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Background: Since 2001, the U.S. Armed Forces' training and deployment have greatly increased, escalating the risk of injury and pain-related issues both at home station and deployment environments., Aims: This integrative review examines the incidence, prevalence, and risk factors for musculoskeletal pain (MSP) and headaches in active duty (AD) military populations., Methods: Peer-reviewed research published between 2001 and 2016 was identified relevant to MSP and headache in AD military personnel using MeSH terms in key biomedical databases. Inclusion criteria were: epidemiological studies examining MSP or headache as primary or secondary outcome; samples that included AD populations; and studies conducted in the theater of operations, at home station, and in military treatment or Veterans Health Administration facilities., Results: Twenty-six articles met inclusion criteria. Low back pain (LBP) was the most prevalent MSP diagnosis. The incidence of LBP was 40.5 per 1,000 person-years and was comparable to nonmilitary populations. Inflammation and pain from overuse comprised the largest proportion of injury mechanism, accounting for about 82% of all injuries among nondeployed military personnel. The risk of MSP was greater for AD, female, Army, enlisted personnel, and those with greater time in a motor vehicle. Evidence suggests posttraumatic headache, occurring in up to 92% of military personnel who have sustained a mild traumatic brain injury, is associated with chronic daily headaches., Implications: Nurses must recognize the consequences military service can have on the development of pain. Nurses have an opportunity to positively impact the health and well-being of military and veteran populations through early recognition and treatment of pain., Linking Evidence to Action: The findings from this review underscore considerable magnitude of MSP in military personnel and expose modifiable risk factors and potential targets for designing nurse-led interventions to improve pain and symptoms in military subpopulations., (© 2018 Sigma Theta Tau International.)

The intense physical demands and dangerous operational environments common to Special Operations Forces (SOF) result in a variety of painful conditions, including musculoskeletal pain, headaches, and acute and chronic pain from combat injuries. Pain is a wellaccepted barrier to human performance. The Pain Management Task Force and the development of the Defense Veterans Pain Rating Scale (DVPRS) are discussed to provide a framework for changing the culture of pain management away from intensity of pain to interference with function and performance. The emergence of complementary and integrative pain management (CIM) practices is briefly reviewed as viable alternatives to the traditional reliance on opioids and other prescription medications. The SOF community can be the change agent for the DVPRS and CIM approaches to pain management, which will in the end serve to accelerate recovery and return SOF operators to duty faster and with an enhanced ability to perform with less pain., (2016.)

Background: The Army Surgeon General released the Pain Management Task Force final report in May 2010. Among military providers, concerns were raised that the standard numeric rating scale (NRS) for pain was inconsistently administered and of questionable clinical value. In response, the Defense and Veterans Pain Rating Scale (DVPRS) was developed., Methods: The instrument design integrates pain rating scale features to improve interpretability of incremental pain intensity levels, and to improve communication and documentation across all transitions of care. A convenience sample of 350 inpatient and outpatient active duty or retired military service members participated in the study at Walter Reed Army Medical Center. Participants completed the five-item DVPRS-one pain intensity NRS with and without word descriptors presented in random order and four supplemental items measuring general activity, sleep, mood, and level of stress and the Brief Pain Inventory seven interference items. Using systematic sampling, a random sample was selected for a word descriptor validation procedure matching word phases to corresponding pain intensity on the NRS., Results: Parallel forms reliability and concurrent validity testing demonstrated a robust correlation. When the DVPRS was presented with the word descriptors first, the correlation between the two ratings was slightly higher, r = 0.929 (N = 171; P < 0.001), than ordering first without the descriptors, r = 0.882 (N = 177; P < 0.001). Intraclass correlation coefficient was 0.943 showing excellent alignment of word descriptors by respondents (N = 42), matching them correctly with pain level., Conclusions: The DVPRS tool demonstrated acceptable psychometric properties in a military population., (Wiley Periodicals, Inc.)

Background: 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., Methods: Pain outcomes data were collected at Camp Bastion from 71 soldiers sustaining major combat injuries followed by an APS., Results: 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., Conclusions: 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., (Wiley Periodicals, Inc.)

Objective: The primary goal of this investigation was to survey military health care professionals at a Camp Bastion, Afghanistan, regarding their perceptions of care delivered by an anesthesiologist-directed acute pain service (APS) at a British Combat Support Hospital (CSH)-Role 3., Methods: The APS was directed by a U.S. Army anesthesiologist experienced in acute pain medicine who established an APS within a deployed British CSH. A brief 15-item survey was developed to assess impressions of outcomes, complexity of care, and satisfaction with the APS. Content validity was established through limited published surveys of APSs, expert review, and end user evaluation., Results: The sample (N = 70, of which 61.4% were male) included 50% nurses, 15.8% surgeons, and 10% anesthesiologists who completed the survey at the end of the 3-month APS implementation period. Approximately 75% of the sample agreed or strongly agreed that injured soldiers managed by an APS obtained better pain relief than those who were not. With a 10-point scale, respondents rated how satisfied they were with the APS (mean 7.70 ± 1.7), how beneficial it was for patients (7.89 ± 2), and how important it would be to deploy an APS again to a level 3 facility (8.52 ± 1.7). Internal consistency reliability (Cronbach's alpha) for the 12-items measuring perceptions was acceptable, alpha = 0.82., Conclusions: Overall, the majority of military health care survey responders indicated support for an APS team as part of a CSH care, and confirmed its contributions to improving trauma care., (Wiley Periodicals, Inc.)

