August 2017

28th August – 3rd September

Dry eye, Traumatic Brain Injury and Pain in US Veterans

Researchers from the University of Miami recently published in the British Journal of Ophthalmology investigating traumatic brain injury (TBI), dry eye and pain diagnoses in US veterans. The aim of the work was to determine whether there was a relationship between dry eye and pain in veterans with and without TBI. Over 3 million veterans were seen during the 5-year period (January 2010-December 2014) at the Veterans Administrative Hospital. 3.97% were seen to have a diagnosis of TBI and these individuals were found to be twice as likely to have a diagnosis of dry eye, a condition that occurs when the eyes do not make enough tears, compared to those without TBI. Those with a TBI diagnosis were also twice as likely to suffer from chronic pain, headaches, depression and post-traumatic stress disorder, compared to those without TBI. This suggests a common pathophysiology between TBI, pain and dry eye that warrants further investigation.

The abstract of the journal article can be accessed here.

Treatment Seeking in Veterans with Problematic Anger

A recent publication in The Journal of Nervous and Mental Disease discussed the level of treatment engagement of veterans who had problematic anger. The study compared US veterans who had anger/no PTSD, to those reporting PTSD/no anger, to those who had neither anger nor PTSD, in terms of treatment engagement and preferences to care. The results suggest that the group exhibiting anger/no PTSD were less likely to receive mental health treatment and were less able to identify the need for treatment than other groups. It will be important to raise awareness for these veterans in order to ensure that they are receiving adequate treatment and to help them manage their anger, so that they may be more willing to utilise healthcare services.

The abstract of the journal article can be accessed here.

21st – 27th August

Study suggests a possible linkage between multiple sclerosis (MS) and military service

Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system that affects approximately 200 in every 100,000 people in the UK. The causes of the disease are unknown but thought to be due to a combination of genetic, environmental and lifestyle factors that can also influence disease onset and progression. A recent study published in Occupational Medicine found a surprising link between MS prevalence and British military personnel. The Office for National Statistics provided data spanning 31 years (1979-2010) on 3.7 million men, aged between 20 and 74 years, on mortality and last full-time occupation. Analyses revealed a statistically significant increase in proportionate mortality rates of MS in those men who had a last full-time occupation in the armed forces. The same elevated mortality rate, due to MS, was not observed for other occupations nor was there a parallel increase in motor neurone disease for the armed forces suggesting that the significant increase in MS was unlikely to have occurred by chance. Researchers found that there was a possibility of an unidentified occupational hazard that may be causing the increase in MS mortality rates among the British military since the finding could not be explained by social class, selective exclusion from other occupations or low mortality from common causes of death. It will now be pertinent to reanalyse data from other military cohorts and to perform further investigation into the possibility of a potential occupational hazard relating to MS.

The published study can be accessed here.

Based on the statistics presented in our Evidence Section:

  • 79 Serving Personnel claimed a compensation for MS under the War Pension Scheme for the last 5 years (2012 – 2017), with the number being the highest in 2012/13 (27) and then remaining constant at an average of 13 claims per year;
  • 53 medical discharges took place due to ‘Diseases of the nervous system G00-G99’[1] for the period 2010 – 2015.

[1] According to ICD 10 MS comes under: ‘Diseases of the nervous system G00 G99<> > Demyelinating diseases of the central nervous system G35-G37<>’.

A Potential Link between Amyotrophic Lateral Sclerosis Mortality and Military Service

There is some evidence to suggest that military personnel might have an increased mortality rate from amyotrophic lateral sclerosis (ALS). ALS is a neurodegenerative disease resulting in paralysis and death. Although there are genetic cases, the majority of diagnoses are sporadic and of unknown causation. Researchers from Harvard T.H. Chan School of Public Health, US, analysed data collected between 1973-2002 to examine the relationship between military service and ALS mortality. Results indicated that there was an increased rate of ALS mortality in those who had served in the military compared with those who had never served. Furthermore, the trend appeared to be strongest for those who had served in World War II. However, importantly, the results should be interpreted with caution as this may be due to the war having the longest follow-up period. An update to the study will be beneficial to assess whether there were specific factors causing the increase in risk for ALS in World War II or whether a similar increase will be observed in more modern wars with time.

The full report can be accessed here.

14th – 20th August

Insomnia and Alcohol Use in Young Veterans

Insomnia is a prevalent disorder that impacts military personnel and veterans. It may be associated with mental health and alcohol misuse. Miller et al. recently published a study in the journal of Drug and Alcohol Dependence where 622 veterans, aged 18-34, who had reported drinking in the past year, were assessed for their drinking behaviour, sleep activity and mental health. Results indicated that depressive symptoms and PTSD increased the risk of drinking behaviour by increasing symptoms of insomnia. Therefore, insomnia may be an appropriate target to reduce drinking in young veterans experiencing PTSD or depressive symptoms.

