title: Back pain during war: an analysis of factors affecting outcome.
abstract: BACKGROUND
  Back pain is the leading cause of disability in the world, but it is even more common in soldiers deployed for combat operations. Aside from battle injuries and psychiatric conditions, spine pain and other musculoskeletal conditions are associated with the lowest return-to-unit rate among service members medically evacuated out of Operations Iraqi and Enduring Freedom.
  
  
  METHODS
  Demographic, military-specific, and outcome data were prospectively collected over a 2-week period at the Deployed Warrior Medical Management Center in Germany on 1410 consecutive soldiers medically evacuated out of theaters of combat operations for a primary diagnosis pertaining to back pain between 2004 and 2007. The 2-week period represents the maximal allowable time an evacuated soldier can spend in treatment before disposition (ie, return to theater or evacuate to United States) is rendered. Electronic medical records were then reviewed to examine the effect a host of demographic and clinical variables had on the categorical outcome measure, return to unit.
  
  
  RESULTS
  The overall return-to-unit rate was 13%. Factors associated with a positive outcome included female sex, deployment to Afghanistan, being an officer, and a history of back pain. Trends toward not returning to duty were found for navy and marine service members, coexisting psychiatric morbidity, and not being seen in a pain clinic.
  
  
  CONCLUSIONS
  The likelihood of a service member medically evacuated out of theater with back pain returning to duty is low irrespective of any intervention(s) or characteristic(s). More research is needed to determine whether concomitant treatment of coexisting psychological factors and early treatment "in theater" can reduce attrition rates.
authors.affiliation: Department of Anesthesiology, Johns Hopkins School of Medicine, 550 N Broadway, Ste 301, Baltimore, MD 21029. USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Conner
authors.initials: C
authors.lastname: Nguyen
authors.forename: Shruti G
authors.initials: SG
authors.lastname: Kapoor
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Anderson-Barnes
authors.forename: Leslie
authors.initials: L
authors.lastname: Foster
authors.forename: Cynthia
authors.initials: C
authors.lastname: Shields
authors.forename: Brian
authors.initials: B
authors.lastname: McLean
authors.forename: Todd
authors.initials: T
authors.lastname: Wichman
authors.forename: Anthony
authors.initials: A
authors.lastname: Plunkett
mesh_terms: D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D010147:Pain Measurement; D011336:Probability; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013315:Stress, Psychological; D014857:Warfare; D055815:Young Adult