Pain Management Strategies and Lessons from the Military: A Narrative Review

Vallerand, April Hazard; Cosler, Patricia; Henningfield, Jack E.; Galassini, Pam

doi:10.1155/2015/196025

Cited by 40 publications

(26 citation statements)

References 45 publications

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“…The experience of pain is prevalent in military and Veteran populations. 388 Pain management can be complex in military populations, who experience combat-related injuries (e.g., ballistic wounds, burns, overpressurization, blunt trauma) in addition to complications from accompanying conditions such as post traumatic stress disorder and traumatic brain injury (TBI), both of which are more prevalent in Veterans than in the civilian population. 48,389,390 Delayed pain treatment following injury can increase the likelihood of acute pain becoming chronic pain in service members and Veterans.…”

Section: Military Active Duty Reserve Service Members and Veteransmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Military Active Duty Reserve Service Members and Veteransmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

View full text Add to dashboard Cite

show abstract

“…Recent prolonged wars, mechanisms of injury (e.g., improvised explosive device), and increased survival rates have influenced the numbers of patients needing pain treatment (Clifford et al., ). A greater understanding of the multimodal aspects of pain will assist healthcare providers in returning patients to AD and potentially minimize psychological stress and disability (Vallerand, Cosler, Henningfield, & Galassini, ).…”

Section: Future Directionsmentioning

confidence: 99%

Musculoskeletal Pain and Headache in the Active Duty Military Population: An Integrative Review

Bader

Giordano

McDonald

et al. 2018

Worldviews Ev Based Nurs

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“… 7 The early use of continuous peripheral nerve blocks in traumatized patients has also not yet been investigated in emergency departments, while it has been found in the treatment of traumatic injuries typical of combat. 8 Furthermore, within the context of multimodal pain treatment in traumatized patients, it is widely recognized that avoiding the use of opioids is an important result to be pursued in patients with potential comorbidities, as this is connected to the potential clinical consequences of excessive use of opioids. 6 In this case, the catheter at the popliteal level allowed administration of anesthesia during two tibia bone osteosynthesis procedures, and during several reconstructive surgery procedures.…”

Section: Discussionmentioning

confidence: 99%

<p>Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report</p>

Fontana

Rocco²,

Vetrugno

et al. 2019

LRA

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Continuous peripheral nerve block is a relevant part of multimodal treatment of postoperative pain. In this context the continuous popliteal nerve block is described as an option for postoperative pain management for surgical procedures on the leg, and particularly on the ankle and foot. We applied continuous popliteal nerve block for different types of anesthesia and postoperative pain management via the same catheter. No clear evidence of this specific use has been described in the literature. A 38 year-old patient wounded in combat with a displaced fracture of left tibia and extensive loss of substance needed orthopedic surgeries as well as several reconstructive procedures. A continuous popliteal nerve block was applied via ultrasound-guided catheter for anesthesia at different times, and postoperative pain control for all surgical procedures. The continuous popliteal nerve block and its long-term positioning, of non-common evidence in literature, was utilized to treat a poly-traumatized patient, thereby avoiding repeated general anesthesia and opioid use and their adverse effects. This technique, within a complicated combat field environment, was demonstrated to be clinically effective with high patient satisfaction.

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Pain Management Strategies and Lessons from the Military: A Narrative Review

Cited by 40 publications

References 45 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Musculoskeletal Pain and Headache in the Active Duty Military Population: An Integrative Review

<p>Long-term placement of continuous popliteal nerve block catheter for management of a wounded patient in a combat field environment: a case report</p>

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