title: Association of Pain With Physical Function, Depressive Symptoms, Fatigue, and Sleep Quality Among Veteran and non-Veteran Postmenopausal Women.
abstract: OBJECTIVE
  To characterize the prevalence and longitudinal effects of pain in older Veteran and non-Veteran women.
  
  
  METHODS
  Data on 144,956 participants in the Women's Health Initiative were analyzed. At baseline, Veteran status, pain severity, and pain interference with activity were assessed. Outcomes of physical function, depressive symptoms, fatigue, and sleep quality were reported at baseline by all study participants and longitudinally on two follow-up occasions (3 years and 13-18 years after baseline) in the observational study participants (n = 87,336).
  
  
  RESULTS
  At baseline, a total of 3,687 (2.5%) had a history of military service and 22,813 (15.8%) reported that pain limited their activity level moderately to extremely during the past 4 weeks. Prevalence of pain interference did not differ in Veterans and non-Veterans (16.8% and 15.7%, respectively; p= .09). At baseline, women with moderate-to-extreme pain interference had substantially worse physical function and greater symptoms of depression, fatigue, and insomnia than those with less pain (p < .001 for all comparisons), adjusting for several social, behavioral, and health related factors. There were no significant military service by pain interference interactions for any of the outcomes (p > .2), indicating that the effect of pain interference on outcomes at baseline did not vary between Veterans and non-Veterans. Moderate-to-extreme pain interference was associated with a greater rate of decline in physical function over time (p < .001) and higher incidence of limited physical functioning (p < .001), but these effects did not vary by Veteran status. Similar results were observed with pain severity as the exposure variable.
  
  
  CONCLUSIONS
  As the Veteran population ages and the number of women exposed to combat operations grows, there will be an increased need for health care services that address not only pain severity and interference but also other disabling comorbid symptoms.
authors.affiliation: Center for Pain Research on Impact, Measurement, and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seatle. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle. kvpatel@uw.edu.
authors.forename: Kushang V
authors.initials: KV
authors.lastname: Patel
authors.affiliation: de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, Washington.
authors.forename: Barbara B
authors.initials: BB
authors.lastname: Cochrane
authors.affiliation: Center for Pain Research on Impact, Measurement, and Effectiveness, Department of Anesthesiology and Pain Medicine, University of Washington, Seatle.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Turk
authors.affiliation: VA Connecticut, Newington. Division of General Internal Medicine, University of Connecticut, Farmington.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: VA Office of Patient Care, Women's Health Services, Washington, District of Columbia. VA Connecticut Health Care System, West Haven. Department of Internal Medicine, Yale University, New Haven, Connecticut.
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.affiliation: de Tornyay Center for Healthy Aging, University of Washington School of Nursing, Seattle. Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Woods
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: Department of Epidemiology, University of Iowa.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven. Department of Psychiatry and Department of Neurology, Yale University, New Haven, Connecticut.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000503:physiopathology; D017698:Postmenopause; D011446:Prospective Studies; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Aging; Pain; Physical function; Symptom burden; Veteran’s health; Women’s health