Pain after combat injury in male UK military personnel deployed to Afghanistan

Br J Anaesth. 2024 Jun;132(6):1285-1292. doi: 10.1016/j.bja.2024.02.019. Epub 2024 Mar 23.

Abstract

Background: Chronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries.

Methods: We used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency-matched uninjured comparison group. Participants completed self-reported questionnaires, including 'overall' pain intensity and self-assessment of post-traumatic stress disorder, anxiety, and depression.

Results: A total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n=202), and was higher in the injured group (n=140, 24%) compared with the uninjured group (n=62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0-1.2, P<0.001), and lower in the amputation injury subgroup (n=31, 19%) compared with the non-amputation injury subgroup (n=109, 26%, relative risk: 0.9, 95% CI: 0.9-1.0, P=0.034). Presence of at least moderate pain was associated with higher rates of post-traumatic stress (RR: 3.7, 95% CI: 2.7-5.0), anxiety (RR: 3.2, 95% CI: 2.4-4.3), and depression (RR: 3.4, 95% CI: 2.7-4.5) after accounting for injury.

Conclusion: Combat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.

Keywords: amputation; battlefield injury; pain; phantom limb pain; veteran health.

MeSH terms

  • Adult
  • Afghan Campaign 2001-*
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Chronic Pain / epidemiology
  • Chronic Pain / psychology
  • Cohort Studies
  • Depression / epidemiology
  • Depression / psychology
  • Humans
  • Male
  • Military Personnel* / psychology
  • Military Personnel* / statistics & numerical data
  • Pain / epidemiology
  • Pain / etiology
  • Pain / psychology
  • Pain Measurement / methods
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology
  • United Kingdom / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / psychology
  • Young Adult