Page 99 - Journal of Special Operations Medicine - Summer 2016

NRS, and other researchers found the DVPRS to be a Table 2 An Overview of Selected Self-Care Pain
41
practical primary care tool for measuring the impact of Management Modalities
pain on daily function and as a general monitor of pa- Modality Comment
tient pain. Clinical research on the DVPRS continues Yoga Becoming a common approach to pain 51–53
42
in a variety of clinical settings, both military and civil-
ian, but the unique and detailed features of the DVPRS Exercise A classic approach for managing pain 51,52
standardize the approach to pain measurement and re- Tai Chi A therapy used for centuries to help
orient patients and providers at all levels of care toward manage pain 54
the objective of maximizing function, optimizing per- Foam Rolling An approach for releasing myofascial tissue
formance, and raising the quality of life when managing and mitigating pain 47,55
pain. This is clearly of utmost importance. For SOF, mis- Mindfulness An upcoming approach for helping to
sion execution will be far easier when the contribution manage pain 53,56
of pain as a barrier to performance is limited. Humor Suggested to have pain relieving properties
since the 1920s 57
Where Does the DVPRS Lead Us? Meditation A self-care approach to diminishing pain 53,58
Evolving the pain discussion to a focus on function and
performance has other potential benefits to the military Music A modality receiving considerable attention
for managing pain
57
and readiness. In a culture where pain is sometimes
equated with weakness, the DVPRS is a starting point Guided A technique used for many years to control
53
pain
Imagery
for recalibrating this paradigm. Rather than dancing
around pain intensity as measure of one’s toughness,
pain can now be discussed as it relates to performance beyond the scope of this report but deserves further atten-
and function and in relation to accomplishing the mis- tion. A brief animated video outlining this new approach
sion. People are not as effective at performing physical to pain screening and assessment practices with instruc-
and mental tasks when they are in pain or, in some cases, tional prompts can be found under “videos” at http://
medicating themselves for pain. 16,19 hprc-online.org/total-force-fitness/pain-management
/interactive-resources. For additional information on
The DVPRS and related changes in the pain assessment self-management of pain, please also visit http://hprc
provide opportunities to introduce a variety of nonmed- -online.org/total-force-fitness/pain-management.
ication and self-management treatments that might not
otherwise be considered or used if medicating the pain Some CIM therapies have been integrated into our mili-
out of existence remained the norm. Although medica- tary treatment facilities, with delivery methods ranging
tions, injections, and surgeries will always have a place from treatments by providers inside an MTF to other
for treating many pain-related conditions, many non- techniques provided by many members of our health-
medication, self-management, and complementary in- care teams in a variety of settings. For example, complex
tegrative medicine (CIM) modalities should also be an acupuncture treatments are offered in an MTF by medi-
option for patients and providers. When viewed against cal acupuncturists or licensed acupuncturist. In contrast,
the relative effectiveness and safety for many accepted “battlefield acupuncture” or auricular acupuncture can
and highly used drug treatments, CIM modalities ap- be delivered in the troop medical clinic, to an aid sta-
pear to be viable additions to the military tool kit. Since tion, in a field environment, or in any setting. 44–47 Like-
2011, the military pain management community has wise, dry needling is an “emerging technique” that is
been introducing acupuncture, biofeedback, massage being used within the SOF community. Providers may
47
therapy, movement therapy (such as yoga and Tai Chi), also use basic acupressure, which can also be taught for
and some mind-body techniques in pain specialty clin- self-management treatment at home for chronic head-
ics with positive feedback from providers and patients. aches. Other modalities include medical massage and
43
48
The objectives for many of these therapies are related to biofeedback, 43,49,50 where, again, persons can be taught
increasing function and flexibility, improving sleep and self-management techniques to manage their pain with-
mood, lowering stress, and improving overall quality of out requiring a trip to the clinic or use of medications.
life. All of these CIM approaches are changing the art of
pain management in very positive ways.
Table 2 presents a brief overview of selected self-care prac-
tices that may be helpful for managing pain. With regard Summary
to myofascial pain, the use of foam rolling has become
common and the literature is emerging that this may be Some within the military health system challenge the wis-
an excellent self-care strategy. The role of myofascial dom of changing our approaches to pain management,
44
pain release, in particular with regard to performance, is but we must because prescription medications for pain

Pain as a Barrier to Human Performance 85