Cigarette Smoking and Musculoskeletal Pain Severity Among Male and Female Afghanistan/Iraq Era Veterans.
OBJECTIVE
Cigarette smoking and musculoskeletal pain are prevalent among Department of Veterans Affairs (VA) health care system users. These conditions frequently co-occur; however, there is limited empirical information specific to Afghanistan/Iraq era veterans. The present study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in US veterans with Afghanistan/Iraq era service.


METHODS
A random sample of 5,000 veterans with service after November 11, 2001, participated in a survey assessing health care needs and barriers to care. One thousand ninety veterans completed the survey assessing post-traumatic stress disorder (PTSD) symptoms, depressive symptoms, and current pain severity. Multivariate logistic regression was used to examine the association between gender, cigarette smoking status, and current moderate to severe musculoskeletal pain.


RESULTS
Findings indicated a significant gender by smoking interaction on moderate/severe musculoskeletal pain, adjusting for age, self-reported race/ethnicity and weight status, combat exposure, probable PTSD, depressive symptoms, service-connected injury during deployment, and VA health care service utilization. Deconstruction of the interaction indicated that female veteran smokers, relative to female nonsmokers, had increased odds of endorsing moderate to severe musculoskeletal pain (odds ratio [OR] = 2.73, 95% confidence interval [CI] = 1.16-6.41), whereas this difference was nonsignificant for male veterans (OR = 1.03, 95% CI = 0.69-1.56).


CONCLUSIONS
Survey data from Operation Enduring Freedom/Operation Iraqi Freedom veterans suggest an association between current smoking, gender, and moderate to severe musculoskeletal pain. The stronger relationship between smoking and pain in women supports the need for interventional and longitudinal research that can inform gender-based risk factors for pain in veteran cigarette smokers.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Kimberly T
KT
Green
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Sarah M
SM
Wilson
Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Paul A
PA
Dennis
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Jennifer J
JJ
Runnals
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Rebecca A
RA
Williams
Department of Internal Medicine, Yale University, New Haven, CT, USA.|Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven Campus, West Haven, CT, USA.
Lori A
LA
Bastian
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Jean C
JC
Beckham
Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Eric A
EA
Dedert
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Harold S
HS
Kudler
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.|Phoenix VA Healthcare System, 650 E. Indian School Road, Phoenix, AZ, USA8.
Kristy
K
Straits-Tröster
Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA.|Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Jennifer M
JM
Gierisch
VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA.|Durham VA Medical Center, Durham, NC, USA.|Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.|Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA.
Patrick S
PS
Calhoun
D000328:Adult; D055826:Afghan Campaign 2001-; D000073865:Cigarette Smoking / Q000453:epidemiology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology*; D015995:Prevalence; D017678:Sex Distribution; D014728:Veterans / Q000706:statistics & numerical data*
Cigarette Smoking; Military Veterans; Persistent Pain