The article addresses criticisms of the Defense and Veterans Pain Rating Scale (DVPRS), emphasizing its development process involving service members and its extensive utilization across different care settings. It details the scale's rigorous evaluation, its alignment with patient needs, and challenges assertions questioning its reliability and validity.

Objective This study evaluated the association between pain outcomes and post-traumatic stress disorder (PTSD) symptom trajectories after combat-related injury, while adjusting for receipt of regional anesthesia (RA) soon after injury. Methods The PTSD symptom trajectories of N = 288 combat-injured service members were examined from within a month of injury up to two-years after. Linear mixed-effects models evaluated the association between PTSD symptom trajectories and average pain and pain interference outcomes while adjusting for receipt of RA during combat casualty care. Results Four PTSD trajectories were characterized: resilient, recovering, worsening, and chronic. Differential pain presentations were associated with PTSD symptom trajectories, even after adjusting for receipt of RA. Compared to those with a resilient PTSD symptom trajectory, individuals presenting with chronic PTSD trajectories were estimated to experience average pain scores 2.61 points higher (95% CI: 1.71, 3.14). Participants presenting with worsening (β = 1.42; 95% CI: 0.77, 1.78) and recovering PTSD trajectories (β = 0.65; 95% CI: 0.09, 1.08) were estimated to experience higher average pain scores than participants with resilient PTSD trajectories. Significant differences in pain interference scores were observed across PTSD trajectories. Receiving RA was associated with improved pain up to two years after injury (β = -0.31; 95% CI: -0.90, -0.04), however no statistically significant association was detected between RA and PTSD trajectories. Conclusions Chronic and worsening PTSD trajectories were associated with greater pain intensity and interference following combat injury even when accounting for receipt of early RA for pain management. These findings underscore the need to jointly assess pain and PTSD symptoms across the trauma care continuum. [ABSTRACT FROM AUTHOR]

Objective. The Defense and Veterans Pain Rating Scale (DVPRS 2.0) is a pain assessment tool that utilizes a numerical rating scale enhanced by functional word descriptors, color coding, and pictorial facial expressions matched to pain levels. Four supplemental questions measure how much pain interferes with usual activity and sleep, and affects mood and contributes to stress. Methods. Psychometric testing was performed on a revised DVPRS 2.0 using data from 307 active duty service members and Veterans experiencing acute or chronic pain. A new set of facial representations designating pain levels was tested. Results. Results demonstrated acceptable internal consistency reliability (Cronbach's alpha = 0.871) and test-retest reliability (r = 0.637 to r = 0.774) for the five items. Excellent interrater agreement was established for correctly ordering faces depicting pain levels and aligning them on the pain intensity scale (Kendall's coefficient of concordance, = 5 0.95 and 0.959, respectively). Construct validity was supported by an exploratory principal component factor analysis and known groups validity testing. Most participants, 70.9%, felt that the DVPRS was superior to other pain rating scales. Consclusion. The DVPRS 2.0 is a reliable and valid instrument that provides standard language and metrics to communicate pain and related outcomes. [ABSTRACT FROM AUTHOR]

Objective. Examine response patterns to low-dose intravenous ( IV) ketamine continuous infusions on multiple pain outcomes, and demonstrate effectiveness, safety, and tolerability of ketamine administration on general wards. Design. Retrospective case series of consecutive patients given low-dose IV ketamine continuous infusions. Setting. Walter Reed Army Medical Center, Washington, DC. Patients. Nineteen eligible inpatients with neuropathic pain from major limb injuries sustained in combat with inadequate pain control from multimodal analgesia. Interventions. A 3-day IV infusion of ketamine at doses ≤120 μg/kg/h. Outcome Measures. Daily present ( PPI), average ( API), and worst ( WPI) pain intensity (0-10), global pain relief ( GPR) (1 'no relief' to 5 'complete relief'), daily assessments of adverse events, and daily opioid requirements measured during therapy. Results. A significant reduction in PPI ( P < 0.001) and improvement in GPR ( P = 0.031) was noted over time. Higher baseline WPI (≥7; N = 14) was associated with a significant decrease in WPI ( P = 0.0388), but lower baseline WPI (N = 5) was not. Significant mean percent decreases in PPI with higher baseline PPI (N = 8; P = 0.0078) and WPI with no phantom limb pain ( PLP) (N = 10; P = 0.0436) were observed. Mean percent increase in overall GPR was better for those reporting GPR scores ≤3 (N = 13) in the first 24 hours of therapy ( P = 0.0153). While not significant, mean opioid requirement ( IV morphine equivalents) decreased from 129.9 mgs ± 137.3 on day 1 to 112.14 ± 86.3 24 hours after therapy. Conclusions. Low-dose ketamine infusions for complex combat injury pain were safe and effective, and demonstrated response patterns over time and by baseline pain score stratification and presence or absence of PLP. [ABSTRACT FROM AUTHOR]