Page 96 - Journal of Special Operations Medicine - Summer 2016

An Ongoing Series

Pain as a Barrier to Human Performance

A Focus on Function for Self-Reporting Pain With
the Defense Veterans Pain Rating Scale

Chester “Trip” Buckenmaier III, MD; Kevin T. Galloway, BSN, MHA;
Rosemary C. Polomano, PhD, RN, FAAN; Patricia A. Deuster, PhD, MPH, FACSM

ABSTRACT
The intense physical demands and dangerous opera- physical demands and dangerous operational environ-
tional environments common to Special Operations ments common to SOF result in a variety of painful con-
Forces (SOF) result in a variety of painful conditions, ditions to include musculoskeletal pain, headaches,
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including musculoskeletal pain, headaches, and acute and acute and chronic pain from combat injuries. 9–11
and chronic pain from combat injuries. Pain is a well-
accepted barrier to human performance. The Pain Man- Musculoskeletal pain is very common—specifically, low
agement Task Force and the development of the Defense back 12,13 and joint pain. Low back pain has been cited
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Veterans Pain Rating Scale (DVPRS) are discussed to as the most common reason SOF and other military
provide a framework for changing the culture of pain personnel seek healthcare services. Between 50% and
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management away from intensity of pain to interference 92% of helicopter aircrew experience low back pain
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with function and performance. The emergence of com- and 56% to 85% experience neck pain. Importantly,
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plementary and integrative pain management (CIM) studies demonstrate that such pain is related to compro-
practices is briefly reviewed as viable alternatives to the mised psychological health and sleep disturbances. 18–20
traditional reliance on opioids and other prescription Bryan et al. noted that over 50% of US Air Force
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medications. The SOF community can be the change Pararescuemen and Combat Rescue Officers reported
agent for the DVPRS and CIM approaches to pain man- musculoskeletal pain, and this pain was associated with
agement, which will in the end serve to accelerate recov- more alcohol and caffeine consumption than in those
ery and return SOF operators to duty faster and with an without pain. Pain is also a reality reinforced by virtue
enhanced ability to perform with less pain. of having to wear body armor and repeated carrying
of heavy loads. Thus, actionable measures of pain—to
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Keywords: complementary; integrative; DVPRS; validation; include the degree to which pain affects human perfor-
pain measurement; pain scales; military pain mance—must be used to signal countermeasures for cor-
recting pain and optimizing performance.

Other studies have indicated that although the magni-
Introduction
tude of pain is likely correlated with how an individual
In previous issues of the Journal of Special Operations performs, 23–25 this might not seem as relevant to SOF
Medicine, we have described approaches for optimizing where simply acknowledging pain is uncommon and
performance and suggested practical ways to implement/ contrary to the SOF culture. The orientation among
apply reasonable performance sustaining/enhancing in- many of those in the military that “pain is weakness
terventions. In this report, we introduce what we per- leaving the body” can often result in delaying necessary
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ceive as a barrier to human performance—pain—which treatments and adversely impact one’s ability to perform
is a reality in SOF. Ibuprofen, or Vitamin M, is typically the mission. Pain, regardless of whether it is actually re-
a daily friend, and a source of concern along with the ported or measured, impacts function and performance.
widespread use of other pain medications. The intense This issue will provide insight into a new methodology
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