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Chronic pain. Severe, unrelenting pain. Pain un-muted by medication.
Pain can negatively impact one’s quality of life, make restful sleep impossible, and even drive some veterans to depression or worse. To complicate matters, it’s not just physical pain that can make life difficult. The brain cannot distinguish between physical and emotional or mental pain and anguish.
The same areas of the brain – the anterior insula and the anterior cingulate cortex – get activated whether people feel physical, mental, or emotional pain. For those experiencing a traumatic event, the painful memory can be triggered repeatedly, creating a deep groove in the brain, neurologically speaking. This makes the breaking of neural patterns of response to pain and stress difficult.
Bob Deschner and Dottie Goodsun co-founded the San Antonio-based nonprofit Vet TRIIP in 2012 to provide veterans and military dependents free, integrated therapies to help clients deal with stress and pain.
“We both had experienced helping people with pain, and were invited to join a veterans advocacy group in Austin (Austin Veterans and Families Advocacy Council) back in 2009 because it was open to community members who wanted to help veterans,” said Goodsun, Vet TRIIP’s executive director.
That experience drove Deschner and Goodsun to learn more about helping veterans with chronic, severe, or undertreated pain.
Integrated Therapies Help Physical, Mental, Emotional Pain
“I found out that PTS (post-traumatic stress) is a major problem for veterans and it turns out many techniques for people who deal with physical pain were also effective for those with PTS,” Vet TRIIP Director Deschner said. “I had a broad background in science but I always found myself coming back to helping people who were not getting relief elsewhere.”
Deschner is a chemical engineer and chemist who started consulting for energy and environmental engineering industries and was drawn into working with medical professionals whose patients suffer from severe chronic pain. Goodsun is a retired school teacher of 28 years now working as a service provider with the veteran clients who visit Vet TRIIP.
“We’ve picked the brains of some of the best people in the country,” Deschner said. “We’ve toured the Fort Bliss Restoration and Recovery program run by Dr. John Fortunato, the Fort Hood DAMC (Darnel Army Medical Center) Warrior Combat Stress Reset program run by Dr. Jerry Wesch, and the Duke Medicine Integrative Medicine Center.”
All this research informs the way Vet TRIIP helps veterans deal with pain and stress.
“The Fort Bliss and Fort Hood programs were two of the best programs at the time,” Deschner told the Rivard Report. “Fort Bliss returned about 60% of their active duty personnel diagnosed with military PTSD back to service after they went through the program. The Fort Hood DAMC program retention was very high – only 10 soldiers dropped out of the program out of 1400 treated.”
Using these model programs’ approach, which integrates multiple therapies in a single session, Vet TRIIP provides veterans and military dependents with two-hour Integrative Immersion Process (IIP) Sessions with 15-20 minutes before and after each session for processing and feedback.
Each IIP Session includes four unified integrated therapies to achieve cumulative effects for pain: therapeutic massage, chiropractic care, acupuncture services, and energy techniques such as qi gong or Reiki. This combined approach in a relaxing environment with calming music seems to help reset the pain and stress responses to provide temporary relief, according to Deschner and Goodsun.
The non-profit’s name reflects its therapeutic approach, as TRIIP is an acronym for Team Recovery Immersion Integrative Process. The nonprofit developed 10 guidelines for providing integrative therapies together to provide synergistic benefits, because no guidelines were readily available.
‘Kindling,’ Plasticity, and Resetting the Brain’s Response to Pain
Deschner told the Rivard Report how researchers have found that the brain needs at least four hours to produce the type of proteins necessary in neurons to form new long term memories associated with relaxation instead of stress. Because it takes at least four hours for someone in a relaxed state to make a new lasting memory of relaxation to offset the intense traumatic memories, a one-hour massage or acupuncture session is often not enough to help address longstanding issues with pain, whether mental or physical.
Vet TRIIP works to break the brain’s tendency to stay stuck in painful patterns, described as ‘kindling,’ the neurological tendency of the brain to become overly sensitized after exposure to trauma.
“The problem with the mature brain is that it tends to be negative, it doesn’t know what it doesn’t know,” Deschner explained. “It tends to work against the recovery because it is maintaining the status quo. When you break that negative closed loop, by providing a positive pain free or reduced pain experience, the brain can break free and become more plastic, more able to adapt to positive changes.”
To break the pattern of kindled trauma, Vet TRIIP’s sessions are provided in three stages. In stage 1 of the IIP Sessions the veteran or military dependent receives three to six two-hour sessions. Stage 2 sessions focus on relaxing group training sessions which last four hours, while in Stage 3 classes, clients are taught helpful techniques, such as yoga, tai chi, mindfulness medications, and relaxation which they can do on a daily basis.
“How do you get a Marine to relax?” Deschner asked. “Surround them with Marines.” This dynamic explains the group approach to providing sessions with vets surrounded by other vets.
“The group setting in Stage 2 sessions helps initiate and maintain the state of relaxation for at least four hours,” Deschner said. “At that point, we see longer term benefits. Even after the 2.5 hours of the IIP sessions, we tell them to plan to stay relaxed for two more hours. ”
Experiencing An Integrated Therapies Session
Due to privacy issues, the Rivard Report was not able to interview veterans who have undergone Vet TRIIP’s sessions. As a military spouse, I qualified for Vet TRIIP’s services, so I experienced a two-hour session.
With eight massage tables and stools moved into an unused church meeting room on a weekday, Vet TRIIP set up to provide sessions for 20 veterans and veteran spouses in the seven-hour window they had available.
After undergoing the intake process with three other veterans, we experienced aromatherapy and learned emotional freedom techniques (ETF) to tap on acupressure points to relieve anxiety and did chair stretches. I was then ushered into the temporary treatment room.
While it may seem odd to undergo massage therapy fully clothed under a light blanket in a room with three other clients on adjoining tables, I quickly forgot they were there. Service providers were gentle, assuring, and were careful not to cause any additional discomfort with their therapies.
Different therapists transitioned easily from table to table in the room, so that each client experienced the four therapies offered over the two-hour period. They readily accommodate veterans who don’t want one of the therapies, but most opt for all four offered.
With only relaxing music and occasional whispers to break the quiet, my chronic pain from multiple injuries and surgeries ebbed until I realized it was mostly gone. After two hours, I felt oddly buoyant and pain free.
Vet TRIIP Seeks to Close Funding Gap
Vet TRIIP received a 2015-2016 grant from the Texas Veterans Commission (TVC), which helped double their capacity, reducing the wait list to a week. However, Vet TRIIP did not receive a TVC grant for the 2016-2017 grant cycle resulting in a 30% loss in services and a three month wait list for appointments.
The nonprofit is in the process of applying for more funding in order to provide stage 3 classes and to continue its services, provided in a rotating series of free spaces in various local churches during the work week.
“In our first three years, 100% of our therapists were volunteers, but now we’re at 50%,” Deschner said. “In the past year, we’ve delivered $535,000 worth of services last year with an annual cash budget of $109,000 – almost five to one. Of the clients we see, 85% are community resource referrals from staff at Audie L. Murphy VA Hospital and their community clinics, the Vet Centers, BAMC, SAMMC, Wilfred Hall, and Lackland.” Deschner added.
“We have a proof of concept with our high success rate, as more than 90% (of clients) report to us that they get some benefit,” Deschner stressed. “We’re trying to reproduce this healing community as a way to support the services we provide the veterans.
“We’re looking to get discovered by donors so we can reproduce this model for veterans in communities across Texas and eliminate our wait list. It’s hard for us to tell veterans with pain and stress levels of 8, 9 and 10 that they have to wait.”