Pain Registry Biobank (DVCIPM)

This project, conducted at Walter Reed National Military Medical Center, San Diego Naval Medical Center, and Naval Medical Center Portsmouth, is a longitudinal effort to establish a comprehensive clinical data registry and biobank. Originating from recommendations by the Pain Management Task Force, this registry captures multidimensional data on pain experiences and management strategies. This initiative aims to provide a holistic, multimodal approach to pain management within the DoD, advancing research through data and biological samples.

By integrating patient-reported outcomes with biological samples, this registry aims to foster groundbreaking insights into pain mechanisms, treatment outcomes, and potential biomarkers. The Pain Assessment Tool & Outcomes Registry (PASTOR) and the Defense and Veterans Pain Rating Scale (DVPRS) provide structured, validated data collection tools, creating a robust platform for empirical evidence and new therapeutic approaches in pain management.

Innovations in Genicular Outcomes Registry (iGOR)

The iGOR registry, based at Walter Reed National Military Medical Center, collects prospective data on patients undergoing treatment for knee osteoarthritis (OA). Focusing on pain management approaches such as cryoneurolysis, radiofrequency ablation, corticosteroid injections, and viscosupplementation, the registry tracks outcomes related to pain control, functional status, quality of life, and healthcare resource utilization.

This registry supports evidence-based treatment for knee OA within the MHS, assessing safety and efficacy across various therapies. The data gathered will inform clinical guidelines, optimize pain management practices, and potentially reduce opioid use in treating knee OA.

Biopsychosocial Mechanisms of Chronic Pain Recovery and Maintenance

This study explores the complex biological, psychological, and social factors that contribute to chronic pain persistence or resolution. Chronic pain is a significant issue among military personnel, affecting operational readiness and overall quality of life. Using advanced systems biology, this research aims to identify biomarkers and develop predictive models to understand chronic pain mechanisms and resilience.

By pinpointing factors that support pain recovery or lead to chronic pain, the study will inform personalized, targeted treatments. These findings could enable a more effective approach to managing chronic pain within the military, reducing its long-term impact on individuals and the healthcare system.

Big-Data Analysis of Pain Management Pathways in a Health Equity Framework

Using big-data analytics, this study examines disparities in pain management within the Military Health System. Chronic pain is widespread, and the variability in treatment access and outcomes across demographic groups is a concern. This research seeks to develop an equitable pain management model that addresses these disparities, optimizing care for all service members.

The study utilizes machine learning to analyze healthcare utilization and patient outcomes. Results will help inform standardized treatment protocols that ensure equitable, effective pain management across diverse populations, supporting better patient experiences and reducing healthcare costs.

Elucidating Postoperative Trajectories Following Chest-Related Surgical Procedures

This study examines postoperative pain trajectories in patients undergoing chest-related surgeries, such as mastectomy. Despite advancements, many patients experience persistent or chronic pain, impacting recovery and quality of life. Risk factors like age, preoperative pain, and anxiety are analyzed to predict chronic pain development post-surgery.

Using a secondary analysis of existing data, this research characterizes pain patterns and identifies risk factors for chronic pain. The findings will inform tailored pain management protocols, aimed at reducing postoperative pain and supporting long-term recovery for chest surgery patients within the military and VA populations.

Sleep Banking Pre-Surgery for Improved Chronic Pain Outcomes Post-Surgery

This pilot study investigates whether extending sleep prior to surgery (referred to as “sleep banking”) can mitigate chronic post-surgical pain and reduce opioid use in patients undergoing hip or knee replacement surgery. Sleep banking involves increasing sleep duration in anticipation of future sleep disruptions, with research indicating its benefits on cognitive, metabolic, and recovery functions. Poor pre-operative sleep has been associated with increased chronic post-surgical pain (CPSP) and higher opioid requirements, making sleep banking a promising intervention for improved recovery outcomes.

In this study, patients will be randomly assigned to either a “sleep extension” group, who will aim for 10 hours of sleep per night, or a control group maintaining their usual sleep schedule. Results will help assess the feasibility of sleep banking in surgical patients and provide preliminary data on its potential to reduce CPSP and enhance functional recovery, supporting the development of larger trials focused on sleep as a modifiable factor in pain management.

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: A Non-Pharmacologic Alternative for the Treatment of Postoperative Pain

This study evaluates percutaneous peripheral nerve stimulation (PNS), an innovative technique for managing postoperative pain without opioids. Using ultrasound guidance, a small electric lead is placed near the nerve site prior to surgery. This lead delivers mild electrical pulses post-surgery, providing effective pain relief without the side effects associated with opioids.

