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Pain-related musculoskeletal disorders, psychological comorbidity, and the relationship with physical and mental well-being in Gulf War veterans

Kelsall, Helen Louisea,*; McKenzie, Dean Philipa,b; Forbes, Andrew Benjamina; Roberts, Minainyo Helena; Urquhart, Donna Michellea; Sim, Malcolm Rossa

doi: 10.1016/j.pain.2013.12.025
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Summary Musculoskeletal/psychological comorbidity was more common in Gulf War veterans, but musculoskeletal disorders were associated with depression, PTSD, and poorer well-being in veterans and comparison group.

ABSTRACT Occupational activities such as lifting loads, working in constrained spaces, and training increase the risk of pain-related musculoskeletal disorders (MSDs) in military veterans. Few studies have investigated MSD and psychological disorder in veterans, and previous studies had limitations. This cross-sectional study compared pain-related MSD and psychological comorbidity and well-being between 1381 male Australian 1990–1991 Gulf War veterans (veterans) and a military comparison group (n = 1377, of whom 39.6% were serving and 32.7% had previously deployed). At a medical assessment, 2000–2002, reported doctor-diagnosed arthritis or rheumatism, back or neck problems, joint problems, and soft tissue disorders were rated by medical practitioners as nonmedical, unlikely, possible, or probable diagnoses. Only probable MSDs were analysed. Psychological disorders in the past 12 months were measured using the Composite International Diagnostic Interview. The Short-Form Health Survey (SF-12) assessed 4-week physical and mental well-being. Almost one-quarter of veterans (24.5%) and the comparison group (22.4%) reported an MSD. Having any or specific MSD was associated with depression and posttraumatic stress disorder (PTSD), but not alcohol disorders. Physical and mental well-being was poorer in those with an MSD compared to those without, in both study groups (eg, veterans with any MSD, difference in SF-12 physical component summary scale medians = −10.49: 95% confidence interval −12.40, −8.57), and in those with MSD and psychological comorbidity compared with MSD alone. Comorbidity of any MSD and psychological disorder was more common in veterans, but MSDs were associated with depression, PTSD, and poorer well-being in both groups. Psychological comorbidity needs consideration in MSD management. Longitudinal studies are needed to assess directionality and causality.

aDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

bCentre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia

* Corresponding author. Address: Monash Centre for Occupational and Environmental Health (MonCOEH), Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Commercial Road, Melbourne, VIC 3004, Australia. Tel.: +61 3 9903 0032; fax: +61 3 9903 0556.

E-mail address:helen.kelsall@monash.edu

URL:http://www.med.monash.edu.au/epidemiology/staff/academic/kelsall.html

Article history:

Received 30 April 2013

Received in revised form 29 November 2013

Accepted 17 December 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2014 International Association for the Study of Pain
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