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Review
. 2015 Sep-Oct;20(5):261-8.
doi: 10.1155/2015/196025.

Pain management strategies and lessons from the military: A narrative review

April Hazard Vallerand, Patricia Cosler, Jack E Henningfield, Pam Galassini
Review

Pain management strategies and lessons from the military: A narrative review

April Hazard Vallerand et al. Pain Res Manag. 2015 Sep-Oct.

Abstract
in English, French

Background: Wounded soldiers often experience substantial pain, which must be addressed before returning to active duty or civilian life. The United States (US) military has instituted several guidelines and initiatives aimed at improving pain management by providing rapid access to medical care, and developing interdisciplinary multimodal pain management strategies based on outcomes observed both in combat and hospital settings.

Objective: To provide a narrative review regarding US military pain management guidelines and initiatives, which may guide improvements in pain management, particularly chronic pain management and prevention, for the general population.

Methods: A literature review of US military pain management guidelines and initiatives was conducted, with a particular focus on the potential of these guidelines to address shortcomings in chronic pain management in the general population.

Discussion: The application of US military pain management guidelines has been shown to improve pain monitoring, education and relief. In addition, the US military has instituted the development of programs and guidelines to ensure proper use and discourage aberrant behaviours with regard to opioid use, because opioids are regarded as a critical part of acute and chronic pain management schemes. Inadequate pain management, particularly inadequate chronic pain management, remains a major problem for the general population in the US. Application of military strategies for pain management to the general US population may lead to more effective pain management and improved long-term patient outcomes.

HISTORIQUE :: Les soldats blessés ressentent souvent des douleurs importantes, qui doivent être soulagées avant qu’ils reprennent le service actif ou la vie civile. Les forces armées américaines ont adopté des directives et des initiatives pour améliorer la gestion de la douleur grâce à un accès rapide aux soins médicaux. Elles ont créé des stratégies de gestion de la douleur multimodales interdisciplinaires en fonction des résultats cliniques observés à la fois au combat et en milieu hospitalier.

OBJECTIF :: Fournir une analyse narrative des directives et des initiatives de gestion de la douleur dans les forces armées américaines, dans l’espoir d’améliorer la gestion de la douleur, particulièrement la gestion et la prévention de la douleur chronique, dans l’ensemble de la population.

MÉTHODOLOGIE :: Les chercheurs ont réalisé une analyse bibliographique des directives et des initiatives de gestion de la douleur dans les forces armées américaines. Ils se sont particulièrement intéressés à la possibilité de les utiliser pour corriger les lacunes en matière de gestion de la douleur chronique dans l’ensemble de la population.

RÉSULTATS :: Il est démontré que les directives de gestion de la douleur des forces armées américaines améliorent la surveillance, et le soulagement de la douleur, de même que l’éducation s’y rapportant. En outre, les forces armées américaines ont commencé à adopter des programmes et des directives pour assurer la bonne utilisation des opioïdes et décourager les comportements aberrants, car les opioïdes sont un volet essentiel de la gestion de la douleur aiguë et chronique.

CONCLUSION :: La gestion insuffisante de la douleur, particulièrement celle de la douleur chronique, demeure un problème important dans l’ensemble de la population américaine. Le recours aux stratégies militaires pour y gérer la douleur pourrait susciter une gestion de la douleur plus efficace et améliorer le sort des patients à long terme.

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Figures

Figure 1)
Figure 1)
Stepped-care model of pain management from the Veterans Health Administration (30)
Figure 2)
Figure 2)
Veterans Affairs Health Administration/Department of Defense guidelines for the management of postoperative pain. Adapted with permission from reference . N No; Y Yes
Figure 3)
Figure 3)
Opioid compliance outcomes for the Opioid Renewal Clinic (ORC) at the Veterans Affairs Medical Center in Philadelphia (Pennsylvania, USA) (44). OTA Opioid treatment agreement
See this image and copyright information in PMC

References

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