A Systematic Review of Chronic Pain Management Interventions Among Veterans of Recent Wars and Armed Conflicts

IF 1.6 4区医学 Q2 NURSING Pain Management Nursing Pub Date : 2024-06-01 DOI:10.1016/j.pmn.2024.03.008

Rital Lakshman MNP, BSN, RN , Emily Tomlinson PhD, RN , Tracey Bucknall PhD, RN, FAAN, GAICD

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Abstract

Objectives

To identify chronic pain management strategies aimed to reduce pain intensity and enhance functional outcomes in veterans of wars and armed conflict.

Design

Systematic review without meta-analysis.

Data Sources

Key words “chronic pain,” “veterans,” and “injuries” were used to search for articles in the MEDLINE, CINAHL, APA PsycInfo, and Embase databases. Articles published in English between 2000 and 2023 were included.

Review/analysis methods

A systematic literature search was conducted in June 2020, updated in April 2023, and managed using Covidence review software. Inclusion criteria focused on combat-injured veterans with chronic pain, excluding nonveterans and civilians treated for acute or chronic pain. Data from included studies were extracted, summarized, and critically appraised using the 2018 Mixed Methods Appraisal Tool. This review is registered with PROSPERO (CRD42020207435).

Results

Fourteen studies met the inclusion criteria, with 10 of them supporting nonpharmacological approaches for managing chronic pain among veterans of armed conflicts and wars. Interventions included psychological/behavioral therapies, peer support, biofeedback training via telephone-based therapy, manual therapy, yoga, cognitive processing therapy, cognitive-behavioral therapy, and social and community integration to reduce pain intensity and enhance functional outcomes.

Conclusion

Nonpharmacological treatments for chronic pain have increased in recent years, a shift from earlier reliance on pharmacological treatments. More evidence from randomized controlled trials on the benefits of combined pain interventions could improve pain management of veterans with complex care needs.

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关于近期战争和武装冲突退伍军人慢性疼痛管理干预措施的系统性综述。

目的确定旨在降低战争和武装冲突退伍军人疼痛强度并提高其功能效果的慢性疼痛管理策略：设计：系统综述，无荟萃分析：使用关键词 "慢性疼痛"、"退伍军人 "和 "伤害 "在 MEDLINE、CINAHL、APA PsycInfo 和 Embase 数据库中搜索文章。收录了 2000 年至 2023 年间发表的英文文章：2020 年 6 月进行了系统性文献检索，2023 年 4 月进行了更新，并使用 Covidence 综述软件进行管理。纳入标准主要针对在战斗中受伤并患有慢性疼痛的退伍军人，不包括非退伍军人和接受急性或慢性疼痛治疗的平民。对纳入研究的数据进行提取、总结，并使用 2018 年混合方法评估工具进行严格评估。本综述已在 PROSPERO 注册（CRD42020207435）：14项研究符合纳入标准，其中10项研究支持采用非药物方法管理武装冲突和战争退伍军人的慢性疼痛。干预措施包括心理/行为疗法、同伴支持、通过电话疗法进行生物反馈训练、徒手疗法、瑜伽、认知处理疗法、认知行为疗法以及社会和社区融合，以减轻疼痛强度并提高功能效果：近年来，慢性疼痛的非药物治疗方法有所增加，一改早期对药物治疗的依赖。通过随机对照试验获得更多关于综合疼痛干预措施益处的证据，可以改善对有复杂护理需求的退伍军人的疼痛管理。

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来源期刊

Pain Management Nursing 医学-护理

CiteScore

3.00

自引率

5.90%

发文量

187

审稿时长

>12 weeks

期刊介绍： This peer-reviewed journal offers a unique focus on the realm of pain management as it applies to nursing. Original and review articles from experts in the field offer key insights in the areas of clinical practice, advocacy, education, administration, and research. Additional features include practice guidelines and pharmacology updates.