Patterns of Change in Pain-related Physical, Mental, and Social Health Outcomes in a Military Population.

OBJECTIVE: Military persons frequently experience pain conditions stemming from noncombat and combat injuries. This study assessed the patterns of change over time and the associations of pain intensity and interference with physical, mental, and social health domains in a military sample. METHODS: A secondary analysis of Pain Assessment Screening Tool and Outcomes Registry (PASTOR) was conducted using data collected over 10 months. Participants selected for analysis completed ≥3 assessments with an interval of ≥14 days between assessments. The Defense and Veterans Pain Rating Scale (DVPRS) measured average and worst pain intensity, and Patient-Reported Outcomes Measurement Information System (PROMIS®) T-scores measured pain and health outcomes. RESULTS: The sample (N = 190) majority reported being active duty (96%); serving in the U.S. Army (93%); and being enlisted (86%). The percent difference from assessment one to assessment three showed improvement for DVPRS average pain (-4.85%) and worst pain (-2.16%), and PROMIS Pain Interference T-score (-1.98%). Improvements were observed for all PROMIS outcomes except depression. The Defense and Veterans Pain Rating Scale average and worst pain intensity and PROMIS pain interference were strongly correlated with physical function. Multilevel models showed that an increase in average and worst pain, and pain interference were associated with a decrease in satisfaction with social roles. CONCLUSION: Analysis identified patterns of change over time in physical, mental, and social health outcomes, as well as associations important to understanding the complexities of pain. This work has implications for pain management nursing in ambulatory settings where ongoing collection and analyses of multivariable outcomes data can inform clinical care.

Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat-Injured Populations: An Integrative Review to Inform Evidence-Based Practice.

BACKGROUND: Understanding the complex interrelationships between combat injuries, physical health, and mental health symptoms is critical to addressing the healthcare needs of wounded military personnel and veterans. The relationship between injury characteristics, pain, posttraumatic stress disorder (PTSD), and depression among combat-injured military personnel is unique to modern conflicts and understudied in the nursing literature. AIM: This integrative review synthesizes clinical presentations and relationships of combat injury, PTSD, depression, and pain in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) United States military service members and veterans. METHODS: A literature search was conducted using relative key terms across databases to identify peer-reviewed publications between 2001 and 2016 that examined health outcomes of combat-injured persons in OEF and OIF. The quality of evidence was evaluated and results synthesized to examine the association of combat injury as a risk factor for PTSD, the relationship of PTSD and depression pre- and postinjury, and pain management throughout care. RESULTS: Twenty-two articles were included in this review. Greater injury and pain severity poses risks for developing PTSD following combat injury, while early symptom management lessens risks for PTSD. Depression appears to be both a contributing risk factor to postinjury PTSD, as well as a comorbidity. LINKING EVIDENCE TO ACTION: Findings demonstrate a compelling need for improvements in standardized assessment of pain and mental health symptoms across transitions in care. This integrative review informs nurse researchers and providers of the clinical characteristics of pain, PTSD, and depression following combat injury and offers implications for future research promoting optimal surveillance of symptoms.

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

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.

Complexities of autonomy in military medical ethics: A brief report.

ABSTRACT: The first Fallen Surgeons Military Educational Symposium was convened in conjunction with the the American Association for the Surgery of Trauma (AAST) 23 meeting, under the guidance of the AAST Military Liaison Committee. The daylong session included a 1.5-hour segment on military medical ethics in combat and its unique challenges. Medical ethical issues arise frequently within the military across a range of varied circumstances, from the day-to-day operations of stateside forces to the complexities of deployed troops in theaters of conflict. Given the scope of these circumstances, preparation and advanced planning are the key to addressing and resolving the ethical issues that occur. The goal of this session was to present illustrative cases, not to prescribe solutions, and to make the attendees aware of some of the challenges they may encounter when deployed.

Comparative Analysis of Health Domains for Neuropathic Pain Patients.

Active duty military members have significant service-related risks for developing pain from injury. Although estimates for neuropathic pain (NP) are available for civilian populations, the incidence and prevalence for NP in military members is less clear. Understanding correlates of pain in military members is vital to improving their physical, mental, and social health. Using a comparative design, a secondary analysis was conducted on longitudinal PASTOR data from 190 pain management center patients. The objectives were to compare trends in patient-reported outcomes over time between those screening positive and negative for NP (NP+, NP-, respectively) based on PROMIS Neuropathic Pain Scale T-scores. Findings showed improvements in fatigue, sleep-related impairment, and anger over time. There was a difference between those screening NP+ and NP- for sleep-related impairment, and the cross-level interaction effect showed sleep-related impairment worsening over time. These results emphasize the need to identify NP and implement and evaluate targeted therapies.

Age-related changes in central and peripheral corneal thickness: determination of normal values with the Orbscan II topography system.

PURPOSE: The thickness of corneal tissue is an important parameter in refractive surgery, Goldmann applanation tonometry, and corneal diseases. The purpose of the study was to record system-specific normal values with the Orbscan II system and to investigate the influence of sex and age on central and peripheral corneal thickness to characterize more precisely the anatomy of the cornea. METHODS: The Orbscan II topography system is a computer-assisted slit-beam scanning technology that can map the anterior section of the eye. It was used to take 2 measurements at 10-minute intervals on 777 eyes of 390 normal white subjects ranging in age between 10 and 80 years. Two hundred forty-two participants were men and 148 were women. The central corneal thickness and the nasal, superior, inferior, and temporal peripheral corneal thickness at a distance of 3 mm from the center were analyzed. No correction factor was used. Using nonparametric test methods, we carried out a statistical analysis of the parameters of sex and age. RESULTS: The mean central corneal thickness of all 777 eyes was 595 +/- 41 microm. No sex-specific central difference was identifiable (P = 0.33), there was no significant difference between the sides (P = 0.23), and no significant difference was found between the first and second measurement. The group of 10- to 39-year-olds had a mean central corneal thickness of 591 +/- 41 microm, whereas that of 40- to 80-year-olds was 600 +/- 39 microm, which was a significant difference (P = 0.03). The mean peripheral corneal thickness was 689 +/- 46 microm nasally, 688 +/- 42 microm superiorly, 667 +/- 40 microm inferiorly, and 655 +/- 42 microm temporally. Nasally and superiorly, we found a significant negative correlation with age (Spearman rank correlation, P = 0.02). CONCLUSIONS: The normal values presented here are a suitable reference basis for future studies in whites. Peripheral corneal thickness is asymmetric and seems to undergo age-related anatomic changes. This information should be considered when planning penetrating keratoplasty and refractive surgery.