The article’s abstract can be found here.

Identifying Factors that Influence Insomnia Treatment within a Veteran Population

Bramoweth et al. recently published in the journal of Behavioural Sleep Medicine with an interesting article that looks to identify factors that influence insomnia treatment in veterans. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first line treatment, however, high rates of medications are being continuously prescribed for insomnia. In this study 5,254 veterans, who were all referred to a single Veterans Affairs Medical Centre for insomnia, were recruited. Results indicated that sedative-hypnotic medications were being prescribed at a surprisingly high rate despite evidence that CBT-I is preferred. A diagnosis of PTSD led to a greater likelihood of being prescribed medication versus CBT-I whereas military related disability, a diagnosis of insomnia and having one or more psychiatric diagnoses led to a higher chance of receiving CBT-I as a treatment, either alone or in addition to medication.

The article’s abstract can be accessed here.

7th – 13th August

A Pilot Study Assessing the Efficacy of an Intensive Outpatient Therapy for PTSD

A team from the University of Central Florida have recently reported on a pilot study that assessed the efficacy of Trauma Management Therapy (TMT) delivered in a 3-week intensive outpatient format. The TMT program usually consists of a 29-session, 17-week intervention utilising virtual reality exposure therapy (VRET) and group therapy to tackle combat-related PTSD, however, the 3-week program proposes to offer the same number of sessions in a smaller time frame. The investigators recruited 112 veterans, with combat-related PTSD, to participate in the pilot study. Outcome measures included PTSD severity, sleep, social-isolation, depression, anger and guilt. These were taken prior to the start of the study and then at 3- and 6-month follow-ups.  The results indicated that after the intensive 3-week program, 66% of the veterans no longer met PTSD criteria, with similar results in other domains and with results being maintained at a 6-month follow-up. Additionally, only 2 participants dropped out of the program, suggesting the intensive TMT may be a suitable program for treating combat-related PTSD and one that should be further assessed in a randomised clinical trial.

The abstract of the published report can be accessed here.

Yoga Helps Ease Chronic Lower Back Pain in Veterans

A recently published study demonstrates yoga may be effective in reducing pain and opioid use in veterans. 150 veterans with lower back pain, recruited by the Veterans Affairs Medical Center in California, were randomised to either a 12-week yoga program with two 1-hour classes per week or a control group. Those who completed the program scored better on a disability questionnaire, had improved pain scores and lower opioid use. The study demonstrates that yoga can be used as a part of a wider program designed to reduce pain and help veterans to choose alternatives to pain medication.

The published study is available online and can be accessed via the the following link.

31st July – 4th August

‘Continue to Work: Transition Mapping Study 2017’ Event

The HVRT attended an event, dedicated to introducing the new report commissioned by Forces in Mind Trust (FiMT), entitled ‘Continue to Work: Transition Mapping Study 2017’. The event was organised by FiMT and took place at the Royal Air Force Club in London last Tuesday (25/07/17). Tim Cooper, Business and Enterprise Consultant at Arkenford and Andrew Curry, Director of Kantar Futures spoke at the event. The official launch of the report was well-attended by researchers, representatives of the MoD, the NHS and the Service charity sector.

To read our review of this conference, please click here.

You can access the full text of  the 2017 report here.

Opioid-Related Overdose in Military Veterans

Opioid-related overdoses are at a high, particularly in Afghanistan/Iraq-era U.S. military veterans. Less is known about the influences that contribute to such risk-taking behaviour. Bennett et al. recently published their research in Substance Use and Misuse. They used a qualitative examination based on interview data from 36 male veterans who had experienced at least 1 opioid overdose either during or after service. The results indicated that the physical, psychological and sociological influences of overdosing included self-medicating, experiencing trauma, social isolation and a history of drug use. It is important then to educate veterans on opioid use and the risks associated with overdose. Alternative treatments for pain that do not involve opioids will also be beneficial in reducing the risk of overdose.

The research from Bennett et al. can be accessed here.

Telementoring for Pain Management in Veterans

In 2012 the Veterans Health Administration launched the Specialty Care Access

Network-ECHO (SCAN-ECHO), a method by which specialist pain consultants are able to advise primary care providers with appropriate pain education. This enables veterans to bypass geographical barriers in order to receive specialist pain care. An evaluation of the SCAN-ECHO pain program was undertaken with the results published in the journal of Pain Medicine. Conclusions state that the program was successful in reducing opioid prescriptions and increased the use of physical and rehabilitation medicine services.

The research can be accessed from the following link.

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