In an editorial published in Pain Medicine, the Holistic Evidence Review Board examined the merits of developing evidence-based dietary recommendations to help operators better manage pain caused by musculoskeletal injuries and amend current policies followed by the US Special Operations Command (USSOCOM).

With this editorial accompanying a series of articles, the board sought to call for additional research that would help provide evidence-based dietary ingredient recommendations to guide clinical practice within the combat arms occupations of USSOCOM.

The work of USSOCOM operators involves significant physical work that can lead to musculoskeletal injuries and acute or chronic pain. Because of the “demand the best” ethos of USSOCOM, operators tend to ignore their pain or self-treat with habitual use of nonsteroidal anti-inflammatory drugs.

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Performance dietitians are embedded across operations to advise operators on better nutritional and dietary choices that might alleviate pain from injuries sustained in the field. But a lack of clear evidence regarding safety and efficacy of dietary supplements limits the ability of dieticians to recommend appropriate treatment methods, according to editorial authors. They therefore sought to provide evidence-based recommendations for specific ingredients that “might serve as an alternative approach for mitigating chronic musculoskeletal pain.” According to the authors, although there is currently not enough evidence to establish definitive guidelines, “processes could be put in place for tracking when ingredients with conditional recommendations are used and for monitoring their impact on pain scores.” Thus, tools already used to monitor changes in intensity and other pain assessment metrics can help build the evidence needed to drive policy change.

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“This evidence evaluation process carried out enabled [the Holistic Evidence Review Board] not only to pinpoint the current gaps in the science to develop future research recommendations, but also to make evidence-based recommendations regarding the use of dietary ingredients as a practical and appropriate pain management tool for Special Operations personnel,” noted the editorial authors.

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Cota S, Williams N, Neff R, Deuster P. How evidence-based recommendations may direct policy decisions regarding appropriate selection and use of dietary ingredients for improving pain [published online April 15, 2019]. Pain Med. doi:10.1093/pm/pnz039