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Beyond medications final
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Military Workshop Beyond Medications: Military Medicine’s Expansion of Pain
Management Treatment Options
National RX Drug Abuse Summit Orlando, Florida
COL RICHARD P. PETRI, Jr., MC William Beaumont Army Medical Center
Interdisciplinary Pain Management Center
4 April 2013
Information Brief Unclassified
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Disclosure
Richard Petri has no financial relationships with proprietary entities that produce health care goods or
services.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Learning Objectives
1. Outline strategies to provide community level support to soldiers and their families struggling with prescription pain addiction.
2. Plan how to establish a support group for spouses and children of military families.
3. Identify ways to leverage partnerships to impact your community.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Questions
• What are the current integrative modalities used by the Department of the Army for pain management.
• Describe the tiered approach to integrative modalities for use in the Department of the Army pain management programs.
• Name five of the pillars of approach to the wholistic pain management program within the Department of the Army
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Goals
Understand the history of, present day usage and impact of Integrative Medicine (IM) in the United States as well as the military
Identify the expansion of IM within the military over the past four years
Identify several IM research projects within the DoD
Understand the importance, now and in the future of IM especially as it relates to the Military
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
The History of Alternative Medicine
In the beginning…..
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
2000 BC
“Where is my root?”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
1000 AD “That root is heathen,
say this prayer”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
1850 AD “That prayer is
superstition, drink this potion”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
1900 AD “That potion
is snake oil, swallow this
pill”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
1945 AD “That pill is
ineffective, take this antibiotic”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
AD 2000
“That antibiotic is artificial, eat this root”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
The cycle of herbals
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
CAM Definition
NCCAM defines CAM as a group of diverse medical and health care systems, prac6ces, and products that are not generally considered part of conven8onal medicine as prac8ced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals such as physical therapists, psychologists, and registered nurses.
Conven8onal medicine is also known as Western or allopathic medicine.
The boundaries between CAM and conven8onal medicine are not absolute, and specific CAM prac8ces may, over 8me, become widely accepted.
NCCAM Publica8on No. D347. “CAM basics What Is Complementary and Alterna8ve Medicine ? Update April 2010. 15 Jul 2010 <hTp://nccam.nih.gov/health/wha8scam>
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
CAM Definitions
• Complementary medicine refers to use of CAM together with conventional medicine
Example- Acupuncture for pain management. Most use of CAM by Americans is complementary
• Alternative medicine refers to use of CAM in place of conventional medicine
Example-herbals instead of chemotherapy for cancer management
• Integrative medicine (also called integrated medicine) refers to a practice that combines both conventional and CAM treatments for which there is evidence of safety and effectiveness
Example- Chiropractic Manipulation for low back pain
• Integrative Health and Healing is similar to Integrative Medicine but replaces the term “medicine” for “Health and Healing”; two concepts representing the goal of the practice of medicine
NCCAM Publica8on No. D347. “CAM basics What Is Complementary and Alterna8ve Medicine ? Update April 2010. 15 Jul 2010 <hTp://nccam.nih.gov/health/wha8scam>
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Terminology
OR
• Scientifically Proven with Evidence Based Research • Unproven Practices
• Conven8onal or Allopathic • Complementary and Alterna8ve Medicine (CAM) or now know as Integra8ve Medicine (IM)
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
NCCAM Classification of CAM Therapies with Examples and Prevalence of Selected Modalities
• Natural Products (17.7%)* – Herbals/Botanicals – Supplements – Probiotics
• Mind-body Medicine – Meditation (9.4%)* – Yoga (6.1%)* – Acupuncture ** (1.4%)* – Guided Imagery – Hypnotherapy – Progressive Relaxation – Qi Gong – Tai Chi
• Manipulative and Body-Based methods – Osteopathic and Chiropractic Manipulation (8.6%)* – Massage (8.3%)*
• Other CAM Practices – Movement Therapies – Traditional Healers – Energy (Magnet, Light, Qi Gong, Reiki, Healing Touch) – Whole Medical Systems (Ayurvedic, TCM)
NCCAM Publica8on No. D347. “CAM basics What Is Complementary and Alterna8ve Medicine ? Update April 2010. 15 Jul 2010 <hTp://nccam.nih.gov/health/wha8scam>
• Based on the 2007 Na6onal Health Interview Survey (NHIS)
**Also considered part of Energy , Manipula6ve and Body Based Methods and TCM
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
CAM in the United States
• 42.1% of patient seek CAM treatments • 72% conceal use from doctors • 83% use in combination with conventional
medicine • 21.2 billions of dollars per year spent per year [1]
• More visits than to Primary Care (60M) • “Minor” treatments include weight loss,
performance enhancement, self-care, pediatrics
[1] Eisenberg DM, Davis RB, Ettner SL, Appel S, et al. Trends in alternative medicine use in the United States. Journal of the American Medical Association. 1998;280: 1569-1575
Updated Tindle, H., Davis, R., Phillips, R., Eisenberg, DM, Trends in Use of Complementary and Alternative Medicine by US Adults: 1997-2002. Alternative Therapies in Health and Medicine Jan/Feb 2005 Vol 11 (1), 42-49.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
What is the usage of CAM in the Military?
