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

Jan Vollert; Alexander Kumar; Emma C Coady; Paul Cullinan; Daniel Dyball; Nicola T Fear; Zoe Gan; Eleanor F Miller; Stefan Sprinckmoller; Suzie Schofield; Alexander Bennett; Anthony M J Bull; Christopher J Boos; Andrew S C Rice; Harriet I Kemp; ADVANCE Study

doi:10.1016/j.bja.2024.02.019

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

Br J Anaesth. 2024 Mar 22:S0007-0912(24)00098-9. doi: 10.1016/j.bja.2024.02.019. Online ahead of print.

Authors

Affiliations

¹ Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. Electronic address: j.vollert@exeter.ac.uk.
² Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK.
³ National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
⁴ King's Centre for Military Health Research, King's College London, London, UK.
⁵ King's Centre for Military Health Research, King's College London, London, UK; Academic Department of Military Mental Health, King's College London, London, UK.
⁶ Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
⁷ Department of Bioengineering, Faculty of Engineering, Imperial College London, London, UK.
⁸ Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Loughborough, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
⁹ Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK.
¹⁰ Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK.
¹¹ Pain Research, MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK.

PMID: 38521656
DOI: 10.1016/j.bja.2024.02.019

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.