Combat exposure tied to subsequent diagnosis of chronic pain among women in the military health system

Key takeaways:

• Odds of chronic pain were higher for active-duty servicewomen and dependents from 2006 to 2013 vs. 2014 to 2020.
• Junior enlisted active-duty servicewomen and dependents had higher odds of pain vs. senior officers.

Diagnoses of chronic pain increased significantly among U.S. active-duty servicewomen and civilian dependents during a time of heightened employment intensity in 2006 to 2013, according to data published in JAMA Network Open.

“The rigors of multiple deployments to combat zones have the potential to exert adverse effects on active-duty servicewomen as well as civilian women dependents whose spouse or partner served on active duty,” Andrew J. Schoenfeld, MD, MSc, an orthopedic surgeon at the Center for Surgery and Public Health at Brigham and Women’s Hospital at Harvard Medical School, and colleagues wrote. “This includes not just the potential for actual combat injury but secondary effects from psychological stress, anxiety and emotional trauma. The impact of these repeated aspects of combat deployment on the development of chronic pain in women servicemembers and dependents has not been adequately studied.”

Schoenfeld and colleagues conducted a cohort study using claims data from the Military Health System data repository and identified 3,473,401 U.S. active-duty servicewomen and women civilian dependents (median age, 29 years) who were diagnosed with chronic pain. Researchers compared the incidence of chronic pain associated with military service from 2006 to 2013 and from 2014 to 2020.

Eighteen percent of those included in the study were active-duty servicewomen.

Overall, chronic pain was documented in 14.8% of active-duty servicewomen who served from 2006 to 2013 compared with 7.1% who served from 2014 to 2020. In addition, 11.3% of dependents associated with military service from 2006 to 2013 and 3.7% of dependents associated with military service from 2014 to 2020 had documented chronic pain.

Active-duty servicewomen who served from 2006 to 2013 had 53% higher odds of chronic pain compared with those who served from 2014 to 2020 (OR = 1.53; 95% CI, 1.48-1.58; P < .001).

Odds of developing chronic pain were also higher among dependents from 2006 to 2013 compared with dependents from 2014 to 2020 (OR = 1.96; 95% CI, 1.93-1.99; P < .001).

Socioeconomic status was associated with chronic pain, with 95% increased odds of developing chronic pain among junior enlisted active-duty servicewomen from 2006 to 2013 (OR = 1.95; 95% CI, 1.83-2.09; P < .001) and a more than threefold increase in odds of developing chronic pain among junior enlisted dependents from 2006 to 2013 (OR = 3.05; 95% CI, 2.87-3.25; P < .001) compared with senior officers.

“More intentional resource allocation and preventative services targeted to service members and civilian dependents with these characteristics may address a potential missed opportunity to reduce the risk of chronic pain development in at-risk individuals,” the researchers wrote. “In light of the representative nature of the population served by the Military Health System, these findings may apply to the civilian health sector as well.”