APS Press Room
News Highlights from The Journal of Pain • December 2007
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
First Gulf War Vets Have High Incidence of Chronic Widespread Pain
Implications for Returning Iraq and Afghanistan Troops
GLENVIEW, Dec. 15, 2007—A large study of military veterans showed that those deployed during the first Gulf War had a significantly higher incidence of chronic widespread pain and poorer overall health status than soldiers not deployed to combat. These findings may have value in providing care for soldiers returning from duty in Iraq and Afghanistan.
For the Iowa Gulf War Study, researchers from the University of Iowa, Indiana University, and Roudebush VA Medical Center, Indianapolis, IN, studied 3,695 veterans to compare the prevalence of chronic widespread pain in deployed versus nondeployed military personnel. They hypothesized that individuals who saw action in the Gulf would show a higher rate of chronic widespread pain and, as a result, their overall health would worsen and lead to a higher use of medical services.
Results of the study showed that 16% of the sampled veterans had chronic widespread pain, twice the prevalence in nondeployed subjects. Those with chronic pain also were more likely to be unemployed and rated their health status as fair to poor. They had greater utilization of mental health services and higher incidence of alcohol abuse, depression, anxiety, and chronic fatigue than nondeployed veterans.
The authors believe that their findings can predict health outcomes for veterans returning from Iraq and Afghanistan and provide guidance for possible treatments. Early recognition of the elevated risk for chronic widespread pain and associated downstream health conditions "may help optimize care and limit inappropriate health care utilization," the study concluded.
Source: Chronic Widespread Pain in Veterans of the First Gulf War: Impact of Deployment Status and Associated Health Affects; Valerie Forman-Hoffman, Paul Peloso, Donald Black, Robert Woolson, Elena Letuchy and Bradley Doebbeling; University of Iowa, Indiana University and Roudebush VA Medical Center, Indianapolis
Cognitive-Behavioral Therapy Reduces Chronic Headache Frequency
For many with chronic headaches, anxiety-laden anticipation of an episode could be as debilitating as the pain itself. According to previous research, an important predictor of adjustment to pain is catastrophizing, the exaggerated anxious mental state brought on during the pain experience. Studies have suggested that changes in catastrophizing can help reduce pain intensity. University of Alabama researchers conducted a randomized clinical trial to examine the benefits of cognitive-behavioral therapy in treating chronic headache patients. They predicted that study participants receiving cognitive-behavioral treatments would report better outcomes.
Forty patients were evaluated. Eligibility required at least 3 pain days per month from migraine or tension headaches and no significant cognitive impairments.
Results showed that chronic headache patients who were exposed to intensive cognitive therapy to mediate pain catastrophizing reported significant changes in their headache management self-efficacy compared with wait-list control subjects. There also were significant posttreatment differences in headache frequency, peak intensity, catastrophizing, depression, and anxiety. The authors concluded that cognitive-behavioral therapy is effective for reducing distress associated with chronic headaches and can reduce headache frequency.
Source: A Randomized Clinical Trial of Cognitive Behavioral Treatment To Reduce Catastrophizing in Chronic Headache Sufferers; Beverly Thorn, Laura Pence, L. Charles Ward, Gary Kilgo, Kristi Clements, Tony Cross, Amber Davis, and Patricia Tsui; University of Alabama Psychology Department, VA Medical Center, Tuscaloosa and Kilgo Headache Clinic.
Study Assesses Patient-Controlled Epidural Anesthesia
Researchers at the University of Pittsburgh compared three commonly used epidural anesthesia procedures: continuous epidural infusion, patient-controlled epidural anesthesia (PCEA) with a background infusion, and demand-dose-only patient-controlled epidural anesthesia. The objective was to assess which procedure is most advantageous for reducing labor pain, using the least medication, lessening motor block, and minimizing staff intervention. One hundred ninety-five obstetric patients were evaluated.
PCEA allows patients to self-manage their labor pain without significant risk for overdosing or underdosing. It can be provided on demand only or with a continuous background infusion. Compared with continuous epidural anesthesia, the patient-controlled method reduces staff time, improves patient satisfaction, and cuts down local doses of anesthetics.
Results showed that PCEA decreased drug utilization in the demand-only procedure, with no differences in patient satisfaction, motor block, and overall outcome. The benefit of reducing drug doses with demand-only PCEA, therefore, does not lead to improved maternal and neonatal outcomes compared with continuous epidural infusions.
Source: Epidural Labor Anesthesia: Continuous Infusion Versus Patient-Controlled Epidural Anesthesia With Background Infusion Versus Without a Background Infusion; Manuel Vallejo, Vimala Ramesh, Amy Phelps and Neera Sah;University of Pittsburgh, Department of Anesthesiology