Researchers recently sought to determine whether war, with its increased training demands and multiple deployments, contributes to the rise of chronic pain in female service members.
Unsurprisingly, given the stresses of combat and the physical impact of military service, the research found that it does.
But in an unexpected twist, combat operations also increase chronic pain in military wives -- a finding that scientists from Brigham and Women's Hospital in Boston described as "sizable."
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In a report published July 5 in the JAMA Network Open medical journal, researchers examined military health records from 2006 to 2020 for female patients diagnosed with chronic pain. They then divided them into groups: those who served or were married to a service member between 2006 and 2013 -- a period of intense combat operations -- and those who served from 2014 to 2020 or were married to an active-duty member during that time frame, when combat operations had slowed.
According to Dr. Andrew Schoenfeld, an orthopedic surgeon and lead study author, the team initially believed the military wives would serve as a control group with which to contrast the active-duty personnel.
But after crunching the data, they found some remarkable results. Female service members had a 53% higher chance of having chronic pain if they served during heightened operations, and the spouses suffered chronic pain at three times the rate of their later counterparts.
"I was surprised by the magnitude of the effect we observed here, particularly among female civilian spouses," Schoenfeld said during an interview Tuesday with Military.com. "Once we saw this finding, which was meaningful ... we wanted to explore that aspect further."
Roughly 19% of the country's 2 million service members are women, and 90% of nearly 580,000 military spouses are women, according to Defense Department data.
The researchers chose to focus on chronic pain because it is preventable but often debilitating after it develops, resulting in lower quality of life or permanent disability.
Factors that may contribute to the development of chronic pain include physical injuries such as musculoskeletal conditions, nerve damage and other disorders linked to combat exposure and training, including intense physical activity and wearing body armor and rucksacks.
Chronic pain also can be caused by mental health disorders such as post-traumatic stress, depression and anxiety, according to Schoenfeld.
The research determined that female troops who served during surge operations had a nearly 15% rate of chronic pain compared with 7% of those who served in the later group, and spouses suffered chronic pain at a rate of 11.3% compared with 3.7% in the later cohort.
While the reasons for a person to develop chronic pain vary, Schoenfeld theorized that the physical and psychological stress of living in a combat zone likely led to the increased rates of chronic pain in female service members.
He added that the stress, both physical and mental, of being alone or serving essentially as a single parent and the constant concern for a deployed loved one, along with the psychological impact of supporting a returning service member who may have physical or mental injuries, could contribute to long-term physical pain in spouses.
"Once you develop chronic pain, it's not something that is, like, reversible," Schoenfeld said. "It can be managed, but it becomes, obviously, a chronic condition you have to manage, like diabetes. It's not like we're going to get you back to totally being pain-free, unfortunately."
The research also found that service members and spouses with lower socioeconomic status faced a higher risk for having chronic pain, as did those previously diagnosed with a mental health condition.
Schoenfeld said he hopes the military health system will consider the findings when allocating resources toward training of providers and patient education. He'd like to see improved communication between physicians in garrison and embedded providers about deployment-related health conditions, and a more proactive approach by military physicians in advising and treating military family members.
"It's not just about the service member[s], although they are incredibly important. The civilian spouses are sharing a burden here, and that also is having an impact," Schoenfeld said.
The study was part of an ongoing effort to understand the long-term impact of military deployments on health. Schoenfeld and his colleagues plan next to study prescription opioid use among active-duty service women and civilian spouses with chronic pain.
Shedding light on deployment health may lead to preventive measures that could improve the lives of service members and civilians in future conflicts, according to Schoenfeld.
"More intentional resource allocation and preventative services targeted to service members and civilian dependents … may address a potential missed opportunity to reduce the risk of chronic pain," he wrote.
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