Presented at the 2013 AAPM Annual Meeting « Back

A Longitudinal Investigation of Major Combat Limb Injuries: The Regional Analgesia Military Battlefield Pain Outcomes Study (RAMBPOS)

Rollin M. Gallagher, MD MPH, rmg3@comcast.net¹, Rosemary C. Polomano, PhD RN², Chester C. Buckemaier, MD³, Yolanda S. Williams, MPH¹, John T. Farrar, MD PhD⁴, Wensheng Guo, PhD⁵, David Oslin, MD⁵, Brandon J. Goff, DO⁶, (1) University of Pennsylvania, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, (2) University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, (3) DVCIPM, Rockville, Maryland, (4) University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, (5) University of Pennsylvania, Philadelphia, Pennsylvania, (6) San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas

Introduction: Few studies document short- and long-term pain and behavioral health in combat-injured service members with major limb trauma. In a 2-year longitudinal study, multiple post-injury pain and related outcomes are reported. Materials and Methods: Regular phone interviews (q3 months) were conducted at the Philadelphia VA Medical Center with 277 combat-injured military service personnel with major extremity injuries (mean age 28.2 yrs. ± 7.0;19-57 yrs) recruited from military and VA facilities following initial acute-care hospitalization. Outcomes collected included the Brief Pain Inventory (BPI), Neuropathic Pain Scale(NPS), Treatment Outcomes in Pain Survey(TOPS), and VA Behavioral Health Laboratory. This study was approved by Philadelphia, VA, University of Pennsylvania, and Walter Reed National Military Medical Center IRBs. Results: BPI average and worst pain and NPS items and subscales were significantly lower (P<0.05) relative to baseline (post-acute care); no statistical differences were noted between subsequent points beyond 1 year post-injury. Selected TOPS subscale scores demonstrate similar results to other chronic pain populations. Across various time points, 38(13.7%) reported depression (16 minor and 22 major) measured by the PHQ9, 39 (14.1%) had evidence of Generalized Anxiety Disorder, 13(4.7%) indicated suicidal ideation. 126(45.5%) scored > 28 (low cut-off) on the PCL-M (range 17 to 85) measuring PTSD and 31(11.2%) > 50 (higher cut-off). Conclusions: Trends of multivariable pain data show greatest improvements in the first 3-6 months after acute care, and mental health issues are noted throughout the 2-years, suggesting the need for a continuum of effective biobehavioral pain care as injured veterans readjust to their lives post-injury.

Funding: 1) VA Merit Award, Department of Rehabilitation Research and Development, 2007-2011 2) Henry M Jackson Foundation/Defense and Veterans Center for Integrative Pain Management, 2011-2013

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