War Related Illness and Injury Study Center
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Other VA Research
The WRIISC research program focuses on improving the health of Veterans with post deployment health concerns. WRIISC researchers and clinicians work together to identify new problems in returning Veterans and respond to their health concerns. We use the knowledge generated by our research to identify promising treatments and the most current evidence based care for our Veterans.
WRIISC research interests cover a wide range of topics including environmental exposures and post deployment health, long-term health effects of combat, memory and mood difficulties, traumatic brain injuries, neurological diseases, integrative health and wellness approaches, disabilities resulting from deployment illnesses or injuries, women Veterans’ health, and risk communication of deployment related concerns.
What causes acute pain to become chronic?
For decades, it has been assumed that acute pain causes disability and physical deconditioning which causes acute pain to become chronic. However, this assumption has never been tested.
To understand the relationship between pain and disability as they develop, Dr. Lisa McAndrew, a Clinical Health Psychologist and Health Scientist and her team followed 790 military personnel returning from deployments in Iraq and Afghanistan. Military personnel were assessed before, immediately after, 3-months after and 1-year after their deployment. Deployment is known to increase physical symptoms, like pain. The researchers found that for those who experienced an increase in pain symptoms during deployment also reported increases in their disability at later time points. Interestingly, the reverse was not found; disability reported during deployment did not lead to later increases in pain. In other words, disability did not cause acute pain to become chronic, as has been commonly assumed. The results of this study suggest the need for new models of how acute pain becomes chronic.
McAndrew, L.M., Helmer, D.A., Lu, S-E., Chandler, H.K., Slotkin, S., Quigley, K.S. (2018). Longitudinal relationship between onset of physical symptoms and functional impairment. Journal of Behavioral Medicine. dx.doi.org/10.1007/s10865-018-9937-4 *
How can patients and providers have an effective relationship with one another when the cause of the health condition is disputed?
This is the question that underlies the difficulty in developing effective patient-provider relationships for treating medically unexplained symptoms, physical symptoms with an unclear cause. Effective patient-provider relationships are considered critical for improving the management of medically unexplained symptoms. This is because patients and providers need to work together to problem solve effective treatments.
Dr. McAndrew and her team reviewed the literature on patient-provider relationships in the context of medically unexplained symptoms. Their review suggests that the key to improving patient-provider relationships is for the patient and provider to negotiate a shared understanding of the patient’s symptoms. Having such a shared understanding of illness perceptions, consequentially, becomes the foundation for developing an effective treatment plan.
McAndrew, L.M., Friedlander, M., Phillips, L.A., Santos, S., & Helmer, D.A. (2018). Concordance of Illness Perceptions: The key to improving the care of medically unexplained symptoms. Journal of Psychosomatic Research. dx.doi.org/10.1016/j.jpsychores.2018.05.015 *
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