Little is known about the impact of early aggressive regional analgesia on short- and long-term pain and psychological outcomes of soldiers with major combat injuries. This ongoing 4-year longitudinal study of soldiers with severe combat-related limb injuries sustained in Iraq and Afghanistan, presented today in a poster at the American Academy of Pain Medicine's 27th Annual Meeting, examines the biopsychosocial phenomenology of their recovery and the effectiveness of early regional anesthesia on long-term outcomes. The study quantifies multiple longitudinal outcomes of post-injury pain, health-related quality of life, and psychological experiences (e.g., posttraumatic stress disorder and depression).
In this early phase of the RAMBPOS, preliminary data are reported on 180 combat-injured soldiers recruited from the Walter Reed Army Medical Center and VA system. Participants were evaluated at predetermined intervals for pain, psychological status and functional status via phone by a team of research staff from the Philadelphia VA Medical Center and University of Pennsylvania. Participant-reported outcomes were obtaining using the Brief Pain Inventory, Neuropathic Pain Scale, Treatment Outcomes in Pain Survey (TOPS), and the VA Behavioral Health Laboratory instruments for measures of mental health.
Findings revealed statistically significant improvements over time in average and worst pain levels (0 to 10) from baseline, 3.48 (P<0.01) and 6.24 (P<0.05), respectively, following acute care. Mean scores for perceptions of pain relief over time remained relatively stable with the most dramatic improvement at the end of the 2-year study period. Mean pain interference subscale and pain interference with general activity scores remained < 4, mild, and did improve over time (P<0.001). Selected TOPS subscales' mean scores show deviations from other chronic pain population data. For psychological outcomes, 70 participants (39.3%) scored for symptoms of mild posttraumatic stress disorder at least once, 22 (12.4%) had depression (13 minor and 9 major), and 8 (4.5%) indicated suicidal ideation at least once.
Overall, trends of multivariable pain data show improvements over time; however, psychosocial outcomes continue to be problematic for this soldier cohort as they struggle to adjust to their severe injuries and co-morbidities in lives after combat. Typical of soldier cohorts, subjects tend to minimize psychological disorders despite data establishing high rates of depression and other co-morbidities associated with combat injury.
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