Women veterans are more likely than men to experience military sexual trauma (MST) which often results in symptoms of posttraumatic stress disorder (PTSD). Women are also more likely to experience pain. Women with severe premenstrual syndrome (PMS, symptoms right before menstruation that often include anxiety and depression) are more sensitive to pain than those without PMS. Pain and PTSD together cause worse PMS symptoms and distress than either by itself and may be worse when women have a history of sexual abuse.

A recent study of 83 women Veterans of the Iraq and Afghanistan conflicts recruited primarily through mental health clinics found that nearly three fourths of these women had both MST and significant pain. Women with MST experienced worse pain and more pain-related difficulties when engaging in activities of daily living. When coupled with PMS, pain resulted in even more interference with activity.

The study was the work of Drs. Melissa Mercedes Buttner and Niloofar Afari at the VA Center of Excellence for Stress and Mental Health (CESAMH) in San Diego. This research suggests that thorough evaluation of trauma in women with pain, as well as treatment of mood fluctuations in PMS, could be beneficial. In addition, research to better understand the interaction of pain, especially related to PMS, and mental health issues may help us develop ways to better treat these problems. For more information, contact Dr. Niloofar Afari at niloofar.afari@va.gov. 

Pain is a significant health problem among Veterans. Physical difficulties are not the only negative effect of pain. Problems with psychological issues, social and financial consequences, and daily activities can also occur. VA has a variety of resources for both patients and providers to help understand and manage pain. A few of these are highlighted below:

VHA Pain Management

http://www.va.gov/painmanagement/

This site includes extensive information related to general pain education, assessment, management, and clinical guidelines. Resources for both Veterans and providers are included. A section is dedicated to opioid safety for Veterans suffering from chronic pain.

Pocket Guide for Clinicians for Management of Chronic Pain

https://www.mirecc.va.gov/visn16/pain-management-pocket-guide.asp

This guide was developed by the South Central Mental Illness Research, Education and Clinical Center (MIRECC) to assist primary care clinicians and trainees gain a basic understanding of pain and facilitate early assessment and interventions.

Chronic Pain and PTSD:  A Guide for Patients

http://www.ptsd.va.gov/public/problems/pain-ptsd-guide-patients.asp

The National Center for PTSD provides guidelines for Veterans diagnosed with PTSD who experience pain.

Make the Connection:  Chronic Pain

http://maketheconnection.net/symptoms/chronic-pain

This website allows Veterans and their friends and family members to access information, resources, and solutions to issues of pain affecting their lives.

Joint Pain Education Project (JPEP)

http://www.dvcipm.org/clinical-resources/joint-pain-education-project-jpep

This program worked to create standardized pain management training to improve complex patient and provider education.

Improving treatment for chronic pain is a high priority as almost half of all Veterans seeking care at the VA report chronic pain. emPower Ourselves With Every Resource (POWER) is a new treatment developed by VA clinicians for Veterans with chronic pain. POWER implements an interdisciplinary multimodal approach to pain management that addresses cognitive, affective, and behavioral aspects of chronic pain. It incorporates specific skills and techniques to increase daily activity, improve pain coping skills, and enhance overall quality of life. All POWER participants were Veterans receiving outpatient treatment. Most common complaints were musculoskeletal pain in the knee, back, or neck, and neuropathic pain. Less common were headaches or arthritis. A few Veterans reported phantom limb pain. Eras of military service ranged from the Korean War to the most recent conflicts.

Over the two years of development, researchers from the Mid-Atlantic MIRECC, VA, and Defense and Veterans Brain Injury Center utilized Veteran feedback to improve the program. This allowed the content to be refined and the number of sessions decreased. Veterans showed improvements in negative pain-related thinking, disability, and distress across groups.

Clinical data were used to evaluate the success of three treatment durations (6, 10, and 12 weeks) of POWER. Decreased pain-related disability and distress for the 6-week group was equivalent or better than the 10- and 12-week groups. This indicates that brief 6-week behavioral interventions are effective in managing chronic pain. These findings have practical implications for clinical planning and program development while offering unique treatment options informed by real-world clinical needs and patient feedback. For more information, contact Dr. Jennifer Cameron at jennifer.cameron2@va.gov.