The US Defense Health Agency has staged a Federal Advanced Skills Training (FAST) seminar highlighting the connection between mental health and limb injuries, emphasizing holistic recovery after long-term trauma.
Hosted by the agency’s Extremity Trauma and Amputation Center of Excellence (EACE), the event focused on leveraging the connection between psychological and physical health to help patients manage chronic pain from limb loss or damage and potentially regain daily function.
As part of the initiative, the EACE, a joint effort between the Department of Defense and the Department of Veterans Affairs, released peer-reviewed care pathways, including “Rehabilitation of Lower Limb Amputation” and “Management of Upper Limb Amputation Rehabilitation,” to support patient care.
These studies are part of a broader set of 28 Clinical Practice Guidelines developed since the early 1990s. Designed as tools for clinicians, the guidelines address a range of medical issues commonly faced by warfighters and are grounded in the latest research and best practices.
The seminar also featured hands-on sessions involving guided imagery, visualization, music, dance, movement, and creative arts therapy, of which many providers are aware but rarely implement.
“FAST always has had some element of mental health, but mental health emerged as the next clear priority topic based on an emphasis in the clinical practice guidelines and clinician input,” said Andrea Crunkhorn, a physical therapy doctor and chief of clinical affairs at EACE.
Connecting Chronic Pain With Behavioral Health
Dr. Ajay Manhapra, Chief of Pain Medicine at Hampton VA Medical Center and a presenter at FAST, introduced a model centered on “trauma narratives.”
By establishing a trauma narrative, patients and providers can co-create a goal-oriented recovery plan focused on achieving a functional “new normal.”
This method is designed to assist patients in making sense of their experiences by mapping a timeline linking physical injuries to behavioral health challenges, such as post-traumatic stress disorder or opioid dependence.
The model also encourages gradual improvements in physical function while managing persistent pain and limited-time medication rather than striving for a return to a completely pain-free state.
“A chronic pain syndrome diagnosis means that the pain has become a separate problem and is not a symptom of some other physical disorder,” Manhapra explained.
