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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.
Mil Med 2000 Dec
PMID:The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital. 1114 69

Pain relief is an essential component of combat casualty care. For the injured soldier, analgesia is not only a matter of comfort. Alleviating pain may allow the soldier to remain quiet when noise discipline is at a premium. It may also allow that person to continue to move, thus avoiding detection and potentially permitting the mission to carry on. Regional anesthetics provide an alternative to systemic medications and thus may avoid a clouded sensorium, limit narcotic administration, and provide superior pain relief. Standard local anesthetics and newer agents with potential field applicability are discussed along with their side effect profiles. Simple nerve block techniques that can be used by Army Special Forces medics, Navy SEAL and Reconnaissance corpsmen, and Air Force pararescuemen in the far forward environment are described step by step. The advantages of these regional anesthetic methods should make their use a must for every special operations medical care provider.
Mil Med 2001 Mar
PMID:Pain management in the special operations environment: regional anesthetics. 1126 21

In 1999, the Joint Commission for Accreditation of Healthcare Organizations published comprehensive pain management standards. Previous research has shown that pain control in people with cancer remains a significant problem in health care, even though cancer pain can be managed effectively in up to 90% of patients. In addition, postoperatively, many patients fail to have adequate pain control because of staff failures to routinely assess pain and pain relief. Many patients, if not questioned, silently tolerate unrelieved pain. National guidelines were published that address both acute and cancer pain in 1992 and 1994, respectively. In 1995, Tripler Army Medical Center dedicated $300,000 to create a 24-hour Pain Management Service to improve pain management. This article describes the structure of, educational programs offered by, and system changes implemented by the Pain Management Service.
Mil Med 2001 Feb
PMID:Implementing a pain management service at an Army Medical Center. 1127 13

Hepatitis A and B viruses are threats to deployed military forces. The objective of this study was to determine the feasibility of concurrent vaccination against hepatitis A and B viruses. One hundred five healthy persons, 20 to 49 years of age and without serologic markers to hepatitis A or B viruses, were randomized to receive an inactivated hepatitis A vaccine (HEP A; 25 units in 0.5 mL), recombinant hepatitis B vaccine (HEP B; 10 micrograms in 1.0 mL), or both (HEP A & B) concurrently in separate arms. Vaccines were administered intramuscularly at 0, 1, and 6 months. Sera obtained at 1, 2, 6, 7, and 12 months after the first dose were tested for quantitative antibody to hepatitis A virus (anti-HAV) and antibody to hepatitis B surface antigen. Local reactions (e.g., pain) were reported by less than half of the volunteers and were similar at the site of HEP A, whether given alone or concurrently. However, more persons complained of pain (usually mild) at the HEP B site when HEP B was given concurrently with HEP A compared with HEP B alone (43% vs. 15%, 34% vs. 9%, and 42% vs. 15% for doses 1, 2, and 3, respectively; p < 0.05 for each dose). Among persons immunized with HEP A alone or HEP A & B, the proportion with > or = 10 mIU/mL anti-HAV was 83% in both groups 1 month after dose 1 and 100% at months 2, 7, and 12. The geometric mean concentrations of anti-HAV increased from 21 mIU/mL at month 1 to 2,649 and 2,312 mIU/mL in the HEP A and HEP A & B groups, respectively, at month 7. The response to HEP B was similar whether administered alone or concurrently. Antibody responses were similar in those receiving HEP A or HEP B concurrently or alone, but more subjects reported pain (usually mild) at the HEP B site after concurrent vaccination than after HEP B alone. Further work should be conducted to approve HEP A for patients younger than 2 years of age and to develop combined HEP A and HEP B vaccines in the United States.
Mil Med 2001 Feb
PMID:Randomized controlled trial of concurrent hepatitis A and B vaccination. 1127 21

Varicocele is a well-known and highly prevalent medical problem in young obligatory service recruits. Still, there are many questions regarding its management. Is there a clear relation between varicocele and infertility? Can early varicocelectomy in young soldiers prevent future infertility? Is there a role for varicocelectomy in pain relief in physically active soldiers? And finally, what are the pros and cons of the open surgical, laparoscopic, or radiographic techniques in this specific population? Answering these questions should help military physicians in varicocele patients' care. It should also help decision makers to build cost-effective and evidence-based health policy. In this article, we review the literature regarding the controversies in the management of varicocele in young adults and delineate the current policy of the Israel Defense Forces Medical Corps.
Mil Med 2001 Dec
PMID:Management of varicocele in military obligatory service: Israel Defense Forces Medical Corps policy. 1177 5

