CHRONIC PAIN SYNDROME IN COMBAT VETERANS: BIOPSYCHOSOCIAL APPROACH TO PHYSICAL THERAPY AND INTERDISCIPLINARY REHABILITATION PROGRAMS

Authors

DOI:

https://doi.org/10.30888/2663-5712.2025-34-05-095

Keywords:

chronic pain, combat veterans, physical therapy, interdisciplinary rehabilitation, post-traumatic stress disorder, biopsychosocial model, polytrauma triad, pain catastrophizing, telerehabilitation, cognitive-behavioral therapy

Abstract

Introduction. Chronic pain syndrome is one of the most prevalent health problems among combat veterans, affecting approximately 30-40% of this population. The article provides a comprehensive analysis of modern approaches to physical therapy for chronic p

References

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Murphy J. L., Palyo S. A., Schmidt Z. S. et al. The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative. // Pain Medicine. 2021. Vol. 22. No. 2. P. 430–443. DOI: 10.1093/pm/pnaa417.

Haun J. N., Fowler C. A., Venkatachalam H. H. et al. Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans. // BMC Health Services Research. 2023. Vol. 23. No. 1. Article 456. DOI: 10.1186/s12913-023-09327-5.

Meerwijk E. L., Adams R. S., Larson M. J., Highland K. B., Harris A. H. S. Dose of Exercise Therapy Among Active Duty Soldiers With Chronic Pain Is Associated With Lower Risk of Long-Term Adverse Outcomes After Linking to the Veterans Health Administration. // Military Medicine. 2023. Vol. 188. No. 7–8. P. e1948–e1956. DOI: 10.1093/milmed/usac074.

Maureen J. Physical therapy program reduces chronic pain for older Veterans. // VA News. 2021. URL: https://news.va.gov/85342/physical-therapy-program-reduces-chronic-pain-older-veterans/ (дата звернення: 22.11.2025).

Pain Management, Opioid Safety, and PDMP (PMOP). // US Department of Veterans Affairs. 2023. URL: https://www.va.gov/PAINMANAGEMENT/CBT_CP/

index.asp (дата звернення: 22.11.2025).

Areias A. C., Doverspike D., Brostek D. F. et al. Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain. // Healthcare. 2024. Vol. 12. No. 15. Article 1518. DOI: 10.3390/healthcare12151518.

Kerns R. D., Philip E. J., Lee A. W., Rosenberger P. H. Implementation of the Veterans Health Administration national pain management strategy. // Translational Behavioral Medicine. 2011. Vol. 1. No. 4. P. 635–643. DOI: 10.1007/s13142-011-0094-3.

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Zou H., Liu M., Lu Z., Wang J., Zhao P. The Relative Efficacy of Different Types of Telerehabilitation for Managing Chronic Musculoskeletal Pain: A Systematic Review With Network Meta-Analysis. // The Journal of orthopaedic and sports physical therapy. 2025. Vol. 55. No. 11. P. 695–704. DOI: 10.2519/jospt.2025.13366.

Hadlandsmyth K., Zhuang C., Driscoll M. A., Lund B. C. Comorbid chronic pain and post-traumatic stress disorder: Current rates and psychiatric comorbidities among U.S. military veterans. // Military Medicine. 2024. Vol. 189. No. 11–12. P. 2303–2306. DOI: 10.1093/milmed/usae313.

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Reed D. E. II, Lehinger E. A., Cobos B. et al. The mediating role of posttraumatic stress disorder symptoms in pain cognitions among Veterans with chronic pain. // Military Psychology. 2025. Vol. 37. No. 2. P. 95–104. DOI: 10.1080/08995605.2024.2309897.

Bair M. J., Outcalt S. D., Ang D., Wu J., Yu Z. Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results. // Pain Medicine. 2020. Vol. 21. No. 7. P. 1369–1376. DOI: 10.1093/pm/pnaa007.

