In the first study to look at sex-specific pain prevalence in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, researchers from the VA Connecticut Healthcare System and the Yale University School of Medicine found women Veterans had a lower prevalence of pain than male counterparts returning from the conflicts. Approximately 60% of OEF/OIF Veterans were assessed with pain during the study period.
Full details of the study appear in the October issue of Pain Medicine, a journal published by Wiley-Blackwell on behalf of the American Academy of Pain Medicine, the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists and the International Spine Intervention Society.
Sally Haskell, M.D. and colleagues set out to evaluate the difference in the prevalence of overall pain, moderate-severe pain, and persistent pain between male and female Veterans. The study sample was derived from U.S. military personnel listed on the Veterans Administration (VA) OEF/OIF roster who were discharged between October 1, 2001 and November 30, 2007. Researchers limited the sample to 153,212 Veterans (18,481 female; 134,731 male) who had 1 year of observation after their last deployment.
Results indicate that for those Veterans evaluated for pain, 43.3% reported any pain, 63.2% of those with pain reported moderate-severe pain, and over 20% of those with pain scores recorded over 3 months time reported persistent pain. Researchers found no significant difference in the probability of pain assessment by sex.
According to the study, female Veterans were less likely to report any pain (38.1% F vs. 44.0% M). In Veterans with any pain, researchers found female Veterans were more likely to report moderate-severe pain (68.0% vs. 62.6%) and less likely to report having persistent pain (18.0% vs. 21.2%) than male colleagues. "We were surprised by the lower pain prevalence in women Veterans which is contrary to studies conducted in civilian populations," noted Dr. Haskell.
Past studies in civilian populations indicate women more commonly report specific pain syndromes including migraine headaches, oral-facial pain, fibromyalgia and abdominal pain. Women also report more severe and longer lasting pain than men.
Researchers hypothesize that the lower pain prevalence in women Veterans may reflect differences in exposure to combat trauma and injury between male and female soldiers. Though women do not serve in direct combat roles, they have supportive roles that may put them in harms way making it difficult to assess the true injury risk for female Veterans. Related studies also indicate women are more reluctant to seek VA treatment and report more barriers to seeking treatment which could result in lower rates of reported pain in female Veterans.
In 2008 the Department of Defense listed 1.4 million active duty military personnel with 200,337 of those women. The number of women in armed service is expected to continue to increase. "As the VA plans care for the increasing numbers of female personnel a better understanding of the prevalence of pain, as well as sex-specific variations in the experience and treatment of pain, is important for policy makers and providers who seek to improve identification and management of diverse pain disorders, "concluded Dr. Haskell
"The VA national office of Women Veterans Health recognizes the pain management needs of women Veterans. This office is working with the VA national office of Pain Management to build a research program that informs both the development of clinical services for women with chronic pain conditions and the training needs of providers," says Pain Medicine Co-Guest Editor Robert Kerns, who is also a co-author of the paper.
- Sally G. Haskell, Cynthia A. Brandt, Erin E. Krebs, Melissa Skanderson, Robert D. Kerns, and Joseph L. Goulet. Pain among Veterans of Operations Enduring Freedom and Iraqi Freedom: Do Women and Men Differ? Pain Medicine, 2009; 10 (7): 1167 DOI: 10.1111/j.1526-4637.2009.00714.x
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