Tuesday, May 29, 2012

What is the Army Pain Management Task Force?

What is the Army Pain Management Task Force?
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Well, the Army decided a couple years ago that the current system of treating pain in returning servicemembers is not adequate and has great room for improvement.

For some useful short overviews of the project, check out these videos:
Interview with General Schoomaker, leader of the Task Force:
Part 1 
Part 2 

The following excerpt is from the article by Catrina Francis, "Army takes a Hard Look at Chronic, Acute Pain" published August 2010 on army.mil.
The Army Pain Management Task Force, "stated in its assessment that the failure to adequately address pain in the health care system continues to result in unnecessary suffering, exacerbation of other medical conditions, and huge financial and personnel costs." [Francis, August 2010.]
The Army Pain Management Task Force's "final recommendations were divided into four areas:
  1. Provide tools and infrastructure that support and encourage practice and research advancement in pain management.
  2. Build a full spectrum of best practices for the continuum of acute and chronic pain, based on a foundation of best available evidence.
  3. Focus on the warrior and family-sustaining the force.
  4. Synchronize a culture of pain awareness, education, and proactive intervention." [Francis, August 2010] 
An Army News article (June 2010) by Alexandra Hemmerly-Brown gives a good synopsis of the task force recommendations. She writes that the Army Pain Management Task Force recommends 109 changes to their current system.
"The Pain Management Task Force's final report, which was initiated by Lt. Gen. Eric B. Schoomaker in August of 2009, addresses the lack of a comprehensive pain-management strategy across the Army, and suggests alternative treatments to medication such as acupuncture, meditation, biofeedback and yoga. Also noted in the report is the fact that pain management has changed very little since the discovery of morphine in 1805.
Schoomaker explained that with the increasing numbers of Soldiers returning from combat with severe wounds, reports of medication abuse and suicides with pain as a possible factor are troubling.
He said part of the problem is that severely injured Soldiers, like those in Warrior Transition Units, are often prescribed multiple medications and sometimes seen by several different doctors, which can cause inconsistencies in care. But he maintained that this is not just an Army problem-it's a problem throughout the U.S. healthcare system." [Hemmerly-Brown, Army News] [emphasis my own]
 
Acupuncture Today 2010 article: "Army to Include AOM for Pain Management" talks about General Schoomaker's Pain Management Task Force and its initiative to include acupuncture and oriental medicine as well as chiropractic care, massage, and yoga in future pain management clinics.
Part of the Army Pain Management Task Force was to create Interdisciplinary Pain Management Clinics which include standard pain care modalities and CAM therapies practiced by licensed and nationally board certified CAM practitioners (chiropractic, yoga, acupuncture, massage therapy, etc).  The related article that talks about the upcoming Interdisciplinary Pain Clinic at Madigan Army Medical Center was written by Tom Bradbury, published in the September issue of the Northwest Guardian
 
 
In "Military Medicine Leading the Way for the Nation" by COL Kevin T. Galloway and published in the online Military Medical and Veterans Affairs Forum November, 2011, is a more recent update of how the Pain Management Task Force items are being implemented.  Standardizing pain care is essential for the military population, Galloway writes, "Because military medicine providers and patients are a transient population, a failure to standardize an approach for pain management leaves the military at increased risks for poor continuity of pain care/treatment/outcomes.  The strategy is 'standardize to optimize'."  However, "the military is unique in its ability to quickly respond to a task of this magnitude" such as completely changing its system of pain management.
Galloway talks about the three missions of the Interdisciplinary Pain Management Centers (IPMCs), as recommended through the Task Force and established by MEDCOM.  The facilities with IPMCs that Galloway lists are:  Tripler Army Medical Center, Madigan Army Medical Center, Dwight Eisenhower Army Medical Center, and Landstuhl Army Medical Center.
  1. Mission 1--Refine an interdisciplinary model of pain management and practice.  Use modern technology and complementary medicine modalities for treating pain.  "Acupuncturists, massage therapists, and movement therapists will be critical members of the IPMC teams.  The IPMC will serve as the pain specialty referral clinic for their facility and designated portion of their geographic region."
  2. Mission 2--Serve as pain management outreach and education for primary care within their facility and region.  Pain management starts in the primary care setting.  Primary care providers must be educated about appropriate pain management and the resources available to them, particularly those through the IPMC
  3. Mission 3--connect to the smaller pain management augmentation teams at smaller medical facilities.  These smaller teams will have a primary care pain champion, a clinical pharmacist, and a care coordinator.  This small team will be the local link to the designated IPMC and "allow for synchronized implementation of education and practice updates as indicated in the" Army Comprehensive Pain Management Campaign Plan. [Galloway, 2011]

Galloway also mentions a system that is being developed for tracking outcome data for pain management.  This system is a combination of PASTOR (Patient Assessment and Outcomes Registry) and PROMIS (Patient-Reported Outcomes Measurement Information System).  PROMIS was created by the National Institutes of Health and Northwestern University.  If successful the PROMIS-PASTOR system will be "a national model for measurements-based care".  [Galloway, 2011]
The Army pain management clinics are under the Army Rehabilitation and Reintegration Division.
The Army Rehabilitation and Reintegration Division (R2D)
This is the U.S. Army’s comprehensive oversight office for all rehabilitation and reintegration programs and policies for wounded, ill, and injured Soldiers and their Families, to include those with chronic/acute musculoskeletal injury and pain, traumatic brain injury, amputations, polytrauma, and functional limitations related to combat stress.
Mission Statement
We develop, guide, and influence strategic rehabilitation and reintegration policy and programs to optimize the quality of life and function of Soldiers and their Families.
Vision Statement
To be military medicine’s premier organization for integrative rehabilitation and reintegration.
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Related blog posts:
NPR story:  The Weight of War, new efforts in Pain Management for the Wounded Warrior
OASIS Center, the Navy Medicine approach to in-patient Combat Stress Care
Related sites:
The June 2011 Institute of Medicine report, "Relieving Pain in America:  A Blueprint for Transforming Prevention, Care, Education, and Research" is the civilian assessment of America's current pain management system.

Sources:
Francis, Catrina.  "Army takes a hard look at chronic, acute pain."  August 5th, 2010.  Army News.
"Army to Include AOM for Pain Management."  Acupuncture Today.  July 21st, 2010.
Bradbury, Tom.  "Army's Pain Management Initiative a Collaborative Effort".  September 15th, 2011.  Northwest Guardian. 
Hemmerly-Brown, Alexandra.  "Army looking at yoga, acupuncture to treat pain."  June 25th, 2010.  Army News.
Galloway, Kevin T.  "Military Medicine Leading the Way for the Nation".  MMT 2011, volume 15, issue 7 (November 2011).

ClipArt:  Chaplain counselling at bedside

2 comments:

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