This title slide focuses on "Pain Management in Chronic Conditions." It provides a guide tailored for UK military nurses in acute medical units.

Pain Management in Chronic Conditions

Guide for UK Military Nurses in Acute Medical Units

Source: UK Defence Medical Services (DMS) – NICE & NHS Aligned

This agenda slide outlines a presentation on chronic pain in UK Armed Forces and veterans, starting with an introduction and epidemiology overview. It then covers pathophysiology, assessment and management; military challenges and interdisciplinary approaches; followed by case studies, conclusion, and references.

Presentation Agenda

1. 1. Introduction & Epidemiology

Overview of chronic pain in UK Armed Forces and veterans.

2. 2. Pathophysiology, Assessment & Management

Mechanisms, tools, NICE-guided pharmacological and non-pharm interventions.

3. 3. Military Challenges & Interdisciplinary Approach

Deployment issues, stigma, DMS-NHS integration and roles.

4. 4. Case Studies, Conclusion & References

UK-focused examples, nurse leadership, key evidence sources. Source: Pain Management in Chronic Conditions: A Guide for UK Military Nurses in Acute Medical Units

This section header slide for "Pain Management in Chronic Conditions: A Guide for UK Military Nurses in Acute Medical Units" introduces Section 1: "Introduction." The subtitle overviews chronic pain prevalence in UK Armed Forces and veterans, emphasizing its impact on readiness and wellbeing.

Pain Management in Chronic Conditions: A Guide for UK Military Nurses in Acute Medical Units

1

Introduction

Overview of chronic pain prevalence in UK Armed Forces and veterans: impact on readiness and wellbeing

Source: MOD reports

UK veterans experience chronic pain in 40-50% of cases, with musculoskeletal disorders 2-3 times higher than civilians. Additionally, 65% of veterans with MSK pain have persistent issues, and 80% are linked to deployment blast or injury history.

2. Epidemiology

• 40-50%: Chronic Pain Prevalence

in UK veterans (MOD)

• 2-3x: Musculoskeletal Disorders

higher than civilians (NHS)

• 65%: Veterans with MSK Pain

persistent issues (NHS stats)

• 80%: Linked to Deployments

blast/injury history (MOD) Source: MOD Health Reports; NHS Veteran Stats

The slide on Pathophysiology contrasts nociceptive (inflammatory) pain, arising from tissue damage activating peripheral nociceptors via mediators like prostaglandins and common in military injuries, which responds to anti-inflammatories per NICE. It also covers neuropathic pain from nerve damage causing allodynia, mixed mechanisms, and central sensitisation amplifying CNS signals, prevalent in veterans and treated with gabapentinoids or antidepressants per NICE.

3. Pathophysiology

Source: NICE NG193 (2021); DMS Pain Guidelines

This Assessment slide recommends using the Brief Pain Inventory (BPI) for pain severity and interference, plus the military-adapted DVPRS for Defence personnel. It also advises psychological screening with the GAD-7 questionnaire and integration of holistic NHS Pain Management Pathways.

4. Assessment

• Use Brief Pain Inventory (BPI) for severity and interference.
• Employ DVPRS (military-adapted) for Defence personnel.
• Screen psychologically with GAD-7 questionnaire.
• Integrate holistic NHS Pain Management Pathways.

Source: NICE NG193, DMS Standards, NHS Pathways

The slide presents a tiered approach to pharmacological pain management. Tier 1 uses paracetamol and NSAIDs for mild-moderate pain; Tier 2 employs amitriptyline and gabapentin for neuropathic pain after Tier 1 failure; opioids are restricted to short-term specialist use; and adjuvants like vitamin D and capsaicin provide supportive relief.

5. Pharmacological Management

{ "headers": [ "Tier", "Medications", "Notes" ], "rows": [ [ "Tier 1", "Paracetamol, NSAIDs", "First-line for mild-moderate pain" ], [ "Tier 2", "Amitriptyline, Gabapentin", "Neuropathic pain, after Tier 1 failure" ], [ "Restricted", "Opioids", "Short-term, specialist approval only" ], [ "Adjuvants", "Vitamin D, Capsaicin", "Supportive, e.g. deficiency, topical" ] ] }

Source: NICE NG193 (2021) & DMS

This slide showcases five non-pharmacological interventions for pain management: physiotherapy for mobility and pain reduction, CBT for coping skills, mindfulness (MBSR) for stress reduction, pain management programmes for self-management, and acupuncture for neuropathic pain. All are endorsed by UK bodies like NICE and NHS, with evidence from clinical and military settings.

