Helping Veterans Manage Pain

VA researchers surveyed veterans with TBI on their levels of pain, revealing missed opportunities for pain management by both practitioners and patients.


Patients with a history of traumatic brain injury (TBI) may be coping with lingering pain in safe and healthy ways, but there are still many areas where their health care practitioners can help, according to a pilot study of how veterans with TBI are managing their pain.

Researchers from VA Western New York Healthcare System in Buffalo, State University of New York in Buffalo, and the Syracuse VAMC in New York surveyed 24 outpatients with a history of mild-to-moderate TBI. Participants completed a series of self-reports, including the Pain Outcomes Questionnaire and Pain Symptom Survey pain scale.

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Most rated their health as average or better, although more than half reported having pain at least 3 days per week, and more than one-third reported having pain daily. About two-thirds reported headache and/or lower back pain; 54% had joint pain, and 42% had neck pain. The researchers note that the pain was not necessarily attributable to TBI, although factors such as the number and severity of injuries might have played a role.

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The veterans were mostly using exercise, nonopioid analgesics, and rest to manage their pain. They also used, to a lesser degree, heat therapy, antidepressants, and opioids. Only regular use of antidepressants was associated with greater benefit.

The takeaway for practitioners, the researchers suggest, is multifaceted. First, they need to be prepared to manage pain of various etiologies in the context of other comorbid conditions. Second, the survey indicates that patients may be underusing some effective pain management tools: 10 of 14 possible strategies in the survey were endorsed by fewer than half the veterans.

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Third, the researchers suggest that because some of the participants were concerned about exercise leading to reinjury, it might be helpful to provide additional education and support about the value of pacing (ie, moderate exercise and rest vs overexertion followed by extended bed rest). VA mental health providers, they add, could also address common anxieties about reinjury and offer nonpharmacologic interventions. Studies of veterans with pain and posttraumatic stress disorder, for instance, have shown that cognitive behavioral approaches such as progressive muscle relaxation, biofeedback, and diaphragmatic breathing, which were underused in the survey group, are effective and well received.

King PR, Beehler GP, Wade MJ. Mil Med. 2015;180(8):863-868.
doi: 10.7205/MILMED-D-14-00472.

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