Chronic pain as a long-term burden for Veterans

Abstract: Chronic pain has often been demonstrated to have significant downstream effects on quality of life, mental and physical health, and can have severe economic and social consequences. At the same time, the risk of chronic pain has been shown to increase if individuals were faced with traumatic experiences. In their work, Vowles et al1 in this issue of BJP demonstrate from a survey data of Northern Irish military veterans that chronic pain is a long-term consequence of armed conflict, and it impacts individuals’ quality of life: chronic pain is coupled with higher rates of depression, anxiety, and post-traumatic stress disorder. An interesting aspect specific to this work is that the authors find veterans with chronic pain to be more likely to have served in Home service tasked to manage the sectarian violence and support civil order during the Northen Ireland conflict between 1969 and 2007. Soldiers were on duty within their own communities. Operating in a highly volatile and deeply personal environment has had a profound impact on both their professional duties and personal lives. The survey results imply that playing an active role while in your home region may have further contributed to how pain has become chronic in this cohort, who had no unscarred place to return to. The unique role they played – serving in conflict in their own communities – has created challenges that have continued long after the operation ended including the effects of prolonged trauma. The increased risk of depression, anxiety, and post-traumatic stress posed by pain is like that recently demonstrated in UK military personnel deployed to Afghanistan.2 These two works present some of the first studies linking chronic pain and adverse mental health in UK veterans, extending previous knowledge mainly derived from US cohorts. A shortcoming of these studies is that they are cross sectional, while it will be important to provide timescale analyses of how and when pain and adverse mental health develop after traumatic experiences, and which tends to come first. Still, the similarity of findings from domestic and international cohorts, despite the highly distinct nature of military structures and conflicts, spanning decades and continents (e.g., Vietnam, Northern Ireland, Afghanistan), hint towards a universality of chronic pain being intrinsically linked with trauma, and form a negatively reinforcing cycle with mental health disorders. This has also been demonstrated in civilian populations, and extended to childhood trauma,3 but it should be kept in mind at which rate armed conflict will increase the risk of any individual exposed, be they military or civilian, to experience severe trauma. Armed conflicts had, for a while, become less prominent in the lives of those living in the Global North. Yet, they were never gone. (Civil) wars, insurgencies, and military uprisings have continued across the world. Through the wars in Ukraine and the Middle East, they have become mainstream political points in the Global North again. It should never be forgotten what human toll these conflicts take, including decades after they ended. The impacts of war reach into mental health, personal relationships and daily freedoms and overall well-being. Those affected – soldier, civilians, and communities alike – carry the weight of trauma and loss. Some struggle with the long-term psychological wounds. Recognising these impacts and to support all victims of war, societies must offer comprehensive support systems to address their unique needs. In doing so, we can help build a foundation of understanding and hope for those who have endured the profound costs of conflict.