McGeary C., Nabity P., Reed D. et al. A test of the fear avoidance model to predict chronic pain outcomes in a polytrauma sample. // NeuroRehabilitation. 2020. Vol. 47. No. 1. P. 35–43. DOI: 10.3233/NRE-203084.

Ravn S. L., Vang M. L., Vaegter H. B., Andersen T. E. Pain-Related Acceptance as a Mediator in the Fear Avoidance Model of Chronic Pain: A Preliminary Study. // Pain Medicine. 2018. Vol. 19. No. 9. P. 1764–1771. DOI: 10.1093/

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Jomy J., Hapidou E. G. Pain management program outcomes in veterans with chronic pain and comparison with nonveterans. // Canadian Journal of Pain. 2020. Vol. 4. No. 1: 149–161. DOI: 10.1080/24740527.2020.1768836.

References.

Qureshi A. R., Patel M., Neumark S. et al. (2025). Prevalence of chronic non-cancer pain among military veterans: A systematic review and meta-analysis of observational studies. BMJ Military Health, vol. 171, no. 4, pp. 310–314. DOI: 10.1136/military-2023-002554.

Hadlandsmyth K., Zhuang C., Driscoll M. A., Lund B. C. (2024). Comorbid chronic pain and post-traumatic stress disorder: Current rates and psychiatric comorbidities among U.S. military veterans. Military Medicine, vol. 189, no. 11–12, pp. 2303–2306. DOI: 10.1093/milmed/usae313.

Murphy J. L., Palyo S. A., Schmidt Z. S. et al. (2021). The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative. Pain Medicine, vol. 22, no. 2, pp. 430–443. DOI: 10.1093/pm/pnaa417.

Smashna O. Ye. (2024). Osoblyvosti funktsionuvannia ta yakosti zhyttia veteraniv z posttravmatychnym stresovym rozladom ta lehkoiu cherepno-mozkovoiu travmoiu [Features of functioning and quality of life of veterans with post-traumatic stress disorder and mild traumatic brain injury]. Psykhiatriia, nevrolohiia ta medychna psykholohiia, vol. 11, no. 2 (24), pp. 184–207. DOI: 10.26565/2312-5675-2024-24-07.

Chudyk A. V., Khotin Ye. H., Tokovenko O. L., Syliuk M. V. (2025). Suchasni pidkhody do fizychnoi reabilitatsii uchasnykiv boiovykh dii [Modern approaches to physical rehabilitation of combatants]. Pedahohichna Akademiia: naukovi zapysky, iss. 14. DOI: 10.5281/zenodo.14840542. (In Ukrainian)

MacGregor A. J., Zouris J. M., Watrous J. R. et al. (2020). Multimorbidity and quality of life after blast-related injury among U.S. military personnel: A cluster analysis of retrospective data. BMC Public Health, vol. 20, no. 1, article 578. DOI: 10.1186/s12889-020-08696-4.

Reed D. E., Fischer I. C., Williams R. M. et al. (2025). Physical health correlates of co-occurring chronic pain and PTSD among U.S. veterans: Results from a nationally representative study. Psychiatry Research, vol. 348, article 116440. DOI: 10.1016/j.psychres.2025.116440.

Dansie E. J., Turk D. C. (2013). Assessment of patients with chronic pain. British Journal of Anaesthesia, vol. 111, no. 1, pp. 19–25. DOI: 10.1093/bja/aet124.

Hoot M. R., Khokhar B., Walker W. C. (2020). Self-report Pain Scale Reliability in Veterans and Service Members With Traumatic Brain Injuries Undergoing Inpatient Rehabilitation. Military Medicine, vol. 185, no. 3-4, pp. 370–376. DOI: 10.1093/milmed/usz272.

Koren Y., Leveille S. G., You T. (2022). Brief Pain Inventory Pain Interference Subscale: Assessing Interference With Daily Living Activities in Older Adults With Multisite Musculoskeletal Pain. Frontiers in Pain Research, vol. 3, article 897725. DOI: 10.3389/fpain.2022.897725.

