5.9
Pain
5.9.1
Pain at follow up
Participants were categorised in to one of five Chronic Pain Grades based on responses to
Von Korff’s (1992)40 questions about pain intensity and disability in the previous six months
(Table 1). The Gulf War veteran group was slightly less likely to be pain free than the
comparison group and, relative to those who were pain free, Gulf War veterans were slightly
more likely than the comparison group to be categorised in each of the higher Pain Grades,
however these differences between groups did not meet statistical significance. Almost 1 in
5 Gulf War veterans and 1 in 6 comparison group participants reported pain that was graded
as being high in disability and moderately or severely limiting. A large proportion of both
Gulf War veterans and comparison group participants (42% and 40% respectively) reported
being kept from their usual activities because of pain for one or more days in the previous six
months (p=0.506; not tabulated).
Table 1 Chronic Pain Grade at follow up
Gulf War
veterans N=602
Comparison
group N=584
n (%)
n (%)
RR
Adj RR (95% CI)
Grade 0, Pain free
64 (10.63)
78 (13.36)
1.00
1.00
Grade I, Low disability, low intensity
366 (60.80)
363 (62.16)
1.23
1.14 (0.79-1.68)
Grade II, Low disability, high
intensity
66 (10.96)
51 (8.73)
1.58
1.50 (0.89-2.51)
Grade III, High disability, moderately
limiting
48 (7.97)
51 (8.73)
1.15
1.10 (0.64-1.88)
Grade IV, High disability, severely
limiting
58 (9.63)
41 (7.02)
1.72
1.61 (0.93-2.78)
Chronic Pain Grade
Two questions, drawn from the pain subscale of the SF36 investigated how much bodily pain
respondents had experienced (Figure 1), and the extent to which pain interfered with normal
work, including work outside the home and house work (Figure 2), during the previous four
weeks. The comparison group were slightly more likely than the Gulf War veterans to report
no bodily pain, and to report that pain had not interfered with their work at all, but these
differences were not tested for statistical significance.
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35
Gulf War veterans
30
Comparison group
Percentage (%)
25
20
15
10
5
0
None
Very mild
Mild
Moderate
Severe
Very severe
How much bodily pain have you had during the past 4 weeks?
Figure 1 The severity of bodily pain in the four weeks prior to follow up
45
Gulf War veterans
40
Comparison group
Percentage (%)
35
30
25
20
15
10
5
0
Not at all
A little bit
Moderately
Quite a bit
Extremely
How much did pain interfere with normal work in the past 4
weeks?
Figure 2 The extent to which pain interfered with normal work in the four weeks prior to follow
up
From a list of 19 body areas, the number of areas that participants reported having pain or
tenderness in, over the previous 7 days, is shown in Table 2. Gulf War veterans were one
and a half times more likely than comparison group participants to endorse between four and
six body areas of pain, and more than two and half times more likely to endorse 11 or more
body areas of pain. These differences between groups were statistically significant.
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Table 2 Number of body areas of pain or tenderness in the seven days prior to follow up
Gulf