Conducted as a multicenter, quadruple-masked, placebo-controlled trial, the study aims to assess PNS's impact on pain relief, opioid requirements, and quality of life. If proven effective, PNS could significantly reduce opioid reliance, supporting an opioid-free recovery and improving post-surgical outcomes for military personnel and civilians.

Eliminating Post-Mastectomy Pain and Opioids with Percutaneous Cryoneurolysis

Cryoneurolysis offers a promising, non-opioid solution for managing post-mastectomy pain by temporarily "freezing" nerves to block pain signals. This study explores whether cryoneurolysis can provide extended pain relief for mastectomy patients, reducing or eliminating the need for opioids during recovery. By numbing targeted nerves for two to three months, cryoneurolysis aims to align pain relief with the critical post-surgical period.

The study, conducted at Walter Reed, will evaluate cryoneurolysis’ effectiveness in reducing both immediate and chronic pain, along with opioid use and quality of life. This research has the potential to transform post-mastectomy care by introducing a safe, non-addictive pain management option, improving patient outcomes and reducing healthcare reliance on opioids.

Evaluation of Massage Service Integration and Outcomes

Massage therapy has shown promise as a non-pharmacologic approach to pain management. This study evaluates the effectiveness of massage therapy for managing chronic pain among military personnel and veterans, with a focus on its impact on pain relief, anxiety, and treatment satisfaction. Given the high prevalence of chronic pain in military populations, massage therapy could serve as an essential complement to traditional pain treatments.

The study uses secondary analysis of medical records to assess patient outcomes. Findings may guide the broader integration of massage therapy within the MHS, providing a holistic approach to pain management that aligns with military health goals of reducing opioid dependency and enhancing recovery.

Complementary and Integrative Health (CIH) Utilization in the Military and Veterans Health Systems

This study evaluates the use of Complementary and Integrative Health (CIH) services, such as acupuncture, yoga, and meditation, within the Military Health System (MHS) for managing chronic pain. As CIH services offer non-pharmacologic solutions, they can reduce reliance on opioids, thus addressing a key concern within the Department of Defense (DoD) and the Veterans Administration (VA). This secondary data analysis aims to describe CIH utilization patterns, patient characteristics, and adherence across MHS facilities.

The study supports data-driven integration of CIH as standard care for chronic pain within the MHS. By leveraging medical record data, it seeks to inform future policies and enhance CIH accessibility, contributing to a more holistic approach to pain management and potentially improving health outcomes for service members.

Assessment of Telehealth Yoga Therapy Delivery for Lower Back Pain in Military Service Members: A Pilot and Feasibility Study

This pilot study investigates the efficacy of telehealth yoga therapy for lower back pain in military personnel, comparing AI-assisted sessions and a self-paced video library to usual care. Given the challenges of in-person care access, especially in remote areas, this study evaluates telehealth's potential to deliver effective, scalable pain management solutions.

Results could guide the implementation of telehealth-based yoga therapy within the MHS, enhancing accessibility to evidence-based non-pharmacologic treatments for chronic pain.

USU Analgesia Pathway

This study focuses on evaluating the utilization and effectiveness of various components of the perioperative analgesia pathway, including treatments like Botox and Dexamethasone, within the MHS. Chronic pain from surgery can affect operational readiness, and optimizing these analgesia pathways can reduce persistent pain and improve patient outcomes.

Findings from this retrospective observational study will support the integration of evidence-based practices in perioperative care, helping service members recover faster and experience less pain, ultimately contributing to overall military readiness and well-being.

Pain Management and Surgical Pathways

This research investigates variations in procedural and pain management pathways within the DoD and VA systems, focusing on access to surgeries, pain management modalities, and procedural timing. These variations can impact recovery outcomes and the overall quality of care that service members receive.

Through a comprehensive analysis, the study aims to standardize surgical and pain management protocols, ensuring consistent, effective care for both acute and chronic pain. By optimizing these pathways, the study seeks to enhance pain management outcomes and improve quality of life for military personnel and veterans.

Real World Effectiveness Tool Development and Implementation for Health System Decision Support and Improvements (MRAB)

This study focuses on creating a standardized Real-World Evidence (RWE) Analytic Blueprint (MRAB) for the Military Health System, designed to support clinical and policy decision-making. The MRAB will allow for consistent evaluation of treatment outcomes across the MHS, improving the ability to make data-driven decisions about healthcare interventions and policies.