Tan G., Jensen M. P., Thornby J. I., Shanti B. F. (2004). Validation of the Brief Pain Inventory for chronic nonmalignant pain. The Journal of Pain, vol. 5, no. 2, pp. 133–137. DOI: 10.1016/j.jpain.2003.12.005.

Lovejoy T. I., Turk D. C., Morasco B. J. (2012). Evaluation of the Psychometric Properties of the Revised Short-Form McGill Pain Questionnaire. The Journal of Pain, vol. 13, no. 12, pp. 1250–1257. DOI: 10.1016/j.jpain.2012.09.011.

Polomano R. C., Galloway K. T., Kent M. L. et al. (2016). Psychometric Testing of the Defense and Veterans Pain Rating Scale (DVPRS): A New Pain Scale for Military Population. Pain Medicine, vol. 17, no. 8, pp. 1505–1519. DOI: 10.1093/pm/pnw105.

Askew R. L., Cook K. F., Revicki D. A., Cella D., Amtmann D. (2016). Evidence from diverse clinical populations supported clinical validity of PROMIS Pain Interference and Pain Behavior. Journal of Clinical Epidemiology, vol. 73, pp. 103–111. DOI: 10.1016/j.jclinepi.2015.08.035.

Von Korff M., DeBar L. L., Krebs E. E. et al. (2020). Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain. Pain, vol. 161, no. 3, pp. 651–661. DOI: 10.1097/j.pain.0000000000001758.

Taub C., Gordon K. S., Goulet J. et al. (2023). Graded chronic pain scale revised: validation in a Veteran sample. Pain Medicine, vol. 24, no. 10, pp. 1169–1175. DOI: 10.1093/pm/pnad068.

Wheeler C. H. B., Williams A. C. de C., Morley S. J. (2019). Meta-analysis of the psychometric properties of the Pain Catastrophizing Scale and associations with participant characteristics. Pain, vol. 160, no. 9, pp. 1946–1953. DOI: 10.1097/j.pain.0000000000001494.

Leonard C., Ayele R., Ladebue A. et al. (2021). Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. Pain Medicine, vol. 22, no. 5, pp. 1167–1173. DOI: 10.1093/pm/pnaa312.

Murphy J. L., Palyo S. A., Schmidt Z. S. et al. (2021). The Resurrection of Interdisciplinary Pain Rehabilitation: Outcomes Across a Veterans Affairs Collaborative. Pain Medicine, vol. 22, no. 2, pp. 430–443. DOI: 10.1093/pm/pnaa417.

Haun J. N., Fowler C. A., Venkatachalam H. H. et al. (2023). Empower Veterans Program (EVP): a chronic pain management program demonstrates positive outcomes among veterans. BMC Health Services Research, vol. 23, no. 1, article 456. DOI: 10.1186/s12913-023-09327-5.

Meerwijk E. L., Adams R. S., Larson M. J., Highland K. B., Harris A. H. S. (2023). Dose of Exercise Therapy Among Active Duty Soldiers With Chronic Pain Is Associated With Lower Risk of Long-Term Adverse Outcomes After Linking to the Veterans Health Administration. Military Medicine, vol. 188, no. 7–8, pp. e1948–e1956. DOI: 10.1093/milmed/usac074.

Maureen J. (2021). Physical therapy program reduces chronic pain for older Veterans. VA News. Available at: https://news.va.gov/85342/physical-therapy-program-reduces-chronic-pain-older-veterans/ (accessed 22 November 2025).

Pain Management, Opioid Safety, and PDMP (PMOP). (2023). US Department of Veterans Affairs. Available at: https://www.va.gov/PAINMANAGEMENT/CBT_CP/index.asp (accessed 22 November 2025).

