Defense and Veterans Center for Integrative Pain Management
A Featured HJF Research Program
When the Army Pain Management Task Force was chartered in 2009, the aim was to recommend a comprehensive pain management strategy that would provide optimal quality of life for soldiers and their family members dealing with pain.
The challenge was answered by the Defense and Veterans Center for Integrative Pain Management, a model for effective integration of acute and chronic pain medicine since 2003. Created to improve the management of pain in military and civilian medicine through clinical research efforts, the center focuses on understanding the continuum of pain care from the battlefield, during evacuation, care at home, and rehabilitation and recovery.
One of the center’s most important projects in 2014 was the Pain Assessment Screening Tool and Outcomes Registry, driven by the National Institutes of Health–Patient Reported Outcomes Measurement Information System. This Internet-driven system and registry allows a far more dynamic and complete understanding of the psychosocial and functional aspects of pain in a way heretofore not possible. Once completed, providers are empowered with a three-page graphical report on the patient’s responses to enhance clinical interaction.
“What we are trying to do is measure somebody between a triathlete in peak physical condition and somebody who’s an invalid in a bed, and there are physical function levels all the way in between,” said retired Army Colonel Chester “Trip” Buckenmaier, M.D., the center’s program director and principal investigator.
The program uses computer adaptive testing technology, which lessens the patient’s burden of response and informs clinicians about a patient’s pain. The computer asks a question in the center of the continuum, and based on the patient’s response—whether they are closer to the triathlete or to the bedridden patient—the next most informative question will be asked in that direction.
“When you use computer adaptive testing, I can get the same answer that standard test theory would give you with 50 questions, in anywhere from four to eight questions,” he said.
Another current project, funded by the Department of Defense and Veteran Affairs’ Joint Incentive Fund, focuses on integrative pain medicine training. The program trains medics and nurses in battlefield acupuncture (an auricular acupuncture procedure), and has enlightened the military on using acupuncture as a viable technique and option for health care.
To help validate battlefield acupuncture and produce meaningful data, a team at Fort Bragg, led by Anthony Plunkett, M.D., is using acupuncture on patients under general anesthesia during tonsillectomies to determine its impact. Acupuncture helps release endorphins, the body’s own painkillers, and stimulates the body’s healing mechanisms.
“What I think is really fascinating about what we’re doing is so many people, particularly in this country, think of acupuncture as an alternative. You’ve tried (Western) medicine, now we’ll try acupuncture,” Buckenmaier said. “That’s not the way we think, and that’s not the way we are introducing acupuncture. We are saying acupuncture is an adjunct to regular care, and it may actually reduce our dependence on some of the medications.”
In 2014, 771 providers were trained through this effort, including 38 new faculty members who carried the training to others. In addition, 22 providers were enrolled in 300-hour medical acupuncture courses. The infrastructure of HJF and USU helps coordinate and manage these educational projects, which have built expertise in the growing field of acupuncture.