2015 National Conference

3191 — Differentiating Mild Versus Clinically Meaningful Chronic Pain Among Recent Service Veterans

Driscoll MA, VA Connecticut Healthcare System; Yale University School of Medicine; Kerns RD, VA Connecticut Healthcare System; Yale University School of Medicine; Higgins DM, VA Boston Healthcare System; Boston University School of Medicine; Burger A, VA Connecticut Healthcare System; Bastian L, VA Connecticut Healthcare System; University of CT School of Medicine; Goulet J, VA Connecticut Healthcare System; Yale University School of Medicine; Heapy AA, VA Connecticut Healthcare System; Yale University School of Medicine; Brandt CA, VA Connecticut Healthcare System; Yale University School of Medicine; Haskell SG, VA Connecticut Healthcare System; Yale University School of Medicine;

Objectives:
The Institute of Medicine reported that over 100 million Americans suffer from pain. Some have criticized this estimate as failing to distinguish clinically meaningful chronic pain from pain that is mild in severity and functional interference. The present investigation focused on pain in recently returning service Veterans and applied stringent chronicity and severity definitions to identify demographic and clinical variables differentiating those with mild chronic pain from those with clinically meaningful chronic pain.

Methods:
The longitudinal Women Veterans Cohort Study survey includes 666 OEF/OIF/OND Veterans (55% female) who served in support of OEF/OIF/OND. Utilizing the pain severity subscale from the BPI, respondents were classified with mild chronic pain (MCP) if they endorsed pain of 3 months duration and pain severity < 4/10 at baseline. Those classified with clinically meaningful chronic pain (CMCP) endorsed pain of 3 months duration and pain severity = > 4/10. Demographic variables included gender, marital status and race. Clinical variables included pain interference, depressive and PTSD symptoms, combat and military sexual trauma, smoking status and perceived support. Bivariate analyses examined differences in demographic and clinical variables between the two groups. Multivariable logistic regression assessed the association of demographic and clinical variables with pain status.

Results:
Altogether, 460 Veterans (69%) reported chronic pain. Of these, 221 (33%) endorsed MCP (M = 1.77); 239 (36%) CMCP (M = 5.00). Relative to those with MCP, those with CMCP were less likely to be white (N = 89% vs N = 80%) and more likely to smoke (N = 17% vs N = 27%). They also reported greater depressive symptoms [M = 5.47(4.99) vs M = 10.83(6.98)], PTSD symptoms [M = 30.55(12.64) vs. M = 46.00(18.95)], combat exposure [M = 10.84(8.21) vs M = 14.97(10.09)], pain interference [M = 1.64(1.46) vs M = 4.58(2.29)] and lower support [M = 2.06(1.19) vs. M = 2.65(1.28)]. Multivariable logistic regression revealed that higher levels of combat exposure, pain interference and smoking were uniquely associated with CMCP (p's < .05).

Implications:
Though clinical and demographic variables differentiated MP from CMCP in bivariate analyses, only combat exposure, pain interference and smoking status were associated with CMCP when considering all variables in concert.

Impacts:
Results underscore the importance of differentiating MCP from CMCP, and lend preliminary support for examining combat exposure and smoking cessation as targets of intervention among Veterans with CMCP.