Staff Perspective: Article Review
I often find myself asking, “What’s the data supporting that finding?” Truth be told, I pose this question not only at work, when looking at research articles, but also in my personal life with friends, family, and others. Sounds fun, right? It’s not that bad (insert smiley face). I bring this up because recently I came across an article by Matthias et al (2014), A Qualitative Study of Chronic Pain in Operation Enduring Freedom/Operation Iraqi Freedom Veterans: "A Burden on My Soul," that caught my attention.
It was a qualitative study examining Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans’ experience with chronic pain and their views on social support. At first glance of the article, I was intrigued. They had a small sample size (26 patients) from one Veterans Affairs medical center who participated in an intervention for chronic pain. Although there were no data charts, the article nicely highlighted the voices of these Veterans regarding their experience with chronic pain. Matthias and his colleagues discovered that the participants with chronic pain described a range of emotions including frustration, depression, hopelessness, fear, and even anger. For some of the participants, social support was described positively whereas for others it was unhelpful. Some of the participants reached out to spouses to talk about their pain experience, others talked with coworkers, and some expressed that talking about their pain was perceived as weakness. The authors concluded that there is a need for more research on OEF/OIF Veterans experiencing chronic pain and that peer-to-peer social support may be helpful for Veterans with chronic pain. In addition, they recommended that Veteran peers be integrated into chronic pain treatment approaches.
Over half the Veterans returning from the conflicts in OEF/OIF are reporting chronic pain. It is the most common reason for medical evacuation and medical boards across services (Cohen et al, 2010). Some of the risk factors specific to the military may include heavy packs (90-110 lbs of equipment) that can create shearing and cause low back pain, operational driving and flight, opt tempo missions, intense physical training, and the stigma (pain equates to weakness).
As we see more and more Service members and Veterans returning with chronic pain, it is important to learn how we as behavioral health providers can be involved as part of the treatment team. I often share with participants attending our Cognitive Behavioral Therapy for Chronic Pain workshops, you don’t have to be in a pain clinic to effectively treat patients with chronic pain. It’s important we start listening to how patients perceive their pain and learn strategies to effectively manage their symptoms and find some relief.
Helpful Questions to Ask Patients Reporting Pain
- What kind of pain are they experiencing (sharp, stabbing, dull)?
- What factors affect the pain?
- What has the patient been told is causing pain?
- What does the patient think is causing pain?
- What helps patient cope with pain?
- What helps patient cope with pain?
- How does family respond to patient’s pain?
- How does pain affect—concentration, memory, work, school, exercise, leisure activities, weight, sleep, household responsibilities, intimacy, etc.?
- What medications is the patient taking, if any, to help with the pain?
- Assess for possible medication abuse
- Obtaining early refills?
- Getting meds from numerous doctors?
- Frequent ER visits?
- Taking meds for uses other than prescribed?
Just like with any clinical population, it is important providers conduct a thorough assessment specific to the presenting problem. The interview itself can be therapeutic. Often, it’s the patient’s first encounter with behavioral health. It can give the patient an opportunity to share their own perspective on the pain experienced and learn about the impact of biopsychosocial factors contributing to pain.
Dr. Diana Sermanain is Assistant Director of Civilian Training Programs at the Center for Deployment Psychology.
References
Cohen SP, Brown C, Kurihara C, Plunkett, A., Nguyen, C., & Strassels, S.A. (2010). Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom. A prospective cohort study. Lancet, 375: 301–9.
Matthias, M. S., Miech, E.J., Myers, L.J., Sargent, C., & Bair, M.J. (2014). A qualitative study of chronic pain in Operation Enduring Freedom/Operation Iraqi Freedom veterans: “A burden on My Soul.” Military Medicine, 179(1), 26-30.
Part III: Pain Terms, A Current List with Definitions and Notes on Usage" (pp 209-214) Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, IASP Press, Seattle, ©1994.
