Impact of an Acute Pain Service on Pain Outcomes with Combat-Injured Soldiers at Camp Bastion, Afghanistan

Abstract

Few studies demonstrate the impact of early aggressive analgesia with acute pain service (APS) involvement at combat support hospitals (CSHs) using real-time data. Collaboration between the British and the United States (US) Army led to a 3-month deployment of a US Army APS to Camp Bastion, the main British military base in southern Afghanistan, from April to July 2009. Pain outcomes data were collected at Camp Bastion from 71 soldiers sustaining major combat injuries followed by an APS. The sample was predominantly male (98.6%) and Caucasian (98.8%) with a mean age 25.4 years ± 5.4 (range 18-45). Regional nerve blocks were performed in 51 (71.8%) and epidurals placed in 11 (15.5%) of the cases. Repeated measures analysis of variance showed a statistically significant decreases in pain intensity (numeric rating scale from 0 for "none" to 10 for "as bad as you can imagine") over the three data collection points; first 3, 4-6, and 7-10 hours (F = 133.35; degrees of freedom [df; 1,68]; P < 0.001). Mean percent pain relief (0% "no relief" to 100% "complete relief") increased significantly over time (F = 193.12; df[1,69]; P < 0.001) with scores 31.29% ± 20.3 (initial 3 hours), 74.86% ± 27.5 (4-6 hours), and 83.14% ± 19.3 (7-24 hours). Overall, the perceived quality of pain control by soldiers was high. Findings from this quality of pain care study show that aggressive multimodal analgesia interventions by an APS in a CSH is associated with decreased pain intensity and increased pain relief.