Special Issue: Military and Veteran HealthAnswering the call to address chronic pain in military service members and veterans: Progress in improving pain care and restoring health
Section snippets
Pain in Military and Veteran Populations
Pain among military service members and veterans represents a wide span of pain-related issues. In 2006, 743,547 injury-related musculoskeletal conditions were recorded for military service members with 82% attributed to inflammation and pain from exertional overuse (Hauret, Jones, Bullock, Canham-Chervak, & Canada, 2010). The overall rate for chronic arm and shoulder pain from 2003 to 2012 reflected a 25% increase possibly explained by a greater incidence of joint pain and higher rates of pain
Prevention of Chronic Pain
As chronic pain originates from central sensitization, it is critically important to effectively treat acute pain in an effort to prevent, minimize, and even possibly reverse central sensitization thus reducing the likelihood for the development of chronic pain (Tighe et al., 2015). These approaches are outlined in a comprehensive expert consensus report on the state-of-the science on acute pain (Tighe et al., 2015). However, even with aggressive pain intervention, acute pain can transition
A Need for Improvements in Pain Assessment Practices and Standardization of Patient-Reported Pain Outcome Measures
For over a decade, the VHA's pain as the “5th Vital Sign” initiative, enacted in 1999, and later adopted in 2001 as a standard by The Joint Commission, focused national attention on the importance of regular assessments of pain intensity (Veterans Health Administration Memorandum, 1999). Unfortunately, this initiative fell short of achieving measurable improvements in pain outcomes as anticipated (Helfand and Freeman, 2009, Lorenz et al., 2009, Mularski et al., 2006). Some attribute the lack of
Treatment for Chronic Pain
Multimodal strategies that combine pharmacological and nonpharmacological therapies, spinal, epidural and peripheral interventional techniques, and pain-related patient education focused on self-management and holistic approaches to alleviating pain are recommended as an integrated approach to chronic pain management (American Association of Nurse Anesthetists, 2014). Integrated chronic pain care requires an interdisciplinary focus capitalizing on the expertise of physical therapists,
Evidence-Based Clinical Guidelines and Expert Consensus Reports
APRNs who prescribe opioids for CNCP and nurses who care for and monitor patients with CNCP receiving analgesics should align care with recommended practices from evidence-based guidelines. Table 3 provides a brief summary of published pain guidelines and expert reports including those generated by the military and VHA that highlight state-of-the-science and consensus recommendations for the treatment of CNCP. Most evidence-based guidelines and expert reports recommend that opioid analgesics
New Health Policy: Strategic Plan for Pain
The National Pain Strategy developed by the Interagency Pain Research Coordinating Committee (IPRCC) and released in early 2016 provides a comprehensive population health-level plan (National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain, 2016). The IPRCC was established by the National Institute of Health (NIH) to advance pain research, care, and education in response to the 2010 Patient Protection and Affordable Care Act. The national strategic initiatives outlined
Nursing and Interprofessional Pain Education
The National Defense Authorization Act of 2010 mandated the development and implementation of targeted efforts to address the crisis of pain treatment in military and veteran populations. This legislation drew attention to the inadequacy of formal education in chronic pain management in nursing and medical schools. Experts have called for the need to systematically integrate pain content into curriculum, conduct competency-based evaluations of learning, utilize interprofessional and interactive
Military and Veteran Health Systems Models for Pain Care
Several nurse driven and interdisciplinary models of care in military and VHA facilities demonstrate how structured and goal-oriented pain care can lead to optimal patient outcomes. For example, a randomized trial of an interdisciplinary functional restoration (FR) program for active duty military service members with chronic musculoskeletal pain was conducted at Wilford Hall Medical Center and Brooke Army Medical Center, San Antonio, Texas. Nurse supervision of FR interventions in
Discussion
Chronic pain places enormous demands on U.S. military health care and VHA systems not only in terms of health care resource utilization but also at a significant cost. The IOM projected that cost for the estimated 100 million Americans suffering from chronic pain is well over $600 billion (Institute of Medicine, 2011). Military and veteran populations share in the burden of suffering, and their unique experiences in military service can increase risks for CNCP and greater pain severity.
Conclusions
In summary, preparing and empowering qualified health care professionals across all transitions in military and veterans care and strengthening health systems to deliver comprehensive chronic pain care require both a nursing and interprofessional coordinated effort. Clearly, more nursing pain specialists are needed to not only implement aggressive acute pain care to prevent chronic pain but also to effectively treat chronic pain with evidence-based integrative therapies that include multimodal
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Influence of Primary Care Provider Type on Chronic Pain Management Among Veterans
2022, Journal of Nursing RegulationCitation Excerpt :NPs in primary care increasingly provide chronic pain management among VHA patients (Bair et al., 2015; Schoneboom et al., 2016; Wiedemer et al., 2007).
Population-Focused Approaches for Proactive Chronic Pain Management in Older Adults
2021, Pain Management NursingEvaluating Suicide Risk Using the Reasons for Dying-Reasons for Living (RFD-RFL) Index in a Military Psychiatric Inpatient Setting
2021, Psychiatry ResearchCitation Excerpt :Accordingly, when military personnel struggle to manage stressors on their own, they may interpret difficulties with coping as personal failures, which may in turn contribute to more frequent reporting of negative self-descriptors as their primary RFD. Further, with regard to escaping pain, chronic pain following deployments is common within the military (Schoneboom et al., 2016), and is positively linked to suicide ideation and behaviors (Blakey et al., 2018; Legarreta et al., 2018). This may partially explain why escaping pain was ranked as the second most important RFD in the current sample.
Relationships between chronic pain and mood symptoms among veterans with bipolar disorder
2020, Journal of Affective DisordersCitation Excerpt :Individuals with comorbid chronic pain and bipolar disorder experience increased pain interference and sensitivity, increased prevalence of multisite pain, increased suicidal ideation, and worse disability and quality of life relative to general adult, pain, and other mental health populations (Abdin et al., 2016; Cerimele et al., 2014; Cook et al., 2015; Failde et al., 2013; Goldstein et al., 2009; Nicholl et al., 2014). At the same time, chronic pain negatively affects mood, physical activity, and sleep in ways that are detrimental to functioning (Failde et al., 2013; Schoneboom et al., 2016; Travaglini et al., 2019). Studies have revealed factors common to both chronic pain and negative mood states (i.e., depression), including shared genetic vulnerability, brain regions implicated in both pain experiences and negative affect, and psychosocial risk factors such as life stress, trauma, and lower socioeconomic status (Adler-Neal et al., 2019; Crofford, 2015; Humo et al., 2019).
Parameter-specific analgesic effects of electroacupuncture mediated by degree of regulation TRPV1 and P2X3 in inflammatory pain in rats
2018, Life SciencesCitation Excerpt :Pain that is induced by inflammation remains a serious health problem with significant social and economic consequences [1].
TelePain: Primary care chronic pain management through weekly didactic and case‐based telementoring
2017, Contemporary Clinical Trials CommunicationsCitation Excerpt :Pain due to injuries, sustained both on and off the battlefield, is a leading cause of short- and long-term disability among military personnel [2–4]. Diagnosis and treatment of pain among the military population can be challenging due to common comorbid conditions such as traumatic brain injuries, pre-concussive syndrome, post-traumatic stress disorder, and behavioral health disorders [5]. To address this problem, the Military Health System has made chronic pain management a priority.