Seventeen-Year National Pain Prevalence Trends Among U.S. Military Veterans
Authors: Taylor Kenneth Adam , Kapos Flavia Penteado , Sharpe Jason Arthur , Kosinski Andrzej Stanislaw , Rhon Daniel I. , Goode Adam Payne 
Published: March 2023

Importance

U.S. military veterans experience higher pain prevalence and severity than nonveterans. However, it is unclear how these differences have changed over time. Previous studies are limited to veterans receiving care from the Veterans Health Administration.

Objective

To characterize pain prevalence trends in the overall population of U.S. veterans compared to nonveterans, using nationally-representative data.

Design

Repeated cross-sectional study. Data: National Health Interview Survey, 2002-2018. Analysis: January 2023.

Setting

Population-based survey of noninstitutionalized U.S. adults.

Participants

Across the 17-year period, mean annual weighted population was 229.7 million adults (unweighted sample total: n=506,639; unweighted sample annual mean: n=29,802).

Exposure

Veteran status.

Main Outcomes

Crude and demographics-adjusted pain prevalence trend differences between veterans and nonveterans across five pain variables (severe headache or migraine, facial pain, neck pain, low back pain, and joint pain) and two composite variables (any pain [≥1 prevalent pain] and multiple pains [≥2 prevalent pains]).

Results

Weighted proportion of veterans varied from 11.48% in 2002 (highest) to 8.41% in 2017 (lowest). Across the study period, crude prevalence was generally similar or higher among veterans than nonveterans for all pain variables except for severe headache or migraine and facial pain. When equalizing age, sex, race, and ethnicity, pain prevalence among veterans remained similar or higher than nonveterans for all pain variables. From 2002 to 2018 there was an absolute increase (95% CI) in pain prevalence among veterans (severe headache or migraine: 2.0% [1.6% to 2.4%]; facial pain: 1.9% [1.4% to 2.4%]; neck pain: 4.7% [4.1% to 5.2%]; joint pain: 11.4% [10.8% to 11.9%]; low back pain: 10.3% [9.5% to 11.1%]; any pain: 10.0% [9.6% to 10.4%]; and multiple pains: 9.9% [9.2% to 10.6%]. Crude and adjusted analyses indicated prevalence of all pain variables increased more among veterans than nonveterans from 2002 to 2018.

Conclusion and Relevance

Veterans had similar or higher adjusted prevalence and higher rates of increase over time for all pain variables compared to nonveterans. Continued pain prevalence increase among veterans may impact healthcare utilization (within and outside of the VHA), underscoring the need for improved pain prevention and care programs for these individuals with disproportionate pain burden.

Key Points

Question

How have differences in pain prevalence between U.S. military veterans and nonveterans changed from 2002 to 2018?

Findings

In this repeated cross-sectional study using 17 years of nationally-representative data of U.S. adults, we found similar or higher pain prevalence and higher prevalence increase over time among veterans than nonveterans, even when accounting for differing distributions of age, sex, race, and ethnicity.

Meaning

Disparities in pain prevalence between veterans and nonveterans worsened from 2002 to 2018, underscoring the need for improved prevention and pain care programs for veterans, who experience a disproportionate burden of pain.