I often find myself asking, “What’s the data supporting that finding?” Truth be told, I pose this question not only at work, when looking at research articles, but also in my personal life with friends, family, and others. Sounds fun, right? It’s not that bad (insert smiley face). I bring this up because recently I came across an article by Matthias et al (2014), A Qualitative Study of Chronic Pain in Operation Enduring Freedom/Operation Iraqi Freedom Veterans: "A Burden on My Soul," that caught my attention.
It was a qualitative study examining Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans’ experience with chronic pain and their views on social support. At first glance of the article, I was intrigued. They had a small sample size (26 patients) from one Veterans Affairs medical center who participated in an intervention for chronic pain. Although there were no data charts, the article nicely highlighted the voices of these Veterans regarding their experience with chronic pain. Matthias and his colleagues discovered that the participants with chronic pain described a range of emotions including frustration, depression, hopelessness, fear, and even anger. For some of the participants, social support was described positively whereas for others it was unhelpful. Some of the participants reached out to spouses to talk about their pain experience, others talked with coworkers, and some expressed that talking about their pain was perceived as weakness. The authors concluded that there is a need for more research on OEF/OIF Veterans experiencing chronic pain and that peer-to-peer social support may be helpful for Veterans with chronic pain. In addition, they recommended that Veteran peers be integrated into chronic pain treatment approaches.
Over half the Veterans returning from the conflicts in OEF/OIF are reporting chronic pain. It is the most common reason for medical evacuation and medical boards across services (Cohen et al, 2010). Some of the risk factors specific to the military may include heavy packs (90-110 lbs of equipment) that can create shearing and cause low back pain, operational driving and flight, opt tempo missions, intense physical training, and the stigma (pain equates to weakness).
As we see more and more Service members and Veterans returning with chronic pain, it is important to learn how we as behavioral health providers can be involved as part of the treatment team. I often share with participants attending our Cognitive Behavioral Therapy for Chronic Pain workshops, you don’t have to be in a pain clinic to effectively treat patients with chronic pain. It’s important we start listening to how patients perceive their pain and learn strategies to effectively manage their symptoms and find some relief.
Helpful Questions to Ask Patients Reporting Pain
- What kind of pain are they experiencing (sharp, stabbing, dull)?
- What factors affect the pain?
- What has the patient been told is causing pain?
- What does the patient think is causing pain?
- What helps patient cope with pain?
- What helps patient cope with pain?
- How does family respond to patient’s pain?
- How does pain affect—concentration, memory, work, school, exercise, leisure activities, weight, sleep, household responsibilities, intimacy, etc.?
- What medications is the patient taking, if any, to help with the pain?
- Assess for possible medication abuse
- Obtaining early refills?
- Getting meds from numerous doctors?
- Frequent ER visits?
- Taking meds for uses other than prescribed?
Just like with any clinical population, it is important providers conduct a thorough assessment specific to the presenting problem. The interview itself can be therapeutic. Often, it’s the patient’s first encounter with behavioral health. It can give the patient an opportunity to share their own perspective on the pain experienced and learn about the impact of biopsychosocial factors contributing to pain.
Dr. Diana Sermanain is Assistant Director of Civilian Training Programs at the Center for Deployment Psychology.
References
Cohen SP, Brown C, Kurihara C, Plunkett, A., Nguyen, C., & Strassels, S.A. (2010). Diagnoses and factors associated with medical evacuation and return to duty for service members participating in Operation Iraqi Freedom or Operation Enduring Freedom. A prospective cohort study. Lancet, 375: 301–9.
Matthias, M. S., Miech, E.J., Myers, L.J., Sargent, C., & Bair, M.J. (2014). A qualitative study of chronic pain in Operation Enduring Freedom/Operation Iraqi Freedom veterans: “A burden on My Soul.” Military Medicine, 179(1), 26-30.
Part III: Pain Terms, A Current List with Definitions and Notes on Usage" (pp 209-214) Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, IASP Press, Seattle, ©1994.