Pain after combat injury in male UK military personnel deployed to Afghanistan

Background: Chronic pain after injury poses a serious health burden. As a result of advances in medical technology, ever more military personnel survive severe combat injuries, but long-term pain outcomes are unknown. We aimed to assess rates of pain in a representative sample of UK military personnel with and without combat injuries.<br /> Methods: We used data from the ADVANCE cohort study (ISRCTN57285353). Individuals deployed as UK armed forces to Afghanistan were recruited to include those with physical combat injuries, and a frequency -matched uninjured comparison group. Participants completed self -reported questionnaires, including 'overall ' pain intensity and selfassessment of post -traumatic stress disorder, anxiety, and depression.<br /> Results: A total of 579 participants with combat injury, including 161 with amputations, and 565 uninjured participants were included in the analysis (median 8 yr since injury/deployment). Frequency of moderate or severe pain was 18% (n = 202), and was higher in the injured group (n = 140, 24%) compared with the uninjured group (n = 62, 11%, relative risk: 1.1, 95% confidence interval [CI]: 1.0 - 1.2, P < 0.001), and lower in the amputation injury subgroup (n = 31, 19%) compared with the non -amputation injury subgroup (n = 109, 26%, relative risk: 0.9, 95% CI: 0.9 - 1.0, P = 0.034). Presence of at least moderate pain was associated with higher rates of post -traumatic stress (RR: 3.7, 95% CI: 2.7 - 5.0), anxiety (RR: 3.2, 95% CI: 2.4 - 4.3), and depression (RR: 3.4, 95% CI: 2.7 - 4.5) after accounting for injury.<br /> Conclusion: Combat injury, but not amputation, was associated with a higher frequency of moderate to severe pain intensity in this cohort, and pain was associated with adverse mental health outcomes.