ARLINGTON, Va. -- Pain is one of the biggest concerns Certified Occupational Therapy Assistant Meredith McDonnell sees at the Fort Belvoir Soldier Recovery Unit, so she decided to do something about it.
When she found that chronic and neuropathic pain were impacting Soldier engagement in the adaptive reconditioning program, she created the Techniques for Pain Management group to familiarize Soldiers with non-invasive treatment options.
“I decided to develop this group after I continuously saw the impact of chronic pain on our service members during my OT [occupational therapy] sessions and how much it affects the way they function in their day-to-day lives,” McDonnell said.
The Army Recovery Care Program supports wounded, ill and injured Soldiers as they transition back to the force or to veteran status. The adaptive reconditioning program is part of ARCP and provides Soldiers with activities that help them improve their wellbeing. One of the ways they accomplish this is through groups like Techniques for Pain Management.
The group approaches pain management from an OT perspective informed by body mechanics and energy conservation principles. Soldiers learn about pain, how the body is physiologically affected and how that impacts everyday life. The group also explores safety modifications for daily activity performance.
Research indicates that more than half of all American veterans experience pain. A study by Richard L. Nahin, Ph.D published in The Journal of Pain in March 2017 estimated that 65.5% of U.S. military veterans reported pain in the last three months and 9.1% were classified as having severe pain.
“It’s a topic I’m really passionate about because we do see so many Soldiers with pain,” McDonnell said.
Before the new coronavirus, the Techniques for Pain Management group met in-person once a week. McDonnell has sent the group information via email throughout the pandemic, but plans to add a virtual Life Skill Group in the near future that will explore several topics, including pain management.
The AR program also held a socially distanced in-person event in August that met all Army COVID-19 guidelines. During the event, McDonnell shared two pain management techniques: the activity-rest cycle and progressive muscle relaxation. The activity-rest cycle is an exercise that helps Soldiers pace their exertions, which may prevent overactivity and reduce recovery times.
McDonnell said that progressive muscle relaxation reduces stress and promotes relaxation through performing diaphragmatic breathing while clenching and releasing parts of the body. In her emails, she provides step-by-step instructions and pictures to make the technique as practicable as possible.
PMR may not be right for everyone in the group. McDonnell suggests progressive relaxation as an alternative exercise for Soldiers who have serious injuries or who have experienced muscle spasms. Progressive relaxation focuses on breathing with eyes closed while imagining muscles releasing tension, and relaxing those muscles, but does not incorporate muscle tightening.
In addition to PMR, Soldiers said that they enjoyed learning about the daily activity checklist and the pain flare-up plan.
Soldiers use the daily activity checklist to track and communicate key details with health care providers and document pain levels over time. One Soldier said it was “definitely a good tool” because it highlights issues that should be discussed with medical providers, but may have been overlooked in the past.
A pain flare-up plan is another option for Soldiers.
“The pain flare-up plan has helped them in preparing ahead of time for a ‘flare-up’ or a time when their pain becomes unbearable,” McDonnell said. “With the pain flare-up plan, they are able to provide themselves with a quick tool that contains emergency contact numbers, warning signs/triggers, strategies to use in a time of crisis and methods to get themselves back on track in the future.”
McDonnell said that there is a great deal of evidence-based research about the link between chronic pain and mental health and how pain symptoms can worsen in times of psychological distress.
“The strategies in Techniques for Pain Management take a multifactorial approach, looking at physical, social, emotional, cognitive and psychological factors,” she said. “Each individual Soldier will find that a different piece of information will help them manage their pain in their own way.”
The Army Warrior Care and Transition Program is now the Army Recovery Care Program. Although the name has changed, the mission remains the same: to provide quality complex case management to the Army's wounded, ill and injured Soldiers.