• 35% of US adults use some type of CAM [1]
• Military has a higher percentage of usage than the general public at 81% [2] [4]
• Herbal use has the highest usage [1],[2]
• Low back pain is the most common reason patients use CAM [3]
• Military personnel reported using three CAM stress-reduction therapies at 2.5-7 times the rate of civilians. [4]
1 Tindle et al Trends in use of complementary and alterna8ve medicine by US adults: 1997-‐2002 Altern Ther Health Med 2005 Jan-‐Feb; 11(1) 42-‐9 2 McPherson F Schwenka MA, Use of complementary and alterna8ve therapies among ac8ve duty soldiers, military re8rees, and family members at a military hospital Mil Med 2004 May;169(5):354-‐7 3 Sherman, et al, Complementary and alterna8ve medical therapies for chronic low back pain: What treatments are pa8ents willing to try? BMC Complementary and AlternaFve Medicine 2004, 4:9 4 Goertz et al Military Report More Complementary and Alterna8ve Medicine Use Than Civilians J Altern Complement Med 2013 Jan 16 [Epub ahead of print]
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
0
10000
20000
30000
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3441 6989 8671 9769 11538 15083
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tions
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Year Range
Growth of CAM Studies from 1966 to 2009
Integrative
Complementary
Alternative
* Pubmed Citations Under Alternative Medicine ** Pubmed Citations Under "Alternative, Complementary or Integrative Medicine"
Data derived from PubMed http://www.ncbi.nlm.nih.gov/pubmed
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
4% 5%
7%
13%
13% 20%
23%
15%
Pub Med Cita6ons by Publica6on Type 2009
Evalua8on Studies (887)
LeTers (946)
Case Reports (1,471)
Compara8ve (2,611)
RCT (2,682)
Clinical Trials (4,054)
Reviews (4,657)
Others (2,935)
Other includes 30+ categories
Data derived from PubMed http://www.ncbi.nlm.nih.gov/pubmed
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Public’s Concerns With Conventional Medicine
• Medical Health Costs • Safety and Iatrogenic
Complications • Aging and chronic illness • Technology and knowledge
(depersonalization) • Role of science in medicine
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Depersonaliza8on Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Unique Aspects of Military and IM
• Lifestyle of being a Soldier • The “testosterone” effect • Demands of the job • Leads to a culture of health promotion • Universal health care • More flexibility toward available services • Visibility
1 Baldwin CM, Long K, Kroesen K, Brooks AJ, Bell IR, Arch Intern Med. 2002 Aug 12-26;162(15):1697-704 2 McPherson F Schwenka MA, Use of complementary and alternative therapies among active duty soldiers, military retirees, and family members at a military hospital Mil Med 2004 May;169(5):354-7
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Psychiatric Drug use among military children on the rise! US Navy Seals blog 2011
Two Army Families deal with PTSD, and Suicide ABC World News 2010
Senators raise concerns with prescription-drug use in military Virginian -Pilot 2008
Army Responds to Rising Suicide Rates www.army.mil 2008
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
Mild TBI Remains Little Understood and Hard to Diagnose US Medicine 2012
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
A Return to the Basics
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Empower
Energize
Enrich Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
April 19, 2011 US aims at its deadliest drug problem: painkillers
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Past Year Initiates for Specific Illicit Drugs among Persons Aged 12 or Older: 2007. Department of Health and Human Services, et al.[6]
Concern for Abuse
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Top concerns among primary care physicians -- related to controlled substance prescribing. From Bhamb B, et al.[5]
Concerns Among PCMs
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Poisoning Deaths, 1999 – 2006
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Poisoning Deaths, 1999 – 2006
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Overview
• One of most frequent reasons for physician care • Over 50 million Americans suffer with chronic pain • Annual cost ~ $100 billion
– Health care expenses – Lost income – Lost Productivity
• Back pain – leading cause of disability for Americans < 45 y/o
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
1980
1984
2005
2011
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Military Relevance
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Musculoskeletal Injuries
386, 562 100% Limited motion, ankle
58, 642 15.2%
Tenosynovitis 65, 364 16.9%
Limited flexion of leg
74, 627 19.3%
Degenerative arthritis, spine
77, 420 20.0%
Lumbosacral or cervical strain
110, 509 28.6%
Total MSK disabili8es of veterans who served from 2001 – 2010:
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Integrative Medicine in the Military Systems
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
The Center for Integrative Medicine ~A Department of Defense First~
• Established Nov 2003 at The Center for Integrative Medicine ~ A Department of Defense First~
• Began with acupuncture and chiropractic services. Currently offering holistic approach to pain with “Conventional” and “Alternative” modalities
• New facility constructed Dec 2008 on Ft Bliss- name changed to the Interdisciplinary Pain Management Center (IPMC) in 2012
• The Center has brought in over $800,000 research dollars and had the first senior Samueli Institute research associate in the DoD (2004)
• The Center conducted the first Military Chiropractic study for Acute Low Back Pain in the United States with Samueli Institute and Palmer College of Chiropractic. Approved for publication in Spine As a result of the study, Congress mandated a follow up study with $7.2M funding.
