Research letter examines reports of chronic pain, opioid use by US soldiers

In a survey of U.S. soldiers returned from deployment, 44 percent reported chronic pain and 15.1 percent reported recent use of opioid pain relievers.

The prevalence of chronic pain and use associated with deployment is not well known, although there are large numbers of wounded service members. The authors assessed the prevalence of chronic pain and opioid use following deployment in active-duty infantry who were not seeking treatment.

How the Study Was Conducted: Surveys were collected in 2011 from an infantry brigade three months after service members returned from Afghanistan. The final sample included 2,597 soldiers who had been deployed to Afghanistan or Iraq. Chronic pain was defined as that lasting at least three months.

Results: Most of the 2,597 survey participants were men, 18 to 24 years old, high school-educated, married and of junior enlisted rank. Nearly half (45.4 percent) reported combat injuries. Past-month opioid use was reported by 15.1 percent of soldiers and among them 5.6 percent of the soldiers reported no past-month pain, while 38.5 percent, 37.7 percent and 18.2 percent reported mild, moderate and severe pain, respectively. Chronic pain was reported by 44 percent of soldiers. Of these, 48.3 percent reported pain duration of a year or longer, 55.6 percent reported nearly daily or a constant frequency of pain, 51.2 percent reported moderate to severe pain and 23.2 percent reported opioid use in the past month.

Discussion: "The prevalence of chronic pain (44 percent) and opioid use (15.1 percent) in this nontreatment-seeking infantry sample were higher than estimates in the civilian population of 26 percent and 4 percent respectively. … These findings suggest a large unmet need for assessment, management and treatment of chronic pain and related opioid use and misuse in military personnel after combat deployments." Robin L. Toblin, Ph.D., M.P.H., of the Walter Reed Army Institute of Research, Silver Spring, Md., and colleagues said in their JAMA Internal Medicine paper.

In a related commentary, Wayne B. Jonas, M.D., LTC (Ret.) of the Samueli Institute, Alexandria, Va., and Eric B, Schoomaker, M.D., Ph.D., LTG (Ret.) of the Uniformed Services University of the Health Sciences, Bethesda, Md., write: "In a study by Toblin et al of one of the Army's leading units published in this issue of JAMA Internal Medicine, 44 percent of the soldiers had chronic pain, and 15.1 percent regularly used opioids."

"While and opioid use have been a long-standing concern of the military leadership, this study is among the first to quantify the impact of recent wars on the prevalence of pain and narcotic use among soldiers," they continue.

"The nation's defense rests on the comprehensive fitness of its service members – mind, body and spirit. Chronic pain and use of opioids carry the risk of functional impairment of America's fighting force," they note.

More information: JAMA Intern Med. Published online June 30, 2014. DOI: 10.1001/jamainternmed.2014.2726
JAMA Intern Med. Published online June 30, 2014. DOI: 10.1001/jamainternmed.2014.2114

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