Walter Reed National Military Medical Center, BETHESDA, Md  –   The National Capital Region Pain Initiative (NCRPI) and Tele-Pain Program, headquartered at Walter Reed National Military Medical Center, is hosting its annual Pain Care Skills Training through Aug. 21.

The training kicked off Aug. 13 with a plenary session and memorial lecture honoring Dr. Anita Hickey, a retired Navy captain who served 28 years in uniform as a pain physician. She was commissioned in 1987 and served on multiple deployments supporting the Global War on Terrorism onboard the USS Abraham Lincoln and USS George Washington. She also served aboard the USNS Mercy, supporting NATO operations in Kosovo, Yugoslavia. After retiring in 2015, she continued to care for active duty and military beneficiaries as a pain management/anesthesia physician at the Naval Medical Center San Diego.

Prior to her death in 2019, Hickey authored numerous articles and book chapters on topics that included pain management, post-traumatic stress, and acupuncture. She also authored the book, “Pain Is Not What It Seems: The Guide to Understanding and Healing from Chronic Pain and Suffering.”

“The NCRPI honors [Hickey] with a plenary memorial lecture each year during the Pain Care Skills Training (PCST),” stated Amy J. Osik, senior program manager for the NCRPI and Tele-Pain Program. “The overall goal of the [PCST is] to promote readiness, restoration of function and relief of pain while reducing the misuse of opioids,” she added.

Presenters during the first day of the training discussed the Pain Reprocessing Theory (PRT), A Whole Person Perspective on Pain Management, Operation Supplement Safety (OSS), and the Consortium for Health and Military Performance (CHAMP) Program.

The training also included virtual workshops on Aug. 14-15, which provided information on issues that included pain in the pelvis; improving sleep in service members and veterans with chronic therapy; medical hypnosis; occupational therapy to prevent and treat pain; therapeutic movement (yoga, tai chi, and qigong); chronic pain and PTSD; headaches, pain and palliative care; orofacial pain; pain care for women; battlefield acupuncture; massage therapy; and more.

In-person training takes place Aug. 20-21 at the National Institutes of Health’s (NIH) Natcher Center. Training workshops on those days include battlefield acupuncture; building empathy in health care teams; medical hypnosis; pain and palliative care: opioids, kids, and communication pearls; physical examination/evaluation (back and lower body); art therapy and pain; massage therapy for pain; musculoskeletal ultrasound; culinary medicine to fight inflammation and pain; and more.

According to Dr. Christopher Spevak, an anesthesiologist and pain physician who leads the NCRPI and Tele-Pain Program, the training is annually held to attract physicians, social workers, pharmacists and others involved in pain management from throughout the Military Health System and elsewhere.

Aug. 31 is Opioid Misuse Prevention Day and International Overdose Awareness Day, observed to raise awareness about overdose and share information on possible ways to prevent it, as well as acknowledge the grief of family and friends left behind.

In addition, September is Pain Awareness Month, which recognizes the needs of people with chronic pain and research that aims to treat and prevent it. It also acknowledges the impact pain has on individuals, families, communities, and the nation.

“We really give attendees what they need in terms of practical information and useable skills,” Spevak explained.

Pain Reprocessing Theory

Dr. Yoni Ashar, of the University of Colorado, discussed the PRT during the first day of the training. He said that the financial expenditures for chronic pain are greater than heart disease and cancer combined, exceeding $635 billion annually with rising prevalence rates for men and women, across all ages, and especially for veterans, for pain and specifically, for low back pain.”

“A main cause of the state of affairs concerning chronic pain,” said Ashar, “is there’s a hyper focus on the body, particularly on peripheral tissue problems, as the cause of chronic pain when we know that a lot of these peripheral tissue changes are highly prevalent in pain-free populations.”
Ashar explained that the changes are “normal abnormalities” throughout the body, including “pain-free” disc degeneration in 52 percent of people in their 30s and 96 percent of people in their 80s; “pain-free” bulging discs in the necks of 87 percent of people; “pain-free” superior labral (shoulder) tears in 72 percent of people; “pain-free” labral (hip) tears in 69 percent of adults, and 89 percent of athletes; “pain-free” knee abnormalities in 97 percent of people; and “pain-free” Achilles tendon changes in 63 percent of people, with 68 percent of runners experiencing “pain-free” retrocalcaneal changes.

