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Gunterstockman BM, Knight AD, Mahon CE, Childers WL, Cagle T, Hendershot BD, Farrokhi S. Relationship between phantom limb pain, function, and psychosocial health in individuals with lower-limb loss. Prosthet Orthot Int 2023; 47:181-188. [PMID: 36637908 DOI: 10.1097/pxr.0000000000000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 08/17/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The adverse influence of chronic pain on function and psychological health in the general population is well understood. However, the relationship between phantom limb pain (PLP) after limb loss with function and psychological health is less clear. The study purpose was to assess the influences of PLP presence and intensity on function and psychosocial health in individuals with lower-limb loss (LLL). METHODS One hundred two individuals with major LLL completed a study-specific questionnaire on the presence and intensity of their PLP. The Patient-Reported Outcomes Measurement Information System -29 questionnaire was also administered. RESULTS Of 102 participants, 64% reported PLP, with a mean intensity of 4.8 ± 2.3 out of 10. Individuals with vs. without PLP demonstrated significantly greater sleep disturbances ( p = 0.03), whereas the differences in function, fatigue, pain interference, depressive symptoms, anxiety, or ability to participate in social roles and activities were not statistically different between groups ( p > 0.05). Of note, mean scores for many of the Patient-Reported Outcomes Measurement Information System-29 short forms among the current sample were similar to the mean of the general population, minimizing the potential clinical impact of PLP on these domains. CONCLUSIONS Our findings indicate a lack of meaningful associations between PLP presence or intensity with function, and psychosocial health among individuals with LLL. These findings conflict with previous research suggesting an adverse relationship between PLP, function, and psychosocial health after limb loss.
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Affiliation(s)
- Brittney M Gunterstockman
- Doctor of Physical Therapy Program, Lincoln Memorial University, Knoxville, TN, USA
- Currently with Lincoln Memorial University, Harrogate, TN, USA
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA
- Department of Physical & Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, USA
| | - Ashley D Knight
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Caitlin E Mahon
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - W Lee Childers
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX, USA
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Tyler Cagle
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, USA
| | - Brad D Hendershot
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Shawn Farrokhi
- Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, San Diego, CA, USA
- Department of Physical & Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD, USA
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Bader CE, Flynn DM, Buckenmaier CC, McDonald CC, Meghani SH, Glaser D, Polomano RC. Patterns of Change in Pain-related Physical, Mental, and Social Health Outcomes in a Military Population. Pain Manag Nurs 2023; 24:265-272. [PMID: 36746698 DOI: 10.1016/j.pmn.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/08/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Military persons frequently experience pain conditions stemming from noncombat and combat injuries. This study assessed the patterns of change over time and the associations of pain intensity and interference with physical, mental, and social health domains in a military sample. METHODS A secondary analysis of Pain Assessment Screening Tool and Outcomes Registry (PASTOR) was conducted using data collected over 10 months. Participants selected for analysis completed ≥3 assessments with an interval of ≥14 days between assessments. The Defense and Veterans Pain Rating Scale (DVPRS) measured average and worst pain intensity, and Patient-Reported Outcomes Measurement Information System (PROMIS®) T-scores measured pain and health outcomes. RESULTS The sample (N = 190) majority reported being active duty (96%); serving in the U.S. Army (93%); and being enlisted (86%). The percent difference from assessment one to assessment three showed improvement for DVPRS average pain (-4.85%) and worst pain (-2.16%), and PROMIS Pain Interference T-score (-1.98%). Improvements were observed for all PROMIS outcomes except depression. The Defense and Veterans Pain Rating Scale average and worst pain intensity and PROMIS pain interference were strongly correlated with physical function. Multilevel models showed that an increase in average and worst pain, and pain interference were associated with a decrease in satisfaction with social roles. CONCLUSION Analysis identified patterns of change over time in physical, mental, and social health outcomes, as well as associations important to understanding the complexities of pain. This work has implications for pain management nursing in ambulatory settings where ongoing collection and analyses of multivariable outcomes data can inform clinical care.