• The Center provides valuable complementary modalities for difficult medical conditions.
• Built and sustained on passion, compassion and “out of the box” ideology
Conceptual Plan for an Institute for Integrative Health and Healing. The current WBAMC Interdisciplinary Pain Management Center (IPMC) Campus buildings are on Ft Bliss, Buildings 2485D and 2487
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Integrative Medicine Model
The mission of the Integrative Medicine Model is to provide an environment that promotes existing and new medical treatments that may offer safe
and effective approaches to the health and healing care through education, clinical practices and
research. Additionally, the mission is to implement those modalities that meet research standards into the current standards of patient health care through collaborative partnerships
with existing medical practices.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
ARMY SURGEON GENERAL ANNOUNCES RECOMMENDATIONS OF PAIN MANAGEMENT TASK FORCE AND RELEASES REPORT
June 23, 2010 • Lt. Gen. Eric B. Schoomaker, Former Army Surgeon General and Commander, U.S.
Army Medical Command, said that “this report is a pivotal effort to better understand and treat the growing challenges of providing comprehensive pain management for our patients.
• Recommendations for a MEDCOM comprehensive pain management strategy that was holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain
• Focus on a holistic, patient-centered approach which employs all modes of therapy--from more conventional means which rely upon the use of drugs, to complementary and alternative modes such as acupuncture, meditation, biofeedback, yoga and others
http://ausar-web01.inetu.net/publications/ausanews/specialreports/2011/06/Pages/AAPMhonorsfiveArmymedicalofficers.aspx
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
TSG Pain TF Recommendations for CAM for Pain Management
• Recommendation 4.2.1.1 Adopt a tiered approach for the effective integration of integrative modalities to augment pain management for military and Veteran populations.
• Recommendation 4.2.1.2 Establish integrative pain medicine capabilities at RPCoE's and DoD sites (Army, Navy, and Air Force) to champion integrative pain care with a focus on the best clinical practices, education, and research.
• Recommendation 4.2.1.3 Establish baseline data on the clinical integrative practices being used, along with provider and patient perspectives, through a comprehensive DoD survey, utilizing existing survey models (if appropriate).
• Recommendation 4.2.1.4 Develop an advisory board, with scholarly leaders in various integrative medicine fields, to assist in the development of appropriate programs, ensure proper credentialing of providers, and establish necessary guidelines for outcome measures and uniformed quality of care.
• Recommendation 4.2.1.5 Establish standardized and appropriate strategic communication plans on integrative health care methods for pain medicine.
• Recommendation 4.2.1.6 Develop and fund pilot programs across DoD in the delivery of integrative pain.
• Recommendation 4.2.1.7 Request Health Affairs undertake the evaluation of integrative medicine modalities in Tier I for inclusion as covered TRICARE benefits.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Clinic A Clinic D Clinic B Clinic
C
Typical Stove Piped Approach
Requires a Cultural Shift in Healthcare Delivery The IPMC is that shift
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Environmental Optimal Healing Philosophy
Green Spaces Zen Gardens
Labyrinth
Medical Management Primary Care Champions
Clinical Pharmacist Interventional Spine
Procedures
Spiritual Core values Perspective
Identity, Meaning and Purpose
Social Soldier and Family Caregiver Support Groups
Educational Curriculum Social, Family and Task Cohesion
Research DoD Survey of IM
Mindfulness and PTSD Spousal Needs Assessment
Most Research in IM (VA/DoD)
Integrative Modalities Acupuncture
Movement-Yoga Warrior Tai Chi Body Based Manipulation
Medical Massage Biofeedback
Mind-Body/Mindfulness
Functional Restoration
Strength Endurance Flexibility
Culinary Education Healthy Choice Kitchen
Behavioral Substance Abuse Counseling
Coping Skills Mind Wellness
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Step Care Model of Treatment
Interdisciplinary Pain Department
IPMC
Tertiary Level Interventions
Advanced Pain Medicine Diagnostics and
Interventions
Secondary Level Interventions Rehabilitation Medicine
Behavioral Medicine
Acute/Primary Care Management PCM Pain Champions
Early Interventions Patient Self Management
Prevention
Goal of restoration with function, risk management
• In processing • Wellness Fusion Campus
• Medical/Post Initiative
Patient Centered
Medical Home
• Outlying Clinics (PCM and Specialty)
Community Based Medical
Home
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Clinical Care is Predicated on the Self
Self actualization
Self awareness
Self responsibility Self discipline
Self care
Self determination
Pillars of Integra6ve Health Model
Clinical Care
Research
Education Community
Patient Provider
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Proposed IPMC Organizational Chart
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
IPMC Programs
• Pain Clinic • Intensive Outpatient
Program (IOP) • Functional Restoration
Program • acute Intensive Outpatient
Program (aIOP) • Addiction based program
http://wunderkammer.ki.se/assets/uploads/image/asset/331/large_Bobbin_tandutdragning_med_tr_d.jpg
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Interdisciplinary Pain Management Center IPMC Process Map 2013
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Clinic Process Chronic Pain Management
Follow-Up Clinical Evaluation with Medical Provider
Medium/High complexity case (CHUP)
Referral Review Individual Service Chiefs
Low complexity case
Clinical Evaluation with Medical Provider
PCM Champion
Rehab Therapy Interventional IM
Discharge Return to PCM with treatment plan.
