Readiness through Pain Management

By Rebecca L. WestfallJune 27, 2019

Elector Acupunture
(Photo Credit: U.S. Army) VIEW ORIGINAL

The Army Comprehensive Pain Management Campaign Plan and Interdisciplinary Pain Management Centers are critical avenues to the readiness of Soldiers and Service Members. Traditional pain management treatments such as oral medications, opioids, and activity modifications are often times not adequate enough to help Soldiers return to duty. In most cases, chronic opioid therapy actually degrades readiness with lower back and musculoskeletal pain being the most frequent conditions that cause soldiers to be non-deployable.

"The mission of the Interdisciplinary Pain Management Center (IPMC) is to provide the supported population with effective, safe, holistic pain management services and to promote the most comprehensive and interdisciplinary pain management care in the Military Health System. "The IPMC seeks to promote the bio-psychosocial health of all beneficiaries through coordinated science-based, interventional, psychological, complementary and alternative (CAM) health services. This includes education, training and research with the desired outcome of improving function and readiness without the use of opioids," said Lt. Col. Brian McLean.

McLean is the leading pain management consultant to the Army Surgeon General. He is a Board Certified physician in pain management, a member of the American Society of Anesthesia Pain Management and currently holds the position as Chief of the Pain Department and Interdisciplinary Pain Management Center at Tripler Army Medical Center in Honolulu, Hawaii.

The Army's Comprehensive Pain Management Campaign plan was created in 2009 by a task force spear-headed by retired Army Surgeon General Lt. Gen. Eric Schoomaker. The long term goal for Army Medicine was to form a pain management strategy for holistic, multidisciplinary approaches to pain management. Currently, there are seven IPMC's that encourage a more holistic and non-pharmacologic view for patients with acute and chronic pain. Interdisciplinary Pain Management Teams include pain physicians, pain psychologists, physician assistants, physical therapists, chiropractors, clinical pharmacists, medical massage therapists, acupuncturists, nurses, techs, and support staff.

McLean added, "The MHS Stepped Care Model (SCM) seeks to provide our patients with the most effective pain management guided by Clinical Practice Guidelines (CPGs) while avoiding chronic pain, limited and carefully considered opioid use, and to minimize complications for the minority of patients that do require opioids."

"Care is delivered as a team-based, interdisciplinary model for pain management aligning across the clinical services. "Stepped care" delivers and monitors pain treatment utilizing the Patient-Centered Medical Home (PCMH) first, then moving patients forward on the continuum of care only as clinically required," said McLean.

Pain focused assets within the primary and secondary levels of care may include physical therapy, internal behavioral health consultants, clinical pharmacists and care coordinators.

Patients with longer-lasting pain or higher medical complexity advance to the IPMC, where they benefit from additional services such as physical therapy, pharmacy review, care coordination, and behavioral health. Only the most chronic and/or complex patients who do not improve in the medical neighborhood will require referral to a pain management clinic. According to McLean, "The biggest complaints currently are for chronic low back pain, chronic neck pain, knee and joint pains."

The priority of the IPMCs is on the care and return to duty of the active duty service member, however other Tricare beneficiaries can be accepted on a space available basis. Tricare beneficiaries can have consults to the civilian pain management network, however most complementary and alternative treatments such as acupuncture, massage or chiropractic care are not currently Tricare covered benefits.

McLean said, "We recommend education and patient self-care as first steps of all pain treatment. Our patients receive education on improving nutrition, sleep, activity, movement therapy, and healthy behaviors such as diet improvement and quitting smoking.

"Movement therapy and yoga therapies are recommended for most patients with chronic pain. Other services include pain psychology-understanding the mind body connection, Cognitive behavioral therapy (CBT), biofeedback, guided imagery, medication, chiropractic care, medical massage therapy classes, physical therapy, acupuncture, medication management and invasive interventional pain procedures," he continued. "

"Based on surveys, pain education programs that we provide as well as our comprehensive physical therapy, movement programs, manipulation and acupuncture services are the more sought-after treatments plans by patients," added McLean.

Army leadership is accommodating of alternative treatments for pain management. For the example, the Army has accepted the Battlefield Ear Acupuncture program that can be taught to providers in the field. Chiropractic care also has been supported in the military longer than the IPMCs. Even Warrior Transition Units (WTU) have started their own yoga therapy and meditation programs.

"The biggest challenge is expectation management and patient education. Our first goal is to help patients understand that chronic pain is not something that can be cured or fixed quickly or easily through a procedure or medication but that we can improve patient's functions and quality of life through partnership of the patient and provider and the patients commitment to self-care and change in behaviors and health," stated McLean.

"Pain management is a rapidly evolving field with new treatments being studied yearly and the army pain programs will be the first to adopt new treatment ideas as well as assist in the research and validation of new pain management strategies," he added.

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