November 4, 2019 Jolie Haun Ph.D., Ed.S., L.M.T.
Many veterans come home from service suffering from chronic pain and post-traumatic stress disorder (PTSD).
These comorbid conditions cause problems for veterans — and their families — that affect all aspects of their lives: physical, mental, emotional, spiritual and social.
Veterans experience pain and PTSD-related symptoms that make it difficult to do everyday activities, such as grocery shopping in a busy store, carrying groceries or standing among a crowd to watch fireworks on the Fourth of July.
Physical activities that might require veterans to interact with crowds and noise can cause an escalation in pain and mental and emotional agitation. Veterans with chronic pain and PTSD may find it hard to maintain employment and healthy relationships when compared to the general population.
Getting care for such conditions can be difficult for many reasons. Though veterans have access to care based on their military service, sometimes veterans avoid health care systems, often due to fears of stigma. When veterans access care, often treatments focus on a single condition or symptom in patients with comorbidities, such as pain and PTSD; but these treatments are often not effective for complex comorbid conditions.
Particularly with PTSD, avoidance and emotional numbing — symptoms detrimental to veterans and their relationships with others — have seen little improvement with current treatment methods. Even more rare are treatments that include the veteran’s family and loved ones.
Multifaceted complementary and integrative health (CIH) therapies that include family members and loved ones are needed to supplement clinical practice to reduce symptoms and improve veterans’ quality of life and ability to function, as well as emotionally reconnect them with their loved ones.
In 2016, U.S. Department of Veterans Affairs (VA) State-of-the-Art Conference and Comprehensive Addiction and Recovery Act mandated the Department of Veterans Affairs commitment to conduct rigorous research to integrate nonpharmacological and CIH approaches into care at every level, with emphasis on pain management.
Additionally, the Creating Options for Veterans’ Expedited Recovery Commission is examining an evidence-based therapy treatment model used by the Secretary of Veterans Affairs for treating mental health conditions of veterans and potential benefits of incorporating complementary and integrative health treatments.
To support these efforts, practitioners and researchers are collaborating across interdisciplinary fields to gather data on therapies that can make a positive difference in veterans’ lives and the lives of their loved ones.
Mission Reconnect is an evidence-based, user-driven, dyadic, self-paced, self-care management program delivered online and by mobile app to help veterans and their selected partners, individually or together, reduce pain and distress and support physical, mental and relationship health.
The program provides video and audio instruction in evidence-based wellness activities including meditation, movement and partnered massage. Mission Reconnect was designed for veterans who face obstacles accessing formal mental health services; it can also be used to complement formal health care services.
One of the key elements of Mission Reconnectis that this intervention is sustainable. Once veterans and their partners learn the skills, they can deliver massage to one another anytime, anywhere.
This is critical because massage can reduce pain, but having access to someone, such as a professional massage therapist who can deliver massage, can be a barrier for many people. Furthermore, pain- and PTSD-related symptoms can occur at any time when the veteran may feel physically, mentally or psychologically stressed.
If veterans know the skills provided in Mission Reconnect, they can use them individually or with their partners to reduce their symptoms and improve their day-to-day lives.
Currently, a randomized controlled trial is being conducted within the Veterans Health Administration to determine if Mission Reconnect can reduce pain- and PTSD-related symptoms with veterans and their partners. The short-term goal of this study is to determine the effects of MR on (1) function for veterans with comorbid chronic pain and PTSD, and (2) relationship outcomes with their partners.
Specifically, can veterans and their partners use the Mission Reconnect modalities, such as partnered massage, to reduce their pain, improve their quality of sleep, and diminish their sense of intrusion, hyper-arousal, avoidance, emotional numbing, depression, stress and anxiety?
This study also wants to determine if Mission Reconnectcan help veterans and their partners improve their relationship satisfaction and compassion for self and others. If a nonpharmacological sustainable intervention is effective, Mission Reconnectcould potentially help veterans and their partners improve their health, relationships and lives.
This research has tremendous potential for clinical impact — currently there is no evidence-based, self-directed complementary and integrative health mobile application for a clinically defined population of veterans and their partners to improve outcomes for chronic pain and PTSD.
If this intervention has meaningful effects, findings will advance the field of science in determining if: (1) mobile interventions can support teaching complementary and integrative modalities to users in informal settings; and (2) partnered massage can provide an economical, sustainable option for complementary and integrative modality delivery to manage pain– and PTSD-related symptoms.
Furthermore, if this intervention is determined effective, it could have a positive impact for clinical and massage therapy practices. Clinicians and therapists in professional settings — supporting clients managing pain and PTSD — may find it useful to recommend this mobile service to clients and their loved ones to manage conditions outside of the therapeutic treatment environment.
As clinicians and massage therapists look for innovative and comprehensive ways to support veterans in managing pain and PTSD, health care providers and massage therapists may find that mobile resources, like Mission Reconnect, can fill the void between visits and reconnect veterans with their well-being and their loved ones anytime, anywhere.
Jolie Haun, PhD, EdS, LMT, completed a National Institutes of Health, National Center for Complementary and Integrative Health post-doctoral fellowship in whole systems research at the University of Arizona’s College of Medicine in the Department of Family and Community Medicine.
Currently, Dr. Haun is a Research Health Scientist at the Veterans Health Administration, James A. Haley Veterans Hospital, in Research Service. She wrote this article on behalf of the Massage Therapy Foundation.