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Affiliation(s)
- Christine E Bader
- Special Assistant to the Dean, Graduate School of Nursing, Uniformed Services University of the Health Sciences.
| | - Diane M Flynn
- Department of Rehabilitative Medicine, Madigan Army Medical Center, Tacoma, Washington
| | - Chester C Buckenmaier
- Professor Emeritus, Department of Anesthesiology, Uniformed Services University of the Health Sciences
| | - Catherine C McDonald
- Associate Professor, University of Pennsylvania, School of Nursing, Perelman School of Medicine at the University of Pennsylvania, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Salimah H Meghani
- Professor & Craig M. Wasserman Term Chair of Palliative Care, Department of Biobehavioral Health Sciences, Associate Director, NewCourtland Center for Transitions and Health, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Dale Glaser
- Principal, Glaser Consulting, Lecturer and Adjunct Faculty at San Diego State University/University of San Diego/University of California San Diego
| | - Rosemary C Polomano
- Associate Dean for Practice, Professor of Pain Practice, University of Pennsylvania, School of Nursing, Professor of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania
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Krause-Parello CA, Flynn L, Hibler DA, Presciutti RE, Pratt BA, Walsh P, Garvin JT, Morse CY, Carter L, Moreno SJ. Social and Chronic Pain: Veterans Sharing a Path in Developing a Patient-Centered Response to the COVID-19 Pandemic. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i1.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Bader C, Flynn D, Buckenmaier C, McDonald C, Meghani S, Calilung C, Polomano R. Comparative Analysis of Health Domains for Neuropathic Pain Patients. Clin Nurs Res 2021; 31:89-99. [PMID: 34291679 DOI: 10.1177/10547738211030640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Active duty military members have significant service-related risks for developing pain from injury. Although estimates for neuropathic pain (NP) are available for civilian populations, the incidence and prevalence for NP in military members is less clear. Understanding correlates of pain in military members is vital to improving their physical, mental, and social health. Using a comparative design, a secondary analysis was conducted on longitudinal PASTOR data from 190 pain management center patients. The objectives were to compare trends in patient-reported outcomes over time between those screening positive and negative for NP (NP+, NP-, respectively) based on PROMIS Neuropathic Pain Scale T-scores. Findings showed improvements in fatigue, sleep-related impairment, and anger over time. There was a difference between those screening NP+ and NP- for sleep-related impairment, and the cross-level interaction effect showed sleep-related impairment worsening over time. These results emphasize the need to identify NP and implement and evaluate targeted therapies.
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Affiliation(s)
- Christine Bader
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Diane Flynn
- Madigan Army Medical Center, Tacoma, WA, USA
| | - Chester Buckenmaier
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
| | | | - Salimah Meghani
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Christian Calilung
- Defense and Veterans Center for Integrative Pain Management, Rockville, MD, USA
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Abstract
A vast number of veterans with posttraumatic stress disorder (PTSD) have chronic somatic comorbidities. However, their relationship with quality of life (QoL) has received little attention. We aimed to compare QoL of veterans with similar intensity of PTSD but different number of chronic somatic disorders. Of 129 veterans, 78% had at least one somatic disorder, and they reported lower QoL across all domains than veterans without somatic comorbidities. The greatest effect size was observed on social relationship (d = 0.65), it was notable on environment (d = 0.4) and psychological health (d = 0.38), and it was not relevant on physical health (d = 0.05). There was a negative correlation between the number of somatic disorders and scores on psychological health (rs = -0.217, p = 0.014), social relationships (rs = -0.248, p = 0.005), and environment (rs = -0.279, p = 0.001). The QoL of war veterans decreases significantly with the number of comorbid somatic conditions, particularly on the nonphysical domains of QoL.
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Stadtmann MP, Maercker A, Binder J, Schnepp W. Why do I have to suffer? Symptom management, views and experiences of persons with a CPTSD: a grounded theory approach. BMC Psychiatry 2018; 18:392. [PMID: 30567517 PMCID: PMC6299949 DOI: 10.1186/s12888-018-1971-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For the 11th version of the International Classification of Diseases, a new stress related diagnosis has been proposed: complex post-traumatic stress disorder (CPTSD). It is described as a chronic condition with several severe and concurrent symptoms. In the literature, these symptoms are discussed as a common reason for seeking psychiatric treatment as they can influence and impair the quality of life not only for affected persons but also for their social and familial system. AIM This research studies symptom management in everyday life by exploring and reconstructing the views, perceptions, experiences, facilitators and barriers of adults with CPTSD. METHODS A theoretical sampling was used to recruit 18 to 65 years old patients diagnosed with CPTSD from an inpatient setting. The 17 semi-structured interviews were audio recorded and transcribed verbatim. The transcriptions were uploaded into MAXQDA, and a Grounded Theory method based on Corbin and Strauss was used to analyse the data. RESULTS We provide a process model with 5 interacting phases: trauma experience, emotional ignorance, overcompensation, paroxysm, and perspectives. Each phase is specified with subcategories. CONCLUSIONS The participants did not recognise their symptoms as such and were unaware of their diagnosis for many years. Nevertheless, they used various resources and were able to develop skills and techniques to deal with their symptoms and to function on a day-to-day basis. Overall, the process of symptom management was extremely exhausting for the participants and they felt left alone with it. The participants were eager to gain support from healthcare professionals and, when necessary, financial support from the government. Thus, these results indicate an essential need to develop support and tailored interventions for the symptom management of persons with a CPTSD. TRIAL REGISTRATION Ethical approval was obtained from the Swiss Cantonal Ethic Commission (Nr 201,500,096). This research was also registered at the World Health Organization Clinical Trials Search Portal through the German Clinical Trial Register, Trial DRKS00012268 .
