Pain management strategies and lessons from the military: A narrative review.

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

doi:10.1155/2015/196025

April Hazard Vallerand, Jack E Henningfield + Show 2 more

Open Access

https://doi.org/10.1155/2015/196025

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Abstract

Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings. To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population. A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population. The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes.

Highlights

Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life
In the extensive series of recommendations, some key strategies that are recommended for addressing the four major goals outlined by the Task Force include: standardizing patient care at all levels of treatment; implementing the stepped-care approach recommended by the Veterans Health Administration to provide optimal pain management across the continuum of care for military personnel; incorporating a multimodal and interdisciplinary approach to pain management; and addressing the risks of opioid abuse and misuse at different levels of health care [21]
In a study involving 110 injured soldiers evacuated from Iraq and Afghanistan to a level III military treatment facility in Germany [36], the percentage of pain relief reported by patients who received continuous peripheral nerve block (74%) was significantly higher than that reported by patients who did not (62%; P=0.029)

Summary

Background

Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. A survey involving 279 VA primary care providers revealed that 77% identified pain control as a top treatment priority, and that 74% were satisfied with the quality of care they provided for patients with chronic pain; only 20% of respondents reported that multidisciplinary pain clinics were available at their clinic sites [48] This shortcoming in health care service for patients with pain is striking given the increasing recognition of interdisciplinary multimodal pain management strategies as critical to addressing the various aspects of pain [4,5] and the evident success of these methods [49,50,51]. By integrating similar pain management clinics in general primary care practices serving the civilian population, the overall care of patients may be enhanced [52]

Conclusions

Findings

19. Acute Pain Management