By Brenda L. Mooney

BETHESDA, MD – Veterans, especially those serving in Iraq and Afghanistan, are about 40% more likely to experience severe pain than nonveterans, according to a new study.

In fact, younger veterans were substantially more likely to report suffering from severe pain than nonveterans, even after researchers controlled for underlying demographic characteristics. On the other hand, female veterans were no more likely to report pain than civilian women.

The surprising results are from an article published recently in the Journal of Pain. The research was led by Richard L. Nahin, PhD, MPH, lead epidemiologist at the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health in Bethesda, MD.1

“These findings suggest that more attention should be paid to helping veterans manage the impact of severe pain and related disability on daily activities,” Nahin suggested.

The new analysis of the National Health Interview Survey (NHIS) found that American veterans experience higher prevalence of pain and more severe pain than nonveterans, with young and middle-aged veterans suffering the most. The study pointed out that the survey provides the first national estimate of severe pain associated with health conditions in veterans as compared to nonveterans.

For the purposes of the research, severe pain was defined as that which occurs “most days” or “every day” and bothers someone “a lot.”

Data from the 2010-2014 NHIS was used for the analysis, focusing on responses from 6,647 veterans and 61,049 nonveterans about the persistence and intensity of self-reported pain during the three months prior to the survey. Veteran respondents were overwhelmingly male, 92.5%, but the majority of nonveteran participants were women, 56.5%. No specific aspects of military service, including branch of the armed forces, years of service or whether the veteran served in a combat role were identified in the data.

Severe Pain

Results indicate that more veterans (65.5%) than nonveterans (56.4%) reported having pain in the previous three months, and a much higher proportion of veterans, 9.1%, revealed they had endured severe pain than nonveterans, 6.3%.

Hit especially hard were younger veterans who, at 7.8%, were substantially more likely to report suffering from severe pain than nonveterans of similar ages, 3.2%.

Pain conditions more common among veterans were back pain (32.8%), back pain with or without sciatica (12.2% and 20.5%, respectively) or joint pain (43.6%), but the former military personnel were less likely to have jaw pain (3.6%) or migraines (10.0%) than the nonveterans.

A key difference between veterans and nonveterans was in the relationship of pain to age. For nonveterans, the prevalence of any pain and severe pain increased with age. For veterans, however, those aged 50 to 59 were most likely to have severe pain, while the youngest and oldest groups were least likely to have severe pain.

Specifically, veterans aged 18-39 and 50-59 were more likely than nonveterans of the same ages to have any pain, with the younger cohort also more likely to have severe pain than nonveterans in the same age group. On the other hand, veterans aged 70 or older were less likely to have severe pain than similarly aged nonveterans.

In fact, another recent report in The Journal of Pain noted that aging veterans frequently show improvements in pain intensity over time. Their likelihood of improvement is lowered, however, with use of opioids, certain mental health conditions and specific pain diagnoses, according to researchers from the VA’s Center to Improve Veterans Involvement in Care and Oregon Health & Science University. Overall, older adults had the highest prevalence of long-term use of pain medications, including opioids, study authors added.2

A significant difference also related to gender. Male veterans were more likely to report severe pain, 9%, than male nonveterans, 4.7%, but no variation was detected between female veterans and nonveterans.

 “These findings show that we still have much more to do to help our veterans who are suffering from pain,” explained Josephine P. Briggs, MD, director of NCCIH. “This new knowledge can help inform effective health care strategies for veterans of all ages. More research is needed to generate additional evidence-based options for veterans managing pain. Over time this research may help nonveterans as well.”

NCCIH is partnering with the VA and DoD on 13 grants to research military and veteran health with a focus on nonpharmacological approaches to pain and related conditions.

This survey had some limitations, according to the author. It did not collect pain treatment information and, therefore, was unable to determine if differences in treatment could have further explained differences in the participants’ pain experiences.

Nahin also pointed out that younger veterans (aged 18-39) are significantly overrepresented by those who served during the wars in Afghanistan and Iraq. He noted that the analysis was not able to determine whether these younger veterans with severe pain were in pain despite treatment or because they were not getting treatment. He suggested, however, that some veterans would benefit from a revised pain management plan that addresses the full range of biological, psychological and social effects of pain on the individual.

For others, Nahin added, services might be needed to help them manage the impact of severe pain on their daily lives.

  1. Nahin RL. Severe Pain in Veterans: The Impact of Age and Sex, and Comparisons to the General Population. J Pain. 2016 Nov 21. pii: S1526-5900(16)30313-3. doi:10.1016/j.jpain.2016.10.021. [Epub ahead of print] PubMed PMID: 27884688.
  1. Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters DM, Hart K, Williams JL, McFarland BH. Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain. J Pain. 2016 Jul;17(7):824-35. doi:10.1016/j.jpain.2016.03.006. Epub 2016 Apr 4. PubMed PMID: 27058162; PubMed Central PMCID: PMC4925248.