Return-to-duty rates among coalition forces treated in a forward-deployed pain treatment center: a prospective observational study.
BACKGROUND
Non-battle-related injuries and the recurrence of chronic pain are major causes of medical evacuation in wartime. Because a pain medicine specialist may or may not be assigned to a forward-deployed medical unit, the treatment of pain from non-battle-related injuries in war zones is a serendipitous endeavor. Previous studies have demonstrated that the return-to-unit rate for soldiers evacuated to a tertiary care facility for pain management is abysmally low.


METHODS
This is a prospective, observational study measuring return-to-duty rates in the first forward-deployed pain treatment center.


RESULTS
Over a 6-month period, 132 patients were treated, the large majority (n = 113) of whom were coalition forces. In descending order, the four most common diagnoses among coalition forces were lumbar radiculopathy (n = 63), thoracic pain (n = 13), cervical radiculopathy (n = 8), and groin pain (n = 8). Epidural steroid injections (n = 125) were by far the most frequently performed procedure, followed by trigger point injections (n = 21), lumbar facet blocks (n = 16), and groin blocks (n = 9). Nonsteroidal antiinflammatory drugs were prescribed to 70% of patients, and 24% were referred to physical therapy. The return-to-duty rate for coalition forces was 94.7%. The primary complaint of all 7 patients who required medical evacuation outside the theaters of operation was groin pain.


CONCLUSIONS
These results demonstrate the feasibility of obtaining high return-to-duty rates when aggressive pain management strategies are used in forward-deployed areas.
White
Ron L
RL
Pain Treatment Center, Landstuhl Regional Medical Center, Landstuhl, Germany.
Cohen
Steven P
SP
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006772:Hospitals, Military / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010146:Pain / Q000453:epidemiology*; D018710:Pain Clinics / Q000639:trends; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods / Q000639:trends; D011446:Prospective Studies; D013997:Time Factors; D014857:Warfare