Military Sexual Trauma in Female Veterans is Associated With Chronic Pain Conditions

Little is known about the impact of MST on chronic pain conditions among female Veterans. The primary objective of this study was to compare the prevalence of chronic pain conditions among U.S. female veterans with a history of military sexual trauma (MST) to those without a history of MST. We anticipated that female Veterans with a history of MST would have higher associations with chronic pain conditions than the female Veterans without a history of MST.

This was a large-scale, retrospective study using the Veterans' Health Administration Corporate Data Warehouse with institutional approval (15-H175). International Classification of Diseases, 9th Revision codes from the outpatient visits, outpatient problem lists, and inpatient discharge diagnoses were used to identify chronic pain diagnoses. Baseline demographic data including date of birth, self-identified race/ethnicity, and body mass index were obtained. Significant findings in the univariate analysis were then placed into a multivariable logistic regression model to adjust the effect of each predictor for the presence of others. Significance was set at p < 0.01 because of multiple comparisons made.

For the entire cohort (516,950 women), 28.9% (149,540) were diagnosed with headaches, 18.3% (94,393) with chronic pelvic pain, 14.4% (74,216) with chronic back pain, 10.5% (54,302) with nonspecific joint pain, 9% (48,509) with fibromyalgia, 6.2% (32,037) with generalized abdominal pain, 4.2% (21,911) with irritable bowel syndrome, and 3.2% (16,309) with dyspareunia. Most women had more than one chronic pain diagnosis. At baseline, women with a history of MST were younger (63.3 ± 15.9 vs. 67.4 ± 17.9 years p < 0.001), heavier (29.5± 6.2 vs. 28.8 ± 6.1 kg/m² p < 0.001), smokers (49.3 vs. 38.8% p < 0.001), and more likely to be non-Hispanic white (56.3 vs. 52.3% p < 0.001) than women without a history of MST. Women with a history of MST had more pain diagnoses than those without the history of MST (all p < 0.001). The adjusted odds ratio of women with history of MST presenting with any pain condition compared to a women without a history of MST was 1.26 (95% confidence interval 1.24-1.28). In the multivariable model there remained an association between MST and chronic pain conditions including irritable bowel syndrome, chronic pelvic pain, back pain, chronic joint pain, fibromyalgia, dyspareunia, chronic abdominal pain, and headaches after adjusting for baseline differences in age, body mass index, smoking, and ethnicity. Importantly, drug abuse, and overdose were also associated with MST.

A history of MST is associated with chronic pain diagnoses. Weaknesses of this study are those applicable to analyses of any retrospective database study. Specifically, the data are limited by the accuracy of physician coding and reporting. The strength of this study is that it represents a comprehensive, retrospective evaluation of potential sources for chronic pain within the female veteran population. In summary, we found that female veteran survivors of MST face an increased burden of chronic pain, including a broad range of pain conditions independent of the psychological effects of MST.