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Special Issue of Pain Medicine Highlights VA Research on Pain among OEF/OIF Veterans


SUMMARY:

  • Considerable gaps exist between the current empirical evidence and strategies for providing effective pain care for Veterans with the most serious combat-related injuries. Moreover, there is virtually no empirically derived information that can inform pain practice in the inpatient medical setting.
  • The most frequently reported barriers to the use of pain self-management among patients with comorbid musculoskeletal pain and depression included the disabling effects of pain, the negative effects of depression and stress, limited resources, and lack of social support. Commonly perceived facilitators included relief of depression symptoms, supportive family and friends, and having a menu of self-management strategies from which to choose.
  • There was a lower prevalence of pain in women Veterans compared to men in the first year post-deployment, even after adjusting for other demographic and clinical factors. Among those with any pain, women Veterans were more likely to report moderate to severe pain, and were less likely to report persistent pain.
  • Consistent with previous research, investigators found a great deal of variation in primary care physicians’ willingness to engage in a number of clinical actions in response to Veterans with chronic low back pain.

BACKGROUND:
Among Veterans receiving primary care in VA healthcare facilities, as many as 50% of male Veterans and 75% of women report the presence of pain. Similarly high rates of pain are documented among Veterans returning from deployment in Iraq and Afghanistan. Moreover, the presence of pain is known to be associated with a high prevalence of other mental health conditions, including PTSD and depression. This Special Issue begins with four articles that build on the growing epidemiological literature on the prevalence and correlates of pain among OEF/OIF Veterans, and considers the evidence for the assessment and management of pain in this population. The Issue also includes several original articles that provide a sample of the relatively large and growing body of research on pain, including research that focuses on the most prevalent and challenging of pain conditions observed among OEF/OIF Veterans, such as neuropathic pain, chronic widespread pain, musculoskeletal/joint pain, and pain secondary to spinal cord injury.

AUTHOR/FUNDING INFORMATION:
This publication is in follow-up to a Pain Research Summit held in September 2007 by VA’s Rehabilitation R&D Service and VA/HSR&D’s Polytrauma and Blast-Related Injury Quality Enhancement Research Initiative (PT/BRI-QUERI).

APPENDIX

  • Pain Medicine October 6, 2009;10(7)
  • Kerns R and Dobscha S. Pain among Veterans Returning from Deployment in Iraq and Afghanistan: Update on the Veterans Health Administration Pain Research Program. (pp. 1161-1164)
  • Gallagher R. Biopsychosocial Pain Research in America: The Veterans Health System Leads the Way (pp. 1165-1166)
  • Haskell S, Brandt C, Krebs E, et al. Pain among Veterans of Operations Enduring Freedom and Iraqi Freedom: Do Women and Men Differ? (pp. 1167-1173)
  • Helmer D, Chandler H, Quigley S, et al. Chronic Widespread Pain, Mental Health, and Physical Role Function in OEF/OIF Veterans (pp. 1174-1182)
  • Helfand M and Freeman M. Assessment and Management of Acute Pain in Adult Medical Inpatients: A Systematic Review (pp 1183-1199)
  • Dobscha S, Clark M, Morasco B, et al. Systematic Review of the Literature on Pain in Patients with Polytrauma Including Traumatic Brain Injury (pp. 1200-1217)
  • Krug H, Frizelle S, McGarraugh P, and Mahowald M. Pain Behavior Measures to Quantitate Joint Pain and Response to Neurotoxin Treatment in Murine Models of Arthritis (pp. 1218-1228)
  • Adler J, Nico L, VandeVord P, and Skoff A. Modulation of Neuropathic Pain by a Glial-Derived Factor (pp. 1229-1236)
  • Tan G, Fink B, Dao T, et al. Associations among Pain, PTSD, mTBI, and Heart Rate Variability in Veterans of Operation Enduring and Iraqi Freedom: A Pilot Study (pp. 1237-1245)
  • Cruz-Almeida Y, Felix E, Martinez-Arizala A, and Widerström-Noga E. Pain Symptom Profiles in Persons with Spinal Cord Injury (pp. 1246-1259)
  • Dib-Hajj S, Black J, and Waxman S. Voltage-Gated Sodium Channels: Therapeutic Targets for Pain (pp. 1260-1269)
  • Phelan S, van Ryn M, Wall M, and Burgess D. Understanding Primary Care Physicians' Treatment of Chronic Low Back Pain: The Role of Physician and Practice Factors (pp. 1270-1279)
  • Bair M, Matthias M, Nyland K, et al. Barriers and Facilitators to Chronic Pain Self-Management: A Qualitative Study of Primary Care Patients with Comorbid Musculoskeletal Pain and Depression (pp. 1280-1290)
  • Lorenz K, Krebs E, Bentley T, et al. Exploring Alternative Approaches to Routine Outpatient Pain Screening (pp. 1291-1299)
  • Otis J, Keane T, Kerns R, et al. The Development of an Integrated Treatment for Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder (pp. 1300-1311)
  • Crowley-Matoka M, Saha S, Dobscha S, and Burgess D. Problems of Quality and Equity in Pain Management: Exploring the Role of Biomedical Culture (pp. 1312-1324)
  • Wolfe D, Wechuck J, Krisky D, et al. A Clinical Trial of Gene Therapy for Chronic Pain (pp. 1325-1330)


Pain Medicine Special Issue,October 2009;10(7)

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.