Areias A. C., Doverspike D., Brostek D. F. et al. (2024). Transforming Veteran Rehabilitation Care: Learnings from a Remote Digital Approach for Musculoskeletal Pain. Healthcare, vol. 12, no. 15, article 1518. DOI: 10.3390/healthcare12151518.

Kerns R. D., Philip E. J., Lee A. W., Rosenberger P. H. (2011). Implementation of the Veterans Health Administration national pain management strategy. Translational Behavioral Medicine, vol. 1, no. 4, pp. 635–643. DOI: 10.1007/s13142-011-0094-3.

Rorke T. (2021). Medically Complex Telerehabilitation program ‘saved my life’. VA News. Available at: https://news.va.gov/90126/medically-complex-telerehabilitation-program-saved-life/ (accessed 22 November 2025).

Zou H., Liu M., Lu Z., Wang J., Zhao P. (2025). The Relative Efficacy of Different Types of Telerehabilitation for Managing Chronic Musculoskeletal Pain: A Systematic Review With Network Meta-Analysis. The Journal of orthopaedic and sports physical therapy, vol. 55, no. 11, pp. 695–704. DOI: 10.2519/jospt.2025.13366.

Hadlandsmyth K., Zhuang C., Driscoll M. A., Lund B. C. (2024). Comorbid chronic pain and post-traumatic stress disorder: Current rates and psychiatric comorbidities among U.S. military veterans. Military Medicine, vol. 189, no. 11–12, pp. 2303–2306. DOI: 10.1093/milmed/usae313.

Asmundson G. J. G., Coons M. J., Taylor S., Katz J. (2002). PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Canadian Journal of Psychiatry, vol. 47, no. 10, pp. 930–937. DOI: 10.1177/070674370204701004.

Sharp T. J., Harvey A. G. (2001). Chronic pain and posttraumatic stress disorder: mutual maintenance? Clinical Psychology Review, vol. 21, no. 6, pp. 857–877. DOI: 10.1016/S0272-7358(00)00071-4.

Reed D. E. II, Lehinger E. A., Cobos B. et al. (2025). The mediating role of posttraumatic stress disorder symptoms in pain cognitions among Veterans with chronic pain. Military Psychology, vol. 37, no. 2, pp. 95–104. DOI: 10.1080/08995605.2024.2309897.

Bair M. J., Outcalt S. D., Ang D., Wu J., Yu Z. (2020). Pain and Psychological Outcomes Among Iraq and Afghanistan Veterans with Chronic Pain and PTSD: ESCAPE Trial Longitudinal Results. Pain Medicine, vol. 21, no. 7, pp. 1369–1376. DOI: 10.1093/pm/pnaa007.

McGeary C., Nabity P., Reed D. et al. (2020). A test of the fear avoidance model to predict chronic pain outcomes in a polytrauma sample. NeuroRehabilitation, vol. 47, no. 1, pp. 35–43. DOI: 10.3233/NRE-203084.

Ravn S. L., Vang M. L., Vaegter H. B., Andersen T. E. (2018). Pain-Related Acceptance as a Mediator in the Fear Avoidance Model of Chronic Pain: A Preliminary Study. Pain Medicine, vol. 19, no. 9, pp. 1764–1771. DOI: 10.1093/pm/pnx223.

Jomy J., Hapidou E. G. (2020). Pain management program outcomes in veterans with chronic pain and comparison with nonveterans. Canadian Journal of Pain, vol. 4, no. 1, pp. 149–161. DOI: 10.1080/24740527.2020.1768836.

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2025-11-30

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Степанова, Г., Данько, Р., Кононенко, А., Євтушенко, О., & Рева, Л. (2025). CHRONIC PAIN SYNDROME IN COMBAT VETERANS: BIOPSYCHOSOCIAL APPROACH TO PHYSICAL THERAPY AND INTERDISCIPLINARY REHABILITATION PROGRAMS. SWorldJournal, 5(34-05), 163–181. https://doi.org/10.30888/2663-5712.2025-34-05-095

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