The blueprint will provide insights into cost-effectiveness, patient-centered outcomes, and treatment equity, helping optimize healthcare for service members. By standardizing data collection and analysis, the MRAB aims to close the gap between clinical trial results and real-world outcomes, ensuring that military personnel receive the most effective, equitable care.

Evaluation of the DVPRS in a Pragmatic Clinical Setting: A Retrospective Data Analysis

This study evaluates the Defense and Veterans Pain Rating Scale (DVPRS) within a civilian clinical setting, comparing it to standard pain assessments for patients undergoing medical yoga therapy for pain. The research examines the validity of DVPRS in predicting treatment response and correlating pain interference scores with other standardized pain measures.

The study’s outcomes will inform the utility of DVPRS across different patient populations, supporting its broader adoption and application in pain assessment beyond military settings.

Accelerated Emergence from Anesthesia with Caffeine Administration

This study aims to develop an intravenous caffeine formulation (C-NaB) that accelerates patient recovery from general anesthesia. In post-surgical care, delayed recovery from anesthesia can extend discharge times, impacting patient flow and resources in the post-anesthesia care unit (PACU). C-NaB is designed to stimulate the central nervous system, helping patients wake up faster and facilitating quicker PACU discharge.

This multi-site prospective, triple-blind, placebo-controlled trial will evaluate C-NaB’s efficacy in reducing recovery time following surgery at several military medical centers. The ultimate goal is to support an FDA submission, establishing C-NaB as a new standard in anesthesia recovery. This innovation has the potential to benefit both military and civilian healthcare by improving post-surgical efficiency and patient outcomes, particularly in settings requiring rapid recovery for patient transport.

Marinol Prescription Patterns in the Military Health System

This retrospective study investigates the prescription trends of dronabinol (Marinol) within the Military Health System as an alternative to traditional pain medications. Dronabinol, a synthetic THC compound, has been considered for managing chronic pain, especially as opioid reduction efforts increase. The study compares Marinol’s effectiveness and patient outcomes to those of opioids and other pain medications, such as NSAIDs and gabapentinoids.

Through data analysis, the study aims to inform future pain management policies within the military. Insights gained may help integrate Marinol as a viable option for chronic pain relief, supporting military efforts to provide safer, non-opioid alternatives and improve the quality of life for service members and veterans.

Assessment of Peripheral Nerve Blocks Performed by SN SAUSHEC Anesthesiology Residents

This study reviews the frequency and relevance of femoral nerve blocks performed by anesthesiology residents at Brooke Army Medical Center. By evaluating current clinical training, this study aims to ensure residents develop combat-relevant skills in peripheral nerve block techniques, critical for managing pain in battlefield and trauma settings.

The findings will guide training improvements, ensuring anesthesiology residents are equipped with essential skills for combat casualty care, aligning with the MHS’s readiness goals.

DoD Anesthesiology Training and Career Outcomes Project

This study examines factors influencing residency and career outcomes among graduates of DoD Anesthesiology Residency Programs, analyzing the impact of military-specific and general factors on performance and career trajectories. By investigating factors such as training pathways, medical school performance, and exam scores, the research aims to identify predictors of career success in anesthesiology within the military context.

Findings will support workforce planning, training improvements, and residency program evaluation, enhancing career outcomes and readiness for DoD anesthesiologists.

Army Active Duty Anesthesiologist Career Disposition Outcomes

This observational study examines the career outcomes and service length of U.S. Army anesthesiologists, analyzing factors that influence their career paths after active duty. Modifications include qualitative interviews with former anesthesiologists to understand decision-making processes regarding service continuation, transition to reserves, or civilian careers.

Insights will inform military medicine staffing and retention strategies, potentially aiding in policy adjustments to improve retention and readiness among Army anesthesiologists, critical for maintaining operational capacity in combat situations.

A Cross-Sectional Analysis of U.S. Army Medical Corps Additional Skill Identifiers

This study analyzes the distribution of Additional Skill Identifiers (ASIs) among U.S. Army Medical Corps officers, specifically physicians. ASIs, which track specialized military skills, play a crucial role in ensuring medical personnel are prepared for deployment demands. With an increasing focus on rapid mobility and combat readiness, this study examines the prevalence of specific ASIs that could enhance the capability of frontline medical care.

The findings will help guide workforce planning within the Army Medical Corps, supporting policies that align physician skills with current and future operational needs.