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Affiliation(s)
- Manuel P. Stadtmann
- 0000 0000 9024 6397grid.412581.bDepartment of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany ,0000 0004 0570 3485grid.491855.4Centre for Trauma Disorders, Integrierte Psychiatrie Winterthur, Technikumstrasse 81, Winterthur, Switzerland
| | - Andreas Maercker
- 0000 0004 1937 0650grid.7400.3Department of Psychology, Psychopathology and Clinical Intervention, University of Zurich, Binzmühlestrasse 14/17, 8050 Zürich, Switzerland
| | - Jochen Binder
- 0000 0004 0570 3485grid.491855.4Centre for Trauma Disorders, Integrierte Psychiatrie Winterthur, Technikumstrasse 81, Winterthur, Switzerland
| | - Wilfried Schnepp
- 0000 0000 9024 6397grid.412581.bDepartment of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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Bader CE, Giordano NA, McDonald CC, Meghani SH, Polomano RC. Musculoskeletal Pain and Headache in the Active Duty Military Population: An Integrative Review. Worldviews Evid Based Nurs 2018; 15:264-271. [PMID: 29957866 DOI: 10.1111/wvn.12301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since 2001, the U.S. Armed Forces' training and deployment have greatly increased, escalating the risk of injury and pain-related issues both at home station and deployment environments. AIMS This integrative review examines the incidence, prevalence, and risk factors for musculoskeletal pain (MSP) and headaches in active duty (AD) military populations. METHODS Peer-reviewed research published between 2001 and 2016 was identified relevant to MSP and headache in AD military personnel using MeSH terms in key biomedical databases. Inclusion criteria were: epidemiological studies examining MSP or headache as primary or secondary outcome; samples that included AD populations; and studies conducted in the theater of operations, at home station, and in military treatment or Veterans Health Administration facilities. RESULTS Twenty-six articles met inclusion criteria. Low back pain (LBP) was the most prevalent MSP diagnosis. The incidence of LBP was 40.5 per 1,000 person-years and was comparable to nonmilitary populations. Inflammation and pain from overuse comprised the largest proportion of injury mechanism, accounting for about 82% of all injuries among nondeployed military personnel. The risk of MSP was greater for AD, female, Army, enlisted personnel, and those with greater time in a motor vehicle. Evidence suggests posttraumatic headache, occurring in up to 92% of military personnel who have sustained a mild traumatic brain injury, is associated with chronic daily headaches. IMPLICATIONS Nurses must recognize the consequences military service can have on the development of pain. Nurses have an opportunity to positively impact the health and well-being of military and veteran populations through early recognition and treatment of pain. LINKING EVIDENCE TO ACTION The findings from this review underscore considerable magnitude of MSP in military personnel and expose modifiable risk factors and potential targets for designing nurse-led interventions to improve pain and symptoms in military subpopulations.
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Affiliation(s)
- Christine E Bader
- Former PhD Student, Robert Wood Johnson Foundation Future of Nursing Scholar (Independence Blue Cross Foundation), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nicholas A Giordano
- Former PhD Student, Hillman Scholar in Nursing Innovation, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Catherine C McDonald
- Assistant Professor, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Salimah H Meghani
- Associate Professor & Term Chair in Palliative Care, Chair, Graduate Group in Nursing, University of Pennsylvania School of Nursing, and Associate Director, NewCourtland Center for Transitions and Health Senior Fellow, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Rosemary C Polomano
- Professor of Pain Practice, University of Pennsylvania School of Nursing, and Professor of Anesthesiology and Critical Care (Secondary), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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