BETHESDA, MD — The U.S. military has seen a steady rise in the annual incidence rates of any chronic pain diagnoses over the past decade. A new report suggests that the overall rates of chronic pain diagnoses varied significantly, however, by demographic and military characteristics.
The article in the Medical Surveillance Monthly Report pointed out that chronic pain negatively affects the ability of military personnel to perform their duties and limits their readiness. “By understanding the burden of chronic pain and recognizing that its upward trend will likely continue, the Department of Defense may better allocate resources to combat chronic pain from a population-based perspective that focuses on prevention and mitigation,” write the authors from the Uniformed Services University and the Defense Health Agency.1
Neurologic disorders represent the fifth-most-common category of diagnoses among active component service members within the MHS, according to the report, which noted that one major subcategory of this disease group is “all other neurologic conditions.” Incidence analysis from 2009-2018 revealed that the vast majority of diagnoses in this undefined subcategory were related to chronic pain and that such diagnoses have been significantly increasing in burden
The authors revealed that chronic pain diagnoses increased from a rate of 85.5 per 10,000 person-years (p-yrs) in 2009 to 261.1 per 10,000 p-yrs in 2018. They also explained that subgroup analysis by demographic characteristics demonstrated that female, non-Hispanic black, older, and enlisted personnel all were at increased risk for chronic pain diagnoses.
As for the branches of service, members of the Army were at the highest risk of a chronic pain diagnosis with a rate ratio of 4.8 compared to the Navy, the branch with the lowest risk. The study suggested that future annual burden analyses should consider chronic pain as its own subcategory to better characterize its impact.
“This analysis revealed a marked increase in the crude annual incidence rates of any chronic pain diagnoses, the numbers of chronic pain-related encounters and the numbers of unique individuals affected by chronic pain during 2009–2018,” the authors wrote, adding that “chronic pain diagnoses were the only subgroup of diagnoses in this subcategory that demonstrated a steady and increasing trend in crude incidence rates over the 10-year period. It is uncertain whether this trend of crude rates of chronic pain diagnoses represents a true increase in the experience of chronic pain across the military over the course of the surveillance period, a change in diagnostic guidelines or methodologies, heightened awareness and acceptance for reporting chronic pain by patients, the expansion of integrated interdisciplinary pain management teams, or some other factors. However, it is notable that this increase in chronic pain diagnoses is not restricted to military populations; these trends have been documented in civilian populations in both the U.S. and globally.”
The articles went on to state, “The existence of similar patterns in other contexts suggests that the increases seen in this analysis reflect true increases in chronic pain. Further, not only are there increasing rates of chronic pain encounters and individuals affected by chronic pain, but the mean number of encounters per chronic pain patient also increased during the surveillance period. This increasing trend of healthcare utilization related to chronic pain has also been noted in U.S. civilian populations in patients with back pain.”
- Smith HJ, Taubman SB, Clark LL. Characterizing the contribution of chronic pain diagnoses to the neurologic burden of disease, active component, U.S. Armed Forces, 2009-2018. MSMR. 2020 Oct;27(10):2-7. PMID: 33112155.