Josh Van Wyngaarden has spent the last 12 years in the Air Force, where he helped develop a safe transport system for Ebola patients, led a physical therapy clinic in South Korea and served on a humanitarian mission to Nepal.
As a University of Kentucky (UK) doctoral student, he developed a research program that explores ways to prevent chronic pain, with the potential to make an impact on the opioid crisis. He has now earned his PhD in rehabilitation sciences in three years — in a program that usually takes nearly five to complete.
We talked to Van Wyngaarden about his research and how it can have an impact on the opioid crisis in Kentucky. Below are the highlights.
Medical News: Congratulations on recently graduating from UK! What has life been like since graduation in May?
Josh Van Wyngaarden: I expected life to slow down after defending my dissertation, but in many respects, it has picked up. I have seven research papers that I am working on getting published in various medical and rehabilitation journals to share my dissertation findings with the greater rehabilitation and medical communities. Additionally, there are a few grant applications that my mentor, Brian Noehren, and I have been working on getting funded. All said, I have made time to slow down and have some fun family time while home.
MN: Why did you decide to focus your research on ways to prevent chronic pain?
JVW: Early in my Air Force career I did a short clinical rotation at the Center for the Intrepid (CFI) in San Antonio, Texas. This is where many of the wounded warriors go after experiencing traumatic injuries in deployed settings. It was readily apparent that many of the issues these patients dealt with were psychological in nature. As I continued working with patients at various clinics in both deployed and stateside settings, I further realized that many patients did not seem to do well no matter what physical intervention I offered. This led me down the path to identify the factors early after injury that are most consistently associated with who develops chronic pain and who does not.
MN: What were the goals of your research?
JVW: Given my experiences with patients who sustained traumatic injuries at the CFI, I wanted to start by identifying those early psychological characteristics associated with the development of chronic pain and pain related disability after traumatic injury. I had 122 patients involved in my dissertation study, and I tracked each patient from the time of lower extremity fracture through 12-months recovery. I screened each patient with surveys and sensory testing measures directly after their injury, and at six weeks, three months, six months and 12 months recovery. I also brought many of these patients through a physical performance test 12 months after injury. This allowed me to evaluate how psychological factors are associated with pain and physical function outcomes 12 months after injury.
MN: Any trends discovered, or final conclusions made?
JVW: There were several important findings, but there were two findings most relevant to the opioid crisis: First, a patient’s pain self-efficacy six-weeks after injury was consistently predictive of chronic pain, pain related disability and physical function at 12 months. Patients with low self-efficacy had significantly greater odds of developing chronic pain, pain related disability and performing poorly on the physical function test battery. Pain self-efficacy is essentially the confidence or belief that the individual will be able to successfully complete activities of daily living despite having pain. Therefore, those patients with low confidence had poor long-term outcomes. Second, we developed a nine-item screening tool that places individuals into low, medium or high-risk categories six-weeks after injury for 12-month outcomes. Patients placed in the low risk category did very well at 12 months. Patients in the medium and high-risk categories had horrible long-term chronic pain and disability.
MN: How can your research make an impact the opioid crisis in Kentucky?
JVW: My research can be applied to helping reduce the opioid crisis. Patients early after injury should probably be screened for their level of self-efficacy or even use the screening tool, we adapted for the traumatic injury population. Patients that have high risk profiles may benefit from a referral to a clinical psychologist to help build their confidence and reduce maladaptive pain coping mechanisms. This will result in more of an active approach to managing the pain rather than a passive medication that results in dependence.
MN: How did the UK Rehabilitation Science PhD program best prepare you for your next steps?
JVW: My mentorship team: Dr. Brian Noehren, Dr. Kristin Archer and Dr. Cale Jacobs. They spent countless hours with me ensuring I was developing my research project appropriately. The program itself ensured we developed a well-rounded approach to our education so that we could have multiple ways to evaluate our research projects. Finally, the program was supportive of presenting our research at national conferences and offering opportunities to network with successful researchers outside of our program. This offered me several amazing experiences and collaborative efforts with individuals I would have otherwise not been able to meet.
MN: What are next steps for you?
JVW: I will be heading to U.S. Army-Baylor University in July to join the faculty team teaching military DPT students and continue with my research projects.