“Treatment can often be focused on these findings, and even when a person does have some type of peripheral tissue pathology, the body naturally heals [itself],” Ashar continued. He added that 60 to 80 percent of herniated discs are naturally resorbed within a year. “Injuries heal, but the brain remembers [the pain],” he added.

Ashar described pain as “a learning signal for guiding behavior – pain is trying to teach us what not to do, such as if you touch the hot stove [experiencing pain], you know you don’t want to do that again.”

Ashar shared that his study with PRT as a way to help people with chronic pain retrain their brains to perceive pain signals as less threatening. PRT uses psychological strategies to help people unlearn their associations with pain and break identifiers surrounding pain. The goal is to reduce the intensity and frequency of chronic pain symptoms by reprogramming the brain to stop generating pain.

The Whole Person and Pain Management

Dr. Mark Pitcher, chief of staff of the National Center for Complementary and Integrative Health, and chronic pain researcher and research development professional at NIH, discussed “A Whole Person Perspective on Pain Management.” He encouraged providers and patients to consider treatment options for pain that may not traditionally be considered as treatments for pain, including lifestyle improvements (nutrition, exercise, weight loss, physical activity, stretching, proper posture, sleep), and self-management practices (mindfulness-based stress reduction, laughter, social connections, etc.).

Operation Supplement Safety

Dr. Andrea Lindsey, senior nutrition scientist and director, Operation Supplement Safety Consortium for Health and Military Performance (and on staff at the Uniformed Services University), agreed that it’s important for people to be cognizant of what they put in their bodies. She said dietary supplements considered high risk include those for bodybuilding, weight loss and sexual enhancement. Some service members face the pressure of meeting body composition and physical fitness standards, factors that can contribute to the use of dietary supplements, she explained. But the use of certain supplements can put the health and careers of service members at risk, she added.

Lindsey also discussed the Department of Defense Prohibited Dietary Supplement Ingredients List, originated to address adverse events from dietary supplements experienced by service members. She encouraged service members to check the list before using any supplement. Checking the list can reduce their chances of health risks or risks to their careers.
In a study that Lindsey co-authored, “Challenges in Reporting Adverse Events from Dietary Supplements [DS],” she and her colleagues state, “Not only do adulterated products pose a risk to military readiness, but inappropriate use of DS [dietary supplements] can be problematic. A convenience sample conducted in 2010-2011 of service members noted that combination product users were more than two times more likely to self-report experiencing abnormal heart beats, stomach pain, dizziness, tremors, and numbness/tingling.”

Lindsey and her colleagues added, “Users of purported steroid analogues were more than 2.5 times more likely than non-users to report experiencing dizziness. Of great concern, however, are the deaths of several service members potentially associated with DS use, and others who were hospitalized with hepatic injury or suffered other AEs [adverse events] from taking DS containing harmful ingredients. Although the evidence is limited, even excessive use of some vitamin and mineral supplements may be associated with higher risk of serious harms (hip fracture [vitamin A], hemorrhagic stroke [vitamin E], and kidney stones [vitamin C, calcium]). Therefore, identifying supplements that are safe to consume and have scientifically validated efficacy are critical for sustaining military health and performance.”

CHAMP – Total Force Fitness

Dr. Gabriel Paoletti, a mental fitness scientist at USU's CHAMP, serves as a subject matter expert in mental skills, positive and performance psychology, resilience, and leadership. He focused his presentation on stress, explaining that “stress doesn’t have to mean that things are going wrong. Stress is actually an indicator of the things that matter to us and what we care about.” Paoletti explained how stress can be used as a fuel for performance.

Substance Use Disorder Symposium

The NCRPI also annually hosts the Substance Use Disorder (SUD) Symposium each September. This year’s SUD symposium is scheduled for Sept. 11.

For more information about the Pain Care Skills Training and the SUD symposium, contact Amy Osik at 301-295-4455, Ext. 171.