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Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure.

Clark ME, Walker RL, Gironda RJ, Scholten JD. Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure. Pain medicine (Malden, Mass.). 2009 Apr 1; 10(3):447-55.

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OBJECTIVES: To compare the physical and emotional presentation and pain treatment outcomes of service members who sustained polytrauma secondary to blast with those of soldiers injured by other means. DESIGN: Retrospective medical record review. SETTING AND PATIENTS: One of four Veterans Affairs multidisciplinary inpatient Polytrauma Rehabilitation Centers. One hundred twenty-eight Operation Enduring Freedom and Operation Iraqi Freedom military personnel with serious polytrauma injuries and concomitant pain categorized into three groups based on type of injuries: blast injuries, combat injuries other than blast, and noncombat, nonblast injuries. INTERVENTIONS: Intensive, interdisciplinary inpatient rehabilitation and pain treatment. OUTCOME MEASURES: Pain intensity ratings; Functional Independence Measure scores; Rancho Los Amigos levels; and opioid analgesic doses. RESULTS: Service members injured via blast demonstrated a broader spectrum of physical injuries, higher levels of admission and discharge opioid analgesic use, reduced improvement in pain intensity following treatment, and much higher rates of posttraumatic stress disorder and other psychiatric diagnoses than those injured via other means. CONCLUSIONS: Blast injury may be associated with differential physical, emotional, and pain-related symptoms that pose increased challenges for successful treatment.

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