Pain Intensity and Pain Interference in Male and Female Iraq/Afghanistan-era Veterans

Abstract

Background: Chronic pain conditions are common among both male and female Iraq/Afghanistan-era veterans and can have substantial negative impacts on quality of life and function. Although in general women tend to report higher levels of pain intensity than men, findings remain mixed on whether gender differences in pain exist in Iraq/ Afghanistan-era veterans. Additionally, the relationships between functional impairment, pain intensity, and gender remain unknown. Methods: This project examined gender differences in pain intensity and pain interference in 875 male and female Iraq/Afghanistan-era veterans. Nonparametric Wilcoxon rank-tests examined gender differences in pain scores. Multivariable generalized linear regression modeling was used to evaluate the magnitude of pain intensity and interference across levels of chronicity and gender, and to evaluate the role of chronicity in gender effects in measures of pain and function. Results: Pain intensity and interference scores were significantly greater among both male and female veterans reporting chronic pain relative to acute pain. Women veterans endorsed higher levels of pain intensity and pain interference compared with men. Results derived from multivariable analyses implicated pain intensity as a factor underlying gender differences in functional impairment among chronic pain sufferers, indicating that gender differences in functional measures were eliminated after controlling statistically for pain intensity. Conclusions: Results demonstrate that the effects of functional impairment are impacted by pain intensity, and not by gender.Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans

“…The included works stem from not only trials (Danan, Sherman, et al, 2019a) and cohort studies (Dursa et al, 2019;Harrington et al, 2019;Naylor et al, 2019;Brown et al, 2019), but also clinical program evaluations (Kumpula et al, 2019), VA patient experience surveys (Breland et al, 2019), and research process metrics (Goldstein et al, 2019). Multiple VA research entities are represented in this collection, including the Cooperative Studies Program (e.g., Harrington et al, 2019;Brown et al, 2019), the VA Evidence Synthesis Program (Danan, Ullman, et al, 2019b), Health Services Research & Development (Combellick et al, 2019;Danan, Sherman, et al, 2019a;Goldstein et al, 2019), and Mental Illness Research Education Clinical Centers of Excellence (Naylor et al, 2019). Bovin et al exemplify the usefulness of combining the VA's array of data sources, including electronic medical record and research survey data, to produce clinically important findings related to MST screening.…”

“…Negative findings are informative for identifying when gender-specific services may not be needed. Second, Naylor et al (2019) examined the experience of pain among Operation Iraqi Freedom/Operation Enduring Freedom/ Operation New Dawn veterans. They found that women reported higher levels of pain than men, and that pain intensity explained gender differences in pain interference.…”

Designing Studies for Sex and Gender Analyses: How Research Can Derive Clinically Useful Knowledge for Women's Health

“…Although it is risky to act on findings from exploratory subgroup analyses, based on interaction tests, they can be used, if interpreted cautiously, to generate hypotheses that are tested in future studies (see Brown et al, [2019] and Danan et al, [2019]). Furthermore, the risks of producing type 1 errors (false positives) can be mitigated by correcting for multiple comparisons (see Benjamini & Hochberg [1995] and Naylor et al, [2019]). Although stratified analyses are not good indicators of whether sex or gender differences exist, if all studies routinely presented findings stratified by sex or gender, perhaps as supplementary materials with warnings about overinterpretation of findings, power issues could be addressed through meta-analysis techniques (Wizeman, 2012).…”

Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities

“…Thus, it is not surprising that pain and mental illnesses are commonly comorbid for Veterans [ 13 ]. Research suggests that pain is strongly associated with symptoms of anxiety, depressive disorders, suicidal ideation, and PTSD [ 13 – 15 ]. Poundja et al [ 16 ] found that both pain severity and pain interference are negatively correlated with mental health quality of life in Canadian veterans suffering from traumatic stress.…”