Pain-related musculoskeletal disorders, psychological comorbidity, and the relationship with physical and mental well-being in Gulf War veterans

Abstract

Occupational activities such as lifting loads, working in constrained spaces, and training increase the risk of pain-related musculoskeletal disorders (MSDs) in military veterans. Few studies have investigated MSD and psychological disorder in veterans, and previous studies had limitations. This cross-sectional study compared pain-related MSD and psychological comorbidity and well-being between 1381 male Australian 1990-1991 Gulf War veterans (veterans) and a military comparison group (n=1377, of whom 39.6% were serving and 32.7% had previously deployed). At a medical assessment, 2000-2002, reported doctor-diagnosed arthritis or rheumatism, back or neck problems, joint problems, and soft tissue disorders were rated by medical practitioners as nonmedical, unlikely, possible, or probable diagnoses. Only probable MSDs were analysed. Psychological disorders in the past 12 months were measured using the Composite International Diagnostic Interview. The Short-Form Health Survey (SF-12) assessed 4-week physical and mental well-being. Almost one-quarter of veterans (24.5%) and the comparison group (22.4%) reported an MSD. Having any or specific MSD was associated with depression and posttraumatic stress disorder (PTSD), but not alcohol disorders. Physical and mental well-being was poorer in those with an MSD compared to those without, in both study groups (eg, veterans with any MSD, difference in SF-12 physical component summary scale medians = -10.49: 95% confidence interval -12.40, -8.57), and in those with MSD and psychological comorbidity compared with MSD alone. Comorbidity of any MSD and psychological disorder was more common in veterans, but MSDs were associated with depression, PTSD, and poorer well-being in both groups. Psychological comorbidity needs consideration in MSD management. Longitudinal studies are needed to assess directionality and causality.

Arthritis, comorbidities, and care utilization in veterans of operations enduring and Iraqi Freedom

“…Our cohort's mental health diagnoses were not as frequent as for subjects without arthritis, but this finding does not contradict previous findings that arthritis and PTSD and depression often co‐exist. Kelsall et al examined a cross‐sectional cohort of Gulf War (1990–1991) era veterans compared to military personnel who did not deploy in the Gulf War and determined that psychological conditions such as depression and PTSD were more common among the war veterans who had a musculoskeletal disorder as a comorbidity . Arthritis has been documented as associated with PTSD in several studies and with a number of sleep disorders …”

The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain

“…Based on retrospective reporting, several studies have shown that military veterans with combat exposure and PTSD symptomatology may be more likely to have experienced previous childhood or adulthood traumas as well. 117;118 Thus, it is possible that the large association of adult-experienced trauma (e.g., combat exposure) with deleterious pain-related outcomes may reflect the cumulative effect of multiple historical traumas as well.…”

Musculoskeletal Pain and Headache in the Active Duty Military Population: An Integrative Review

“…Complicating pain in AD military personnel and veterans is the burden of other conditions such as sleep disturbances, fatigue, depression, anxiety, and posttraumatic stress disorder (PTSD) affecting physical and mental health (Higgins et al., ; McGeary, McGeary, Moreno, & Gatchel, ; Young‐McCaughan et al., ). Even evidence from Gulf War veterans affirms a significant relationship between pain‐related musculoskeletal disorders and reduced physical and mental well‐being (Kelsall et al., ).…”

“…and mental health (Higgins et al, 2014;McGeary, McGeary, Moreno, & Gatchel, 2016;Young-McCaughan et al, 2017). Even evidence from Gulf War veterans affirms a significant relationship between pain-related musculoskeletal disorders and reduced physical and mental well-being (Kelsall et al, 2014).…”