IOP
ECHO consultation prn
Behavioral Health
Multi-disciplinary Pain Management Clinic
Patient with minimal symptoms requiring only one provider
Interventional
Integrative
Behavioral
Pain Champion
Pharmacological
Patient tailored care plans Multi-Disciplinary Weekly Team Meetings
PCM participation/education Nurse Case Management
Functional Restoration
Patient
Patient identified as good candidates for holistic care
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Clinic Process Intensive Outpatient Program
Mul6disciplinary Pa6ent Intake Evalua6on (MDPIE)
High risk, at risk pa6ents Developmental Stages
Team Huddle Weekly Multi-D meeting
Patient Completed Question (30 mins)
Patient Interview
with Team
(90 mins)
Individual Assessments BH
(30 mins)
Rehab (30 mins)
MD (30 mins)
Treatment recs. to PCM-Augmentation Team with ECHO
follow-up PRN
Data Analyst to follow
outcomes
Does Not Meet IOP Criteria
Meets IOP Criteria
NCM obtains
command approval
Discharge/ Return to Duty
with recs. for PCM-
Augmentation
ECHO Follow-Up, as needed
Day 1
IOP Team (Individualized Care Plan) Core MD, Rehab, BH, Pharm, NCM, Education Additional IM
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Clinic Process Acute Intensive Outpatient Program
Acute Mul6disciplinary Pa6ent Intake Evalua6on (Acute MDPIE)
Pain less than 7 days No history unevaluated trauma (ER or PCM level)
No history of fracture
Patient and Team
Huddle
Begin treatments
in afternoon
Patient presents to clinic, given appointment time for that
morning, paperwork completed (30 mins)
Patient Interview
with Team
(40 mins)
Team Assessment Pain
Champion
Rehab
Chiropractor/DO
Treatment recs. to PCM-Augmentation Team or appropriate
IPMC service
Data Analyst to follow
outcomes
Does Not Meet aIOP
Criteria
Meets aIOP
Criteria
Pa6ent obtains
command approval
Discharge/ Return to Duty
with recs. for PCM-
Augmentation
Long term Goals
Create management team at PCM/Unit levels
Educational Awareness on Pain Management
Day 1 Individualized Care Plan Biweekly treatments
Milieu environment
Nurse Case Management
2 week re-evaluation with pain champion
Continued treatment prn
Team consists of MD, IM providers, Rehab team, Chiropractor/DO
IM Provider
Telephonic/Records F/U over 3-6 mos
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
WBAMC IPMC Patient Visits
IPMC Pa6ent Visits
FY12 FY13
July Aug Sept FY 12 Total Oct Nov Dec Jan Feb Mar Apr May June Jul Aug Sept Oct FY13 Total
Total Since Jul 12
Acupuncture 36 114 106 256 151 128 176 234 244 933 1189
Anodyne 25 59 87 171 102 22 39 13 13 189 360
Case Management 8
Chiroprac6c 325 415 252 992 626 704 517 769 692 3308 4300
Clinical Pharmacy 0 0 0
Clinical Psychology 0 6 6 12 12
Electrodiagnos6cs (EDx) 2 6 8 21 8 9 13 47 98 106
Interven6onal Medicine 145 133 113 391 75 78 101 125 41 420 811
Massage Therapy 0 0 0
Physical Therapy 0 3 41 43 45 60 192 192
Primary Care 94 128 109 331 114 82 110 93 132 531 862
Research 6 13 11 30 16 15 2 6 2 41 71
Yoga 0 9 65 81 120 65 340 340
Total 631 864 684 2179 1117 1143 1078 1424 1310 0 0 0 0 0 0 0 0 6064 8243
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Chiropractic Care in the Military
Picture/clip art is non-copyrighted material taken off the internet
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Synergy between Integrative and Conventional Medicine
Health and Healing
Global Context
Community
Patient Centered
Care
Interdisciplinary Pain
Management Center
Combat Stress Disorder
PTSD Facility
TBI Treatment Facility
NICoE
Patient Centered Medical Home Polypharmacy
Surgery Perioperative
Medicine Primary Care Prescriptions
Behavioral Care
Educational Outreach
Research Endeavors
Clinical Practices
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Military IM Research