We examined the influence of mental health service use on outpatient health service use among female veterans. We conducted a retrospective and correlational study of treatment-seeking women and their pattern of health service use and the relationship between mental health and somatoform symptoms and service use. Data were obtained from a self-report measure designed to screen for mental and somatoform symptoms and from a federally maintained database of all outpatient contacts. Women who used mental health services were more likely to have a greater number of non-mental health visits than women who did not. The most commonly endorsed somatoform symptoms were feeling tired or having low energy and pain in extremities and joints. These symptoms were correlated with non-mental health service use, as were back pain, menstrual pain or problems, and trouble sleeping. We conclude that a history of somatoform symptoms might increase rates of health service use despite treatment for mental problems.
Mil Med 2002 Jan
PMID:Outpatient care use among female veterans: differences between mental health and non-mental health users. 1179 6

Between 1990 and 1996, 119 Finnish male conscripts underwent operative treatment for patellar dislocation. There were 68 conscripts (58%) with primary and 51 conscripts (42%) with recurrent patellar dislocation. Sixty-five (55%) dislocations occurred during military service, 40 (34%) occurred during sports activities, and 14 (11%) occurred during leisure time. The most common cause of injury was military training at battle exercises (n = 30). The typical injury mechanism was knee valgus rotation on fixed foot and tibia (97 conscripts, 82%). Surgical procedures performed were open in 75 conscripts (63%) and arthroscopically assisted in 44 conscripts (37%). Twenty-three (19%) redislocations occurred during follow-up (mean, 6 years; range, 3-9 years). The subjective outcome of treatment was excellent in 23 (19%), good in 42 (35%), moderate in 44 (37%), and poor in 10 (9%) conscripts. The most common residual complaint was patellofemoral pain (25 conscripts, 21%). Only 42 (35%) conscripts were able to finish their military service normally; fitness classification was decreased in 16 conscripts (13%), and 61 (52%) were temporarily exempted from military service (class E). The results of operative treatment did not differ significantly in conscripts with primary and recurrent dislocation, except for the time of first recurrence, which was significantly longer in conscripts with primary than with recurrent dislocation (27 versus 9 months). Patellar dislocation is the most common form of severe knee injury among conscripts and significantly hampers military service. Operative treatment yields only satisfactory results. Preventive measurements should be considered. A suggested algorithm for the treatment and classification of acute and recurrent patellar dislocation among military conscripts is presented.
Mil Med 2002 Jul
PMID:Patellar dislocation in army conscripts. 1212 43

The purpose of this study was to report information regarding dental emergency rates, conditions that cause soldiers to present for care, and arrival patterns of dental emergency patients. Data came from a retrospective cohort analysis of dental emergencies experienced by the soldiers of the Third Infantry Division while deployed in the Multinational Division North area of Bosnia from September 2000 to March 2001. Defective restorations or caries accounted for 25% of the diagnoses prompting soldiers to report for dental sick call, third molar-related problems (pain or pericoronitis) were 19%, and periodontal conditions accounted for less than 5%. More aggressive treatment of unerupted or partially erupted third molars would appear to have the greatest potential for reducing the rate of emergencies.
Mil Med 2002 Nov
PMID:Dental emergencies during SFOR 8 in Bosnia. 1244 15

Furuncular myiasis is a parasitic infestation of human and other vertebrate tissues by fly larvae of primarily two species: Dermatobia hominis (human botfly, t6rsalo, or berne) in Mexico and South and Central America and Cordylobia anthropophaga (tumbu fly or mango fly) in Africa. Cuterebra species (rabbit and rodent botflies) are also rarely reported to cause furuncular myiasis only within the United States. Although these species inhabit different geographic regions and have different life cycles, their clinical presentations can be similar. We describe a case of "imported" human botfly (D. hominis) furuncular myiasis in a U.S. Army soldier stationed in Germany. We review the life cycles of human botflies and key aspects of their clinical presentation, differential diagnosis, and various therapeutic modalities. Most physicians may never encounter myiasis and attribute a patient's complaints to an insect bite or skin infection that will heal without treatment. However, the diagnosis of furuncular myiasis should be considered by remembering the basic elements of this condition: recent travel history to the tropics and a sterile, persistent furuncle with sensations of movement and pain.
Mil Med 2002 Dec
PMID:Imported furuncular myiasis in Germany. 1250 73

Hamstring injuries are common in active athletic populations, such as military service members. Ruptures of the hamstring origin from the ischial tuberosity are rare injuries and missed if not considered in the differential diagnosis of ischial pain. Unlike other hamstring injuries, complete hamstring avulsions must be treated surgically. Results of untreated hamstring avulsions are poor. The purpose of this article is to describe the case of an active duty airman who presented for an unrelated complaint and was discovered to have a 5-week-old hamstring avulsion. Surgical repair of the hamstring avulsion 6 weeks after injury yielded an excellent result and return to full duty. Hamstring avulsions recognized early by history and physical examination and diagnostic imaging permits early and effective treatment. Early surgical repair of the tendon to bone can result in return to full duty.
Mil Med 2003 Jan
PMID:Avulsion of the common hamstring tendon origin in an active duty airman. 1254 44


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