Revealing the Progression of Pain Pathways and Identifying Chronification of Pain Predictors After an Isolated Lateral Ankle Sprain: Project RECOIL
Abstract
A lateral ankle sprain (LAS) was the number one reason for lost duty days within the United States (U.S.) Military between 2017 and 2018. These estimates mirror civilian-based encounters as more than 2 million people are treated annually in the U.S. for an LAS. Therefore, our clinically oriented study will address the Fiscal Year 2022 Chronic Pain Management Research Program (CPMRP) Investigator-Initiated Research Award (IIRA) Focus Area of Chronification of Pain by (1) identifying risk or protective factors for a military population susceptible to pain chronification and (2) investigate the relationship between pain and co-morbidities that contribute to pain chronification. An LAS creates a substantial economic burden within the Military Health System (~$3400 per sprain) and civilian-based health insurance markets (~$1200 per case). Many active-duty Service Members who sustain an LAS continue to seek care up to 120 days post-injury because of residual symptoms, pain, loss of function, or sensations of ankle joint giving way. Our published data demonstrate that patients with an LAS are more likely to receive opioid or non-opioid medication rather than a referral for physical rehabilitation. This treatment pattern may help explain our preliminary data that suggests a greater frequency of patients who do not attend physical rehabilitation also develop chronic ankle pain. In fact, active-duty Service Members (~40%) and civilians (50- 79%) who sustain an LAS are at a greater risk of developing chronic ankle pain within 6 months. Unfortunately, published data also indicates that the odds of a recurrent injury, suffering a diminished quality of life, or experiencing functional limitations can increase if a patient fails to receive timely physical rehabilitation and cause added healthcare expenditures (~$1400 per episode). Therefore, health care utilization patterns after an LAS and the subsequent development of chronic ankle pain sparks a cycle of continued disability and recurrent injury, impacts the quality of duty-relevant task performance, increases the risk for early separation from military service, and generates a large population of Veterans who require long-term care after retirement. Thus, the long-term goal for our multidisciplinary research team is to improve the quality of life and level of function for all Americans by reducing pain and disability after an LAS through timely physical rehabilitation. This proposal aims to prospectively identify the prevalence of chronic ankle pain after an LAS and examine its relationship with health care utilization patterns, subsequent musculoskeletal injury, and the development of new co-comorbidities. Secondly, to identify the susceptibility and resiliency factors underlying the transition from acute to chronic pain by prospectively assessing pain-generating pathways, clinician-based outcomes, and PROs after an LAS. The rationale for the proposed study is that prospectively evaluating the course of pain from acute, subacute, to chronic may hold the key to developing new non-pharmacological therapies that are effective at preventing chronic pain or reversing its course once it becomes persistent. Prospectively evaluating the transition from acute to chronic pain may also be vital for developing tailored interventions at critical windows of opportunity. The proposed research is aligned with the Federal Pain Research Strategy, as prospective studies examining the transition from acute to chronic pain have been identified as a top priority for the most prevalent and costly conditions (e.g., ankle sprain). Our study meets the intent of the FY22 CPMRP IIRA because it (1) impacts the understanding of more than one Focus Area, (2) is innovative by looking at an existing problem from a new perspective, (3) includes preliminary data, (4) involves a multidisciplinary team constructed from both military and non-military investigators, (5) is relevant to military health b
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311054
Entities
People
- Kyle Kosik
Organizations
- United States Army
- University of Kentucky