Slide 65 of
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Acupuncture treatment for sinusitis
Research
Survey of Complementary and Alternative Medicine Services within the Department of Defense
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Survey of Complementary and Alternative Medicine Services within the Department of Defense
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
2
4
6
8
10
12
14
16
18
20
Wal
ter R
eed
AM
C
Mad
igan
AM
C
Bro
oke
AM
C
Wrig
ht-P
atte
rson
M
C
Land
stuh
l AM
C
Nav
al M
edic
al
Cen
ter S
an D
iego
Will
iam
Bea
umon
t A
MC
Wom
ack
AM
C
Nav
al H
ealth
Clin
ic
Gre
at L
akes
Trip
ler A
MC
Nav
al M
edic
al
Cen
ter P
orts
mou
th
Mal
colm
Gro
w M
C
Eis
enho
wer
AM
C
Num
ber o
f CA
M S
ervi
ces
Prov
ided
Facility
Change in the Number of Services Provided by Facility N = 13
(% Change)
2005
2009
-36% -22%
44%
80% 80% 60%
50%
333%
233% 175%
171%
133% Decrease In Existing Services
New Services
Increase in Existing Services
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
15%
15%
8%
8%
46% 15%
77% 62%
92% 15%
69% 38%
62%
93%
8% 8% 8% 8%
8% 8%
15% 15%
23%
31% 31%
46%
54% 54% 54%
69% 85%
92% 92% 92% 92%
100%
0% 20% 40% 60% 80% 100% 120%
Native
EMDR, NLP, Life Coach
Rife
Sound Therapy
Vibe
Qi Gong
Healing Touch
Herbal
CES
Yoga
Meditation
Relaxation
Imagery
Behavioral Techniques
Spiritual Healing
Biofeedback
Percentage
Type
of S
ervi
ce
Type of CAM Services Available at MTF with CAM 2005-2009
2009
2005
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
4
1 8
Types of CAM Facilities at MTF with CAM 2005, 2009
Centralized but not CIM
Designated as a CIM
Services available in existing clinic as additional service (Chiropractor, Physical Medicine & Rehab, or Family Practice , Pain or TBI)
MTF with individuals performing CAM modalities as additional services
MTF with designated Center for Integrative Medicine
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
0%
0%
92%
69%
8%
8%
15%
15%
15%
23%
23%
31%
62%
85%
92%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Other
LVN
Native American
Naturopaths
Volunteers
Nurse Practitioner
PharmD
Energy Therapist
Massage Therapist
Physician Assistant
Nurse Anesthetist
Licensed Acupuncturist
RN
PhD
Chiropractor
MD
Percentage
Type
of P
rovi
der
Types of Providers by Percentage at MTF with CAM 2005-2009
2009 2005
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
1
1
15
20
37
2
3
5
6
9
13
32
2
5
21
89
187
0 20 40 60 80 100 120 140 160 180 200
Other
Na8ve American
Naturopaths
LVN
Volunteers
Physician Assistant
Energy Therapist
Massage Therapist
Nurse Prac88oner
RN
Nurse Anesthe8st
PhD
PharmD
Licensed Acupuncturist
Chiropractor
MD
TOTAL
Number of Providers
Type
of P
rovide
r
Number of Providers at MTF with CAM 2005-‐2009
2009
2005
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
8%
54% 54%
38%
15%
85%
15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Congressional OTSG Facility Other (Grants)
Perc
enta
ge o
f Fun
ding
Type of Funding
Source of CAM Funding at MTF with CAM 2005-2009
2005 2009
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
A Randomized Controlled Trial of Chiropractic Manipulative Therapy and Standard of Care for Active Duty Soldiers with Acute Low Back Pain
Picture/clip art is non-copyrighted material taken off the internet Dr Aaron Harris, WBAMC Chiropractic Service
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Methods
Inclusion Criteria
" Age range 18-35 " Diagnosis of acute low back pain or
reoccurrence of chronic low back pain of no more than 4 weeks
" Written informed consent " Military Active duty status
Exclusion Criteria
" LBP pain from other than somatic tissues as determined by history, examination.
