Post-Deployment Pain: Musculoskeletal Conditions in Male and Female OEF/OIF Veterans

Musculoskeletal conditions are among the most common diagnoses of men and women Veterans returning from deployment. Studies of Persian Gulf War Veterans as well as Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans show that diseases of the musculoskeletal system are the most frequent diagnoses in cumulative reports of both inpatient and outpatient encounters. Musculoskeletal injuries sustained during training or active duty may go on to cause chronic persistent pain, which is emerging as a highly prevalent and clinically important problem among the population of OEF/OIF Veterans.

More than 200,000 women have now been deployed in support of the wars in Iraq and Afghanistan, representing up to 15 percent of the armed forces. Like their male counterparts, female soldiers are subjected to the many physical stresses of war. Although still excluded by law from participating in combat, women are serving in a variety of roles where they come under direct fire. Additionally, women soldiers carry heavy loads, wear gear originally designed to fit men, and participate in strenuous physical training.

Because research in the civilian sector has demonstrated that women are more likely to report painful musculoskeletal conditions than men, and to report more severe and longer lasting pain than men, we hypothesized that women Veterans might be at particular risk for the development of chronic musculoskeletal pain. In a series of studies, we utilized VA administrative data to examine pain and musculoskeletal conditions in male and female Veterans after deployment.

HSR&D Studies Reveal Differences

Our HSR&D-funded study initially examined medical and mental health conditions in men and women Veterans who utilized VA care within one year after return from deployment. Our study population was composed of Veterans from the VA's OEF/OIF roster provided by the Defense Manpower Data Center-Contingency Tracking System Deployment File. Data from the OEF/OIF roster was linked with the VA National Patient Care Database, Decision Support Systems, and the Corporate Data Warehouse. We evaluated records for 19,520 female and 144,292 male Veterans, using previously validated diagnostic code groupings, and found that back problems, joint disorders, and musculoskeletal conditions were among the most frequent diagnoses for both men and women.1

In a second study, we evaluated pain numeric rating scores, which are recorded along with vital signs at each clinical encounter in VA. We evaluated records for all male and female Veterans who had one year of observation after the end of their last deployment. Results indicated that 60 percent of both men and women were assessed for pain. Men (44 percent) were more likely to report pain than women (38 percent), but among those with pain, women were more likely to report moderate to severe pain than men.2

A third study examined the prevalence of back, musculoskeletal, and joint conditions in female compared to male Veterans in years 1-7 after return from deployment. For each year of analysis, we limited the sample to Veterans who had an encounter during that year. We used previously validated diagnostic code groupings for back problems, joint disorders, and musculoskeletal/ connective tissue disorders, and counted only those conditions that were coded at least once for an inpatient stay, or twice for an outpatient visit. For both male and female Veterans, the prevalence of painful musculoskeletal conditions increased each year after deployment. After adjustment for significant demographic differences, women were more likely than men to have back problems, musculoskeletal problems, or joint problems and the odds of having these conditions increased each year for women compared to men in years 1-7 after deployment. Among patients who had been seen in VA for 7 years, 20 percent of women (compared to 17 percent of men) had back problems; 12 percent of women and 10 percent of men had musculoskeletal conditions; and 19 percent of women and 17 percent of men had joint problems.3

Further Research Needed

The growing difference in prevalence of painful musculoskeletal conditions between women and men over time may represent a difference in the chronicity of musculoskeletal problems sustained during military service, a difference in the incidence of newly reported pain between men and women over time, or a difference in the effectiveness of treatment. Compared with men, women may face challenges in pain treatment such as stigmatization, misunderstanding, and gender bias. These factors may be particularly important in the VA health care system where most pain treatment protocols have been developed for a largely male population. Further research will be critical to determine factors leading to development of chronic pain so that prevention and treatment protocols can be tailored to meet the needs of women Veterans.

  1. 1. Haskell, S.G. et al. "The Burden of Illness in the First Year Home: Do Male and Female VA Users Differ in Health Conditions and Healthcare Utilization," Women's Health Issues 2011; 21-1:92-7.
  2. 2. Haskell, S.G. et al. "Pain Among Veterans of Operations Enduring Freedom and Iraqi Freedom: Do Women and Men Differ?" Pain Medicine 2009; 10(7):1167-73.
  3. 3. Haskell, S.G. et al. "The Prevalence of Painful Musculoskeletal Conditions in Female and Male Veterans in 7 Years After Return from Deployment in Operations Enduring Freedom/Operation Iraqi Freedom," Clinical Journal of Pain 2012; 28(2):163-7.