6. Non-Pharmacological Interventions

{ "features": [ { "icon": "💪", "heading": "Physiotherapy", "description": "NICE-endorsed exercises to enhance mobility and reduce chronic pain." }, { "icon": "🧠", "heading": "Cognitive Behavioural Therapy", "description": "UK-recommended CBT for improving pain coping and psychological resilience." }, { "icon": "🧘", "heading": "Mindfulness (MBSR)", "description": "Evidence-based stress reduction to alter pain perception in NHS pathways." }, { "icon": "👥", "heading": "Pain Management Programmes", "description": "Multidisciplinary PMPs promoting self-management skills per UK guidelines." }, { "icon": "🪡", "heading": "Acupuncture", "description": "NHS evidence-based for neuropathic pain relief in military settings." } ] }

Source: NICE NG193, NHS Evidence, DMS Guidelines

In the UK military setting, key challenges include deployment disruptions to pain management, MOD-NHS handover gaps, stigma delaying pain reporting, and veteran transition issues via Op COURAGE. Acute strategies emphasize rapid assessment and liaison protocols.

7. Challenges in UK Military Setting

• Deployment constraints disrupt pain management continuity
• MOD-NHS care handover gaps challenge treatment adherence
• Stigma barriers prevent timely pain reporting
• Veteran transition issues via Op COURAGE
• Acute strategies: rapid assessment, liaison protocols

Source: Deployment constraints | MOD-NHS care continuity | Stigma | Veteran transition (Op COURAGE). Strategies for acute units.

The slide outlines a four-phase DMS-NHS integration workflow—Assess, Plan, Refer, and Review—using an interdisciplinary, holistic approach led primarily by nurses. Key actions include holistic evaluations with GP input, MDT-tailored plans involving physio and MH specialists, referrals to PMPs and NHS pathways with veteran protocols, and ongoing monitoring via 4-6 week huddles per NICE.

8. Interdisciplinary & Holistic Approach: DMS-NHS Integration Workflow

{ "headers": [ "Phase", "Lead", "Key Actions & Collaborators" ], "rows": [ [ "Assess", "Nurse", "Holistic eval: BPI/DVPRS, psych screening. GP initial input for comorbidities." ], [ "Plan", "MDT (Nurse-led)", "Develop tailored plan: pharma/non-pharma. Involves physio, MH specialist." ], [ "Refer", "Nurse/GP", "Refer to PMPs, physio, NHS pathways. Ensure veteran transition protocols." ], [ "Review", "Nurse", "Ongoing monitoring/adjustments. MDT huddle every 4-6 weeks per NICE." ] ] }

Source: NICE NG193 (2021), DMS Guidelines (2023)

Slide 9, titled "Case Studies," presents an image with two highlighted cases: chronic low back pain post-training and neuropathic injury from blast. It also covers DMS hospital management and outcomes.

9. Case Studies

!Image

• Case 1: Chronic low back pain post-training.
• Case 2: Neuropathic injury from blast.
• DMS hospital management and outcomes.

Source: UK Defence Medical Services

The conclusion slide summarizes the nurse's key role in the UK Defence Medical Services (DMS). It highlights leading advocacy for soldiers, ensuring MOD-NHS care continuity, promoting NICE-aligned evidence-based strategies, and driving holistic outcomes under the subtitle "Leadership for Optimal Recovery."

10. Conclusion

Nurse Role in UK DMS:

• Lead advocacy for soldiers
• Ensure care continuity (MOD-NHS)
• Promote NICE-aligned, evidence-based strategies
• Drive holistic outcomes

Leadership for Optimal Recovery

Source: Pain Management in Chronic Conditions: A Guide for UK Military Nurses in Acute Medical Units

This slide, titled "11. References," lists key sources for the presentation. It includes NICE NG193 (2021), DMS Guidelines (2023), NHS England Pain Pathways (2024), BMJ Mil Health (2019-24), and MOD Reports.

11. References

• NICE NG193 (2021)
• DMS Guidelines (2023)
• NHS England Pain Pathways (2024)
• BMJ Mil Health (2019-24)
• MOD Reports