Mental health problems linger in veterans with major limb injuries

Veterans who sustained major limb injuries during combat reported little improvement in symptoms of depression, anxiety, post-traumatic stress disorder and other mental health problems up to 2 years post injury, according to recent study results. However, pain showed the most improvement 3 to 6 months after acute hospitalization and then leveled off at 1 year.

Researchers conducted phone interviews with 277 combat-injured military service personnel beginning after initial hospitalization for acute care, every 3 months for 2 years. Participants answered questions designed to measure multiple outcomes related to pain and behavioral health.

Measurement tools included the Brief Pain Inventory (BPI), Neuropathic Pain Scale (NPA), Treatment Outcomes in Pain Survey (TOPS) and VA Behavioral Health Laboratory.

Overall, study results showed that the BPI average and worst pain and the NPS items and subscales were significantly lower post-treatment vs. baseline. Across various points of time, researchers found that 13.5% of participants reported depression, 5% suicidal ideation and 13.9% generalized anxiety disorder. A low level of post-traumatic stress disorder was reported by 45.9% of participants, while an additional 11.7% reported a high level, according to study results.

The results suggest that severely injured veterans will need ongoing biobehavioral pain and psychological care to help them cope with the pain and trauma of injury. However, whether early intervention with aggressive pain management, including continuous neural blockade, will ultimately change the trajectory of chronic pain following severs injury remains to be seen.

“Our research confirms that chronic daily pain, including neuropathic pain, continues to be a burden for limb-injured servicemen, that post-traumatic stress is a far more prominent feature of recovery than in other chronic pain populations and that returning to meaningful role functioning in their lives is challenging for many,” Rollin M. Gallagher, MD, MPH, deputy national program director for pain management in the Department of Veterans Affairs and clinical professor of psychiatry and anesthesiology at the University of Pennsylvania and the Philadelphia VA Medical Center, stated.

For more information:

Gallagher RM. A longitudinal investigation of major combat limb injuries: the regional analgesia military battlefield pain outcomes study. Presented at: The American Academy of Pain Medicine 29th Annual Meeting; April 11-14, 2013; Fort Lauderdale, Fla.

Disclosure: The researchers received funding from the Veterans Affair Merit Award, Department of Rehabilitation Research and Development and the Henry M. Jackson Foundation/Defense and Veterans Center for Integrative Pain Management.

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