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Chronic pain: treatment, rehabilitation, and quality of life

JRRD tipsheet

Veterans Affairs Research Communications

The current issue of the Journal of Rehabilitation Research and Development (JRRD), a publication of Rehabilitation Research and Development, Department of Veterans Affairs (VA), includes a special section that focuses on the treatment, rehabilitation, and quality of life for individuals who experience chronic pain. Also in this issue are articles that report on structuring exercise for people with motion-provoked dizziness, improving arm movement with functional electrical stimulation, and predicting wound healing in individuals with spinal cord injury.

Also published with Volume 40 Issue 5 of JRRD is a supplement addressing chronic obstructive pulmonary disease (COPD). The only major chronic disease with increasing mortality, COPD places a significant strain on the healthcare system. This special edition highlights three critical outcomes of pulmonary rehabilitation: smoking cessation, symptom relief, and improved functional performance. Full-text manuscripts for both issues of JRRD are available, free of charge, on-line at www.vard.org.

MANUSCRIPTS FEATURED IN VOL. 40, IS. 5

Development and validation of a pain management survey, pg # 381
Paper presents the development and validation of a comprehensive and efficient self-report measure of pain treatment outcomes. 957 veterans receiving inpatient and outpatient pain treatment at six VA medical centers completed the Pain Outcomes Questionnaire-VA (POQ-VA) intake items during their inpatient admission or initial outpatient appointment. Results of this project support the reliability, validity, and clinical use of the POQ-VA for evaluating the effectiveness of pain treatment for veterans experiencing chronic noncancer pain and provide a more appropriate means of evaluating the efficacy of pain interventions.

Pain and associations with health and the healthcare system, pg 371
Study reports on the prevalence of pain among veterans and describes associations between pain and health-risk behaviors, psychosocial factors, and use of medical and mental health services. 685 veterans completed a questionnaire about their experience of pain and other healthcare issues. Data were also retrieved about the participants' use of healthcare services. Persons reporting pain, relative to those not reporting pain, were younger, indicated worsening health, had greater emotional distress, used tobacco, had diet and/or weight concerns, and used more outpatient medical services.

Chronic pain and post-traumatic stress disorder, pg # 397
Article summarizes the current literature pertaining to the symptoms, prevalence, and treatment of chronic pain and Post-Traumatic Stress Disorder (PTSD). The literature review also describes the relationship between pain and PTSD and explores mechanisms that may explain this relationship. Data in this review suggest a high relationship between chronic pain and PTSD. Several potential mechanisms are presented to explain the high level of symptom overlap between chronic pain and PTSD and to provide direction for future research.

Study indicates MST a good measure of motion sensitivity, pg 415
This study determined the validity and reliability of the Motion Sensitivity Test (MST), which is used to develop an exercise program for patients with motion-provoked dizziness and to measure the effectiveness of vestibular rehabilitation therapy. Fifteen individuals with motion-provoked dizziness and ten control individuals were tested during sessions occurring 90 minutes and/or 24 hours after baseline testing. The MST was reliable across examiners and test sessions. Test validity was good. The MST can be used reliably in clinical practice to develop exercise programs for patients with motion-provoked dizziness and to measure rehabilitation outcomes.

Pressure ulcers in veterans with spinal cord injury, pg 433
Article discusses the prevalence, duration, and severity of pressure ulcers in veterans with spinal cord injury (SCI) and identified predictors of the number of ulcers that healed, did not heal, or were referred for surgery; number of hospitalizations for pressure ulcer treatment; and SCI clinic or home care visits for pressure ulcer treatment. Stage IV pressure ulcers were the most prevalent. Duration of pressure ulcers varied from one week to three years. More severe ulcers were less likely to heal and more likely to be referred for surgery. Patients whose study ulcer healed had fewer total numbers of ulcers and fewer clinic or home visits than those whose ulcer did not heal. Over half of the study population was admitted to the hospital for pressure ulcer treatment at least once during the three years of the study.

Exercise and obstructive and restrictive breathing conditions, pg 407
Study analyzed breathing patterns and shortness of breath of patients with obstructive and restrictive ventilatory abnormalities during exercise. Twenty patients with chronic obstructive pulmonary disease and restrictive ventilatory abnormalities completed exercise tests. For obstructive patients, relationships existed between shortness of breath and inspiratory time to expiratory time, flow ratio, and inspiratory time to total time. Inspiratory-to-expiratory time changes provide further insight into the pathophysiology of ventilatory abnormalities and shortness of breath during exercise.

Functional electrical therapy improves arm, hand recovery after stroke, pg # 443
Paper describes a randomized single-blinded study of the effects of Functional Electrical Therapy (FET) on the paretic arms of volunteers with acute hemiplegia caused by strokes. FET is an exercise program integrating voluntary arm manipulation and joint electrical stimulation of forearm and muscles that control hand functions. Twenty-eight acute hemiplegic subjects participated in a 6-month study. FET consisted of 30-minute daily exercise for three consecutive weeks and conventional therapy. Investigators developed a new method and instrumentation for treatment of patients with impaired hand control. This new methodology is especially important for people after a stroke, since it promotes faster and better recovery of arm and hand function.

Performance and safety testing smart walkers for the elderly, pg 423
Study evaluates the safety and performance of the Veterans Affairs Personal Adaptive Mobility Aid (VA-PAMAID), a walker that provides both obstacle avoidance and navigational assistance. The VA-PAMAID underwent vigorous testing to determine the stability of the walker, the energy consumption of the electronics, the strength of the frame and components, the robustness of the sensors and control system, and other important factors. The walker passed the stability, climate, and fatigue testing. VA-PAMAID can travel 10.9 km on a full charge and avoid obstacles while traveling at a speed of up to 1.2 m/s. This mobility device could be of benefit to aging veterans while reducing the need for supervision and the overall cost of care.

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JRRD is a peer-reviewed, scientifically indexed publication covering all rehabilitation research disciplines: neurology, orthopedics, engineering, audiology, ophthalmology and optometry, outcomes, restorative, prosthetics, geriatrics, psychiatrics, and community reintegration. Formerly the Bulletin of Prosthetics Research, JRRD debuted in 1983 to include cross-disciplinary findings in rehabilitation. JRRD accepts original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers who investigate disability rehabilitation.

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