Regional Anesthesia Military Battlefield Pain Outcomes Study

BACKGROUND:

Adequate pain management for combat casualties balances the need for emergent, life-saving
care with the urgency to remove soldiers from harm's way. Control of pain in traumatic
battlefield situations may be impossible until safe evacuation to a surgical facility is
achieved and a wounded soldier can receive general anesthesia. Recent evidence suggests that
neural plasticity in the central nervous system coupled with hyperstimulation of central
neuronal pathways lead to neuropathological remodeling. This neural rewiring may result in
chronic pain for patients who have experienced severe, unrelieved acute pain. In addition,
the stress of combat along with the suffering of prolonged uncontrolled pain may contribute
to psychological disorders, such as post-traumatic stress disorder, depression, and
substance abuse.

OBJECTIVE:

The purpose of this study is to evaluate the effect of early and aggressive advanced
regional anesthesia on the chronic neuropathic pain, health related quality of life, and
mental health of OEF/OIF veterans who have suffered a major limb injury in combat. An
additional aim of this study is to quantify and characterize the short-term and long-term
effects of traumatic combat limb injuries on post-injury acute pain, chronic pain, health
related quality of life, functional status, social reintegration, psychological adjustment,
and substance abuse behaviors in a population of injured military personnel.

METHOD:

This study employs a cohort repeated measures study design involving prospective data
collection at scheduled intervals. Interviews with participants provide data on pain
outcomes, psychiatric morbidities, and quality of life. Follow up evaluations conclude at
the two year anniversary of the start of combat injury rehabilitation. Medical records
information collected retrospectively from armed services treatment facilities provide data
on the use of pain management therapies as well as individual responses to regional
anesthesia.

IMPLICATIONS FOR RESULTS:

The findings of this study may impact the clinical field by providing information on the
effectiveness and benefits of early advanced regional anesthesia for chronic pain control.
This study may also provide data to determine whether regional anesthesia pain treatments
prevent or reduce the development of psychological maladjustment disorders such as
post-traumatic stress disorder, depression, and substance abuse in a population of military
personnel with combat limb injuries.

Inclusion Criteria:

- Major injury in one or more extremities requiring hospitalization and inpatient
rehabilitation.

Exclusion Criteria:

- Major head trauma

- Cognitive deficits

- Inability to concentrate

- Poor judgment and impulse control

- Substantial hearing loss

- Bilateral upper extremity amputation with no alternate means to complete the survey
forms