Self-deploying, Instrumented, Shape-Memory Polymer Endotracheal Tubes for Non-Expert, Autonomous Emergency Intubation and Monitoring of Thoracic Injuries in Battlefield Conditions

This project aims to develop self-deploying endotracheal tubes (ETTs) that can autonomously secure an airway in emergency situations, especially on the battlefield where expert medical support may not be available. Utilizing shape-memory polymers, these ETTs are designed to provide reliable, autonomous intubation and airway management for trauma patients.

The study involves prototype development and testing in preclinical models to assess functionality. Successful development of these ETTs could revolutionize field trauma care by enabling rapid, reliable airway management, ultimately improving survival rates in combat and other austere environments.

The Effect of Trauma on Gastric Emptying via Point of Care Ultrasound Examination After Pre-Operative Fasting

This study assesses delayed gastric emptying in trauma patients, a known risk for aspiration during surgery, by comparing fasted stomach volumes of trauma and non-trauma patients. Utilizing point-of-care ultrasound at Brooke Army Medical Center, researchers aim to determine when gastric volumes normalize post-injury, allowing for safer anesthesia practices.

Findings could impact anesthetic management guidelines, helping anesthesiologists better assess fasting times and aspiration risk, ensuring safer procedures for trauma patients undergoing additional surgeries.

The Effect of the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist on Gastric Emptying per Point of Care Ultrasound Examination After Pre-Operative Fasting

This observational study at Brooke Army Medical Center examines whether patients taking GLP-1 agonists, commonly used in managing diabetes and weight loss, have altered gastric volumes after fasting. By assessing fasted gastric volume in patients undergoing surgery, the study addresses potential adjustments needed in preoperative fasting guidelines for patients on these medications.

This research provides insights into the perioperative management of GLP-1 agonist users, potentially guiding updates to the American Society of Anesthesiologists’ fasting recommendations to minimize aspiration risks during anesthesia.

Acute Pain Management: An Overview of the Inpatient Acute Pain Service at the US Military's Only Level 1 Trauma Center

This study reviews eleven years of data from Brooke Army Medical Center’s Acute Pain Service (APS) to evaluate the correlation between operational deployments and APS usage, focusing on trends in patient encounters and treatment innovations. The goal is to assess how operational demands affect APS workload, as well as to examine the use of novel treatments like peripheral nerve catheters and methadone.

Insights from this analysis will help optimize APS resources, enhance treatment protocols, and potentially correlate pain service demand with military operational activity, improving care for trauma patients.

Percutaneous Cryoneurolysis: A Single-Administration, Non-Opioid, Non-Addictive, Multiple-Month Analgesic for Thoracic Trauma Free of Systemic Side Effects

This study examines the efficacy of percutaneous cryoneurolysis as a pain management solution for patients with thoracic trauma, particularly those with rib fractures. Conducted at Walter Reed National Military Medical Center, this protocol assesses cryoneurolysis' ability to provide prolonged, opioid-free pain relief, potentially lasting for several months. Data collected includes pain ratings, respiratory function, PTSD symptoms, and opioid consumption.

Results from this study will inform the use of cryoneurolysis in military healthcare, offering a non-addictive pain management option for thoracic injuries. This technique could become a vital tool in treating combat-related trauma, reducing reliance on opioids and enhancing recovery.

Circuit-Based Neuromodulation to Improve Mental Fatigue After Traumatic Brain Injury

Mental fatigue following traumatic brain injury (TBI) is a common, debilitating symptom that affects cognitive recovery. This study investigates transcranial stimulation as a neuromodulation technique to alleviate mental fatigue, targeting specific brain circuits to reduce cognitive load and improve resilience.

By identifying components of mental effort that correlate with fatigue, the study will assess transcranial stimulation’s effects on cognitive recovery. This approach has the potential to offer a non-invasive treatment for TBI-related mental fatigue, enhancing the quality of life and operational readiness of affected service members.

Quadriceps Strength Outcomes of Pharmacologic Neuromodulation of the Femoral Nerve

This pilot study investigates the impact of femoral nerve block on quadriceps strength to assess how pharmacologic neuromodulation affects motor function. Conducted in collaboration with Brooke Army Medical Center’s Orthopaedic Clinic, this study will analyze motor strength changes post-femoral nerve block in 10 healthy participants.

The results will inform military anesthesiologists on optimal neuromodulation techniques, potentially enhancing post-surgical recovery protocols by preserving motor function while managing pain effectively.