Musculoskeletal pain management in active serving military populations: A systematic review

Abstract

Background: Musculoskeletal (MSK) pain has a significant impact on international military organisations’ force preparedness and capability. To date, there are no systematic reviews synthesising and analysing current available evidence for MSK pain management in active serving military populations. Objective: To identify and determine the effectiveness of MSK pain management strategies used in active serving military populations. Design: Systematic review Methods: A search of electronic databases (MEDLINE, EMBASE, CINAHL, SportDISCUS and PubMed) was conducted to identify randomised control trials (RCTs) assessing MSK pain management interventions conducted in active serving military populations. Included studies were assessed for quality using GRADE framework and the Cochrane group Risk of Bias 2.0 appraisal tool. Results: Twelve articles met the inclusion criteria, including personnel from all branches of military service. Majority of the included studies (9/12 studies) were conducted in US military populations. Low back pain was the most common MSK condition addressed (10/12 studies). Interventions included: glucosamine-combination therapy, multidisciplinary pain programmes, exercise therapy, adjunct manipulative therapy, electromagnetic therapy, home cervical traction, and early physical therapy. The strength of the body of evidence was assessed as “low” to “very-low” as per the GRADE framework, with risk of bias identified as high or of some concern. Studies assessing MSK pain management interventions in active serving military populations were typically underpowered and lacked homogenous control groups. Conclusions: Existing RCTs do not provide a sufficient body of evidence to guide military organisations or healthcare professionals in making appropriate treatment decisions for managing pain in active serving military populations. Future research in the area is encouraged to enable evidence-based recommendations for effective MSK pain management in this unique population.