Combat Exposure Raises Chronic Pain in Women in the Military

Combat exposure is associated with an increased risk for a chronic pain diagnosis in both active-duty servicewomen and women dependents of active-duty personnel, according to study results published in JAMA Network Open.

The longest duration of sustained combat, from 2001-2021, correlated with a rise in the number of women service members, resulting in an increase in women combat veterans. However, the effects of multiple deployments on chronic pain in these women and their civilian dependents remain under-researched.

Therefore, researchers conducted a retrospective observational cohort study to explore the connection between high deployment intensity from 2006-2013 and the diagnosis of chronic pain in active-duty servicewomen and women civilian dependents.

The primary outcome was the diagnosis of chronic pain.

The researchers also assessed demographics, active service details, comorbidities, and the presence of polytrauma triad.

They sourced data from 2 distinct periods: 2006-2013, characterized by heightened deployment intensity, and 2014-2020, marked by reduced deployment intensity within the Military Health System.

Eligible individuals included active-duty servicewomen aged 18-64 and women dependents of active-duty personnel.

A total of 3,473,401 participants (mean age, 29; aged 18-24, 34.6%; active-duty servicewomen, 18.6%). Chronic pain was reported in 324,499 individuals, accounting for 9.3% of the population studied.

Between 2006-2013, active-duty servicewomen faced a 53% higher likelihood of experiencing chronic pain compared to their counterparts from 2014-2020 (odds ratio [OR], 1.53; 95% CI, 1.48-1.58; P <.001). Similarly, civilian dependents during the 2006-2013 period had a 96% greater risk of chronic pain than those from 2014-2020 (OR, 1.96; 95% CI, 1.93-1.99; P <.001).

Between 2014-2020, individuals with chronic pain exhibited a significantly higher likelihood of being diagnosed with the polytrauma clinical triad compared to those without chronic pain (OR, 7.63; 95% CI, 6.49-8.98; P <.001).

When comparing individuals with chronic pain from 2006-2013 to their counterparts from 2014-2020, the former group also demonstrated an increased risk for diagnosis (OR, 1.69; 95% CI, 1.38-2.07; P <.001).

Lower socioeconomic status was significantly associated with chronic pain, with junior enlisted active-duty servicewomen from 2006-2013 exhibiting a 95% increased risk (OR, 1.95; 95% CI, 1.83-2.09; P <.001), while junior enlisted dependents showed a striking 205% increased risk (OR, 3.05; 95% CI, 2.87-3.25; P <.001).

Socioeconomic status was strongly associated with an increased likelihood of chronic pain. Junior enlisted active-duty service personnel from 2006-2013 had an OR of 1.95 (95% CI, 1.83-2.09; P <.001), while junior enlisted dependents during the same period exhibited an OR of 3.05 (95% CI, 2.87-3.25; P <.001).

Study limitations included reliance on potentially inaccurate claims-based data and lack of specific details on deployment and combat experiences, leading to potential underestimation of chronic pain prevalence.

“More intentional resource allocation and preventative services targeted to servicemembers 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 concluded.

This research was supported by the US Department of Defense, Defense Health

Agency. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.