, pain, PTSD, TBI, substance abuse, physical therapy and case management.

“Our objectives are to maximize function and life adjustment, prevent symptom development or exacerbation, and reduce stress through a single team effort,” Dr. Clark said. “Treatment involves established and modified cognitive behavioral therapy interventions targeting PTSD, pain, mild TBI, sleep and substance abuse, typically in combination, and with a physical training component.

“As we extend and refine our PMD treatment components and complete more research on PMC treatment and how overlapping comorbidities interact, our hope is that this raised awareness level for integrated care within the VA will eventually be reflected in community care center treatment for our returning service personnel,” Dr. Clark summarized.

About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.