Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Rosemary C. Polomano

Second Advisor

Salimah H. Meghani

Abstract

Pain is a major health problem in the United States (U.S.), and early effective pain relief is a national priority. The U.S. military population shares in the burden through pain experienced in military- and nonmilitary-related duties. Although precise estimates of pain in military service members are not available, studies document that many military members receive treatment for pain. Because of the burden of pain in this population it is essential to understand pain-specific interrelated physical, mental, and social health outcomes to improve pain management.

This dissertation examined the magnitude of pain in military personnel, and explored pain-related outcomes. A comprehensive integrative review highlighted the challenges surrounding pain in the military population, and identified factors associated with acute and chronic pain. A secondary analysis was conducted using Pain Assessment Screening Tool and Outcomes Registry (PASTOR) data collected over time from a sample population (N=190) receiving specialty care in a military interdisciplinary pain management center. Results revealed that military members with neuropathic pain may experience more sleep-related impairment compared to those with nonneuropathic pain. Further, the analysis of percent change from the first PASTOR assessment to the third assessment showed improvement in pain intensity, pain interference, physical function, fatigue, sleep-related impairment, anxiety, and anger. However, higher levels of depression were evident over time. Additional multilevel modeling demonstrated that as pain intensity and pain interference increased, there was a small but statistically significant decrease in satisfaction with social roles.

This study elucidated the complexities of pain by identifying associations between pain intensity and pain interference, and pain-related outcomes. It supports the growing body of evidence demonstrating that the use of a standardized patient-reported outcomes system, such as PASTOR, captures the interacting biopsychosocial health problems encountered with pain. A systematic and comprehensive point of care collection of pain-related outcomes is central to effective pain management across the continuum of care with the overall goal of improving quality of life and returning military personnel to optimal functioning.

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