" Radicular pain worse than back pain " Co-morbid pathology or poor health conditions
that may directly impact spinal pain. " Bone and joint pathology contraindicating
patient for M/MT. " Other contraindications for M/MT of the lumbar
spine and pelvis (ie, bleeding disorders or anticoagulant therapy)
" Pregnancy; all female potential participants will undergo pregnancy testing
" Use of manipulative care for any reason within the past month
" Unable to follow course of care for four weeks " Unable to give informed consent for any
reason " Unable to confirm that they will not be deploy
during the course of the study.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Study Logarithm
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results Logarithm
122 Excluded 80 Ineligible 42 Declined
Enrolled Patients (n = 91)
Assessed for Eligibility (n = 213)
Standard Care SC (n = 46) Attended at least 1 visit with medical provider: 46
Standard Care + Spinal Manipulation SC + M/MT (n = 45)
Attended at least 1 visit with medical provider: 45 Treated by chiropractor at least twice: 45 (Median: 7 visits)
Week 2: 28 Week 4: 29
Analyzed: 32
Week 2: 39 Week 4: 40
Analyzed: 41
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Characteristics Standard Care (%) n=46
Standard care + MM/T (%)
n=45
Total (%) n=91
Age Mean 26.2 25.1 25.7
Gender Male 84.8 86.7 85.7 Female 15.2 13.3 14.3
Marital Status Married 50 42.2 46.2
Divorced/Separated 8.7 4.4 6.6 Widowed --- --- --- Never been married 26.1 51.1 38.5
Race American Indian or Alaska Native
6.5 4.4 5.5
Asian 2.2 --- 1.1 Native Hawaiian or Other Pacific Islander
2.2 --- 1.1
Black or African American
21.7 22.2 22
White 52.2 73.3 62.6
Ethnicity Hispanic 17.4 15.6 16.5 Not Hispanic 78.3 82.2 80.2
Results- Demographic Characteristics All participants
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results- Demographic Characteristics Completed
Characteristics Standard Care (%) n=30
Standard care + MM/T (%)
n=39
Total (%) n=69
Age Mean 26.2 25.1 25.7
Gender Male 84.8 86.7 85.7 Female 15.2 13.3 14.3
Marital Status Married 50 40 45.1
Divorced/Separated 6.5 2.2 4.4 Widowed --- --- --- Never been married 23.9 46.7 35.2
Race American Indian or Alaska Native
6.5 2.2 4.4
Asian 2.2 --- 1.1 Native Hawaiian or Other Pacific Islander
2.2 --- 1.1
Black or African American
21.7 22.2 22
White 50 71.1 60.4
Ethnicity Hispanic 17.4 15.6 16.5 Not Hispanic 78.3 82.2 80.2
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Results
0
2
4
6
8
Baseline 2 Weeks 4 Weeks
Mea
n N
RS
Numerical Pain Rating Scale
Standard care
Standard Care + MM\T
0
2
4
6
8
10
12
14
Baseline 2 Weeks 4 Weeks M
ean
RM
Q
Roland-Morris Disability
Standard care
Standard Care + MM\T
Measure Week Mean difference* 95% CI* p
NRS (0-10) 2 2.1 1.1, 3.1 <0.001 4 1.2 0.1, 2.2 0.03
RMQ (0-24) 2 4 1.8, 6.1 <0.001 4 4.1 1.3, 6.8 0.004
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
3.4
24.1
37.9
17.2 13.8
3.4 2.5
7.5
17.5
32.5
37.5
2.5
0
5
10
15
20
25
30
35
40
45
50
Much worse
A liTle worse
About the same
A liTle beTer
Moderately beTer
Much beTer
Completely gone
Percen
t
Category
Back Pain at 4 Weeks Compared to Baseline
Standard care
Standard care + MM/T
Results
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
3.4% 0.0%
24.1%
2.5%
37.9%
7.5%
17.2%
17.5%
13.8%
32.5%
3.4%
37.5%
0.0% 2.5%
Back Pain at 4 Weeks Compared to 1st Visit
Completely Gone
Much Better
Moderately Better
A Little Better
About the Same
A Little Worse
Much Worse
SC SC + M/MT
Results
Above “a little better”
90%
Above “a little better”
34.4%
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Ft Bliss and WBAMC Initiatives
Research • Survey of Complementary and
Alternative Medicine Services within the Department of Defense
• Needs Assessment Among Military Spouses of Active Duty Personnel
• Relaxation Response (RR) Training for PTSD Prevention in Soldiers a.k.a. “SPIRIT SMART” (Stemming PTSD, Increasing Resilience and Impeding Trauma in Service Members: Assessing Relaxation Response Training)
Clinical • Ft Bliss Wellness Fusion Campus • Interdisciplinary Pain Management
Center (IPMC)
Collaborations • NATO Task Force • OTSG Pain Task Force • Samueli Institute
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Col. Emmet Schaill, Wellness Fusion Campus project head, and Doug Briggs, director of human performance here, cut the ribbon outside Campus Headquarters, Bldg. 2438 on Cassidy Road May 25 symbolizing the opening of the now fully operational Wellness Fusion Campus. Photo by Marcie C. Wright, Monitor Staff.
http://fbmonitor.com/2011/06/01/bliss-wellness-fusion-campus-now-up-and-running-complex-encompasses-five-pillars-of-strength/
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Fort Bliss Wellness Fusion Campus
Vision Enhance the health and wellness of the Fort Bliss Community by improving the balance,
health, self-confidence Soldiers, Families and Army Civilians whose resilience and total fitness enables them to excel in an era of high operational tempo and persistent conflict.
Mission The Fort Bliss Comprehensive Fitness Initiative provides a holistic, multidisciplinary,
multimodal fitness campus for Soldiers, Families and Army Civilians in order to optimize performance and build resilience through assessment, education, prevention and treatment. The campus provides a centralized location for comprehensive fitness, well-being, and assessment by assisting in the establishment and attainment of individualized and measurable goals.
Values We aspire to equip members of the Fort Bliss Community with the capacity to access and
utilize the resources that make up the five pillars of comprehensive fitness; physical, emotional, social, spiritual, and family that sustain their well-being, and their capacity to individually and collectively cope with stress and adversity.
Target Population Service Members, Families, DA Civilians, Retirees
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Evaluation Communicate results and measures via CHPC
ACS (Family) ACEP (Emotional/Physical) CBHS (Emotional) MWR (Family, Social, Physical) Chaplains (Spiritual) MFLCs (Emotional, Family) FAP (Family) USO (Social) CDC (Family) ASAP (Physical) COSC (Emotional)
Teach Intro to Resiliency (RSA for Spouses/FMs)
Deliver Comprehensive Screening/ assessment modules along the 5 Pillars of CSF
Train Soldiers to be fit along the 5 pillars of CSF
Market Center as the premier source of CSF for Soldiers and Families
Provide a recreational and social center for Soldiers and Families
Provide a venue to help Commanders provide assistance to Soldiers in need
Outcomes MEDIUM
TERM LONG TERM
Soldiers and Family members have access to a centralized location capable of providing Comprehensive Fitness and assessment /treatment as required.
An oasis like atmosphere to draw Soldiers and families to the environment
Improved Soldier and Family life
Improved Leader engagement in the lives of their Soldiers
SHORT TERM
Change in attitude toward help and health seeking behavior
Soldier and Family confidence in their ability to navigate resources available on the installation
Facilitate help and health seeking behavior
Visitors to center are knowledgeable of goal setting principles and complete goals book
Activities
Evidence of
Delivery
Drivers
250 individuals visit the center/week
At least one module is offered for each of the five pillars of CSF/week
All visitors are identified as either command or self referrals in a central database
85 % Satisfaction score for modules offered at Center
All Soldiers referred by Commanders are seen at the center
Quarterly article published in The Monitor highlighting activities at the Center
Create feedback mechanism that provides leaders assessment of their Soldiers and Family members
Soldiers and Family members utilize the center more for health seeking versus help seeking behaviors
Commander’s Intent: To provide a Centralized approach to Comprehensive Fitness for our Soldiers and Family members
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
• Health Related Fitness: Physical training required to reduce the risk of disease or injury .
• Performance Related Fitness: Physical training required to achieve physical goal .
PHYSICAL
• Psychological fitness: Integration and optimization of mental, emotional and behavioral abilities and capacities to optimize performance and strengthen resilience of war fighters and family .
EMOTIONAL
• Social Cohesion: Group of members liking each other and task cohesion to sharing a common goal . Access and use of common facilities and activities participation will fulfill the needs of the individual.
SOCIAL
• Family Fitness: Immediate military family ability to use physical, psychological, social and spiritual resources to prepare for, adapt to, and grow from military lifestyle demands .
FAMILY
• Spiritual Fitness: A set of components, all pertaining to spirituality, Spiritual beliefs, Spiritual Values, Spiritual Practices and Self-Awareness .
SPIRITUAL
• Program Fitness: Continuous program evaluations with appropriate redirection as indicated. Research on program metrics and outcomes.
PROGRAM EVALUATION AND
RESEARCH
Comprehensive Fitness Core Dimensions and Operational Definitions
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
(Left to Right) Rollin M. Gallagher, editor, Pain Medicine Journal, American Academy of Pain Medicine, presents AAPM Presidential Commendations to Lt. Gen. Eric B. Schoomaker, commanding general of the U.S. Army Medical Command and the Army’s surgeon general; Brig. Gen. Richard W. Thomas, assistant surgeon general for force protection; Col. Kevin Galloway, chief of staff for the Army’s Pain Management Task Force; and Col. Chester C. Buckenmaier, chief, Army Regional Anesthesia and Pain Management Initiative, Walter Reed Army Medical Center, during the March 26 AAPM conference.
http://ausar-web01.inetu.net/publications/ausanews/specialreports/2011/06/Pages/AAPMhonorsfiveArmymedicalofficers.aspx
Department of The Army OTSG Pain Initiative
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
OTSG Pain Management Task Force • Developed 109 recommendations that lead to a
comprehensive pain management strategy that is holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain.
• The recommendations rely heavily on an education and communication plan that crosses DoD and VHA .
• Emphasis on the synchronization of existing Service and MHS initiatives (e.g. Patient Centered Medical Home, Comprehensive Soldier Fitness).
• Recommendations are divided into four areas:
– Provide Tools and Infrastructure that Support and Encourage Practice and Research Advancements in Pain Management
– Build a Full Spectrum of Best Practices for the Continuum of Acute and Chronic Pain, Based on a Foundation of Best Available Evidence
– Focus on the Warrior and Family - Sustaining the Force
– Synchronize a Culture of Pain Awareness, Education, and Proactive Intervention
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Hierarchy of IM Implementation
Modality Passive Active
Acupuncture Clinic based Acupuncture Self directed acupressure
Yoga / Yoga Nidra Facility based yoga classes Self directed with video, exercising
Non-allopathic Chiropractic Care Clinic based manipulations Self-correcting exercises
Therapeutic Medical Massage Clinic based treatments Partner or self treatment
Biofeedback Clinic based biofeedback techniques
Self directed biofeedback with video, heart rate variability monitors, meditative
practices Mind-body Therapies
(Meditation, Mindfulness) Facility based classes Self directed
The tiered structure represents a hierarchy of implementation based on current accepted literature supporting efficacy, safety, and widespread use or acceptability. Additionally, licensing and credentialing concerns were taken into consideration in the development of the recommendations. Within the tiers, active and passive treatments are identified to allow for an understanding of how passive treatments can become active
treatments to avoid the pitfalls of passive patient participation.
Tier 1 Modalities
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Hierarchy of IM Implementation
Modality Passive Active
Movement therapy (Qi Gong, Tai Chi, Marital Arts) Facility based classes Self directed with video, exercising
Art Therapy Facility based classes Self expression through journaling, art,
dance, etc.
Music Therapy Facility based classes Self directed with iPods, etc.
Aroma Therapy Facility based treatment Self directed
Cold Laser Facility based treatments N/A
Monochromatic Near Infrared Energy (MIRE) Treatments Clinic based treatments
Self directed with MIRE personal equipment
Cranial Electrical Stimulation Clinic based treatments Self directed with CES personal
equipment
Tier 2 Modalities
Tier 2 modalities were not implemented in the initial phase of the IPMC roll out.
While scientific evidence exists regarding some CAM therapies, for most, there are key questions that have yet to be answered through well-designed scientific studies – questions, such as whether these therapies are safe and whether they work for the purposes for which they are used.
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
acute Intensive Outpatient Program Data (Jul to Present)
Slide 92
Demographics
N = 43
Gender M 98% F 2 % Ave Age 31.9 Age Range 20-61
Number of Visits 275 PCM 18% Chiropractic 54% Acupuncture 25% Interventional 3%
Ave # Visit/patient 6.4 Ave # of week seen 4.0
Presenting Conditions Cervical 20% Thoracic 7% LBP 51% Myofascial 25% Shoulder 13% Hip 15% Shin 9% Scoliosis 19%
5.6 2.7 0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
Pre Treatment Pain Level
Pain
Lev
el N
RS
0-10
aIOP Pre and Post Pain Levels
Post Treatment Pain Level
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Research Initiative
Needs Assessment Among Military Spouses of Active Duty Personnel
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Needs Assessment Among Military Spouses of Active Duty Personnel
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Research Initiative
Relaxation Response (RR) Training for PTSD Prevention in Soldiers a.k.a. “SPIRIT SMART” (Stemming PTSD, Increasing Resilience and Impeding Trauma in Service Members:
Assessing Relaxation Response Training)
One armed man in yoga pose http://photos.com
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Relaxation Response (RR) Training for PTSD Prevention in Soldiers a.k.a. “SPIRIT SMART” (Stemming PTSD, Increasing Resilience and Impeding Trauma in Service Members: Assessing Relaxation Response Training)
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Initiatives and Partnerships
NATO Task Force on Integrative Medicine RTG195
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Initiatives and Partnerships
U.S. Army Telemedicine and Advanced Technology Center
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
National Intrepid Center of Excellence (NICoE)
Initiatives and Partnerships
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Initiatives and Partnerships
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Initiatives and Partnerships
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Combat Initiatives
Picture/clip art is non-copyrighted material taken off the internet
COL Richard Niemtzow placing auricular acupuncture needles for the battlefield acupuncture protocol
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Slide 104 of
• “The Voodoo of it all” -overcoming the Stigma of Integrative Medicine and belief that CAM is pseudo-science
• “Balancing the budget”- obtaining support for non-core treatments in an environment of shrinking funding for core services
• “The tyranny of the blank page”-moving forward when there is so much to do and other stuff to do
• “A new direction”-selling the concept when leadership changes
• “Competing for Soldier’s Time”-allowing soldiers time to heal
• “Rowing in the same direction” –developing coordination of efforts in patient care, research and education
After thoughts
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
The Paradigm Shift
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
“Cure sometimes
Heal often
Comfort always”
“The natural healing force within each of us is the greatest force in getting well”
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Questions
1. What are the current integrative modalities used by the Department of the Army for pain management.
a) Acupuncture b) Chiropractic Manipulation c) Massage Therapy d) Mind-body techniques/meditation e) Yoga/Movement
2. Describe the tiered approach to integrative modalities for use in the Department of the Army pain management programs.
a) Tiers 1 and 2 b) The tiered structure represents a hierarchy of implementation based on current accepted
literature supporting efficacy, safety and widespread use or acceptability. Tier 1 and Tier 2
3. Name five of the pillars of approach to the wholistic pain management program within the Department of the Army
a) Integrative Modalities b) Functional Restoration c) Medical Management d) Behavioral Management e) Social Support and Network f) Spirituality g) Research h) Environmental
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Apr-9-13 COL Richard P Petri, Jr., MC/ WBAMC IPMC / (915) 742-7407 (DSN 969) / [email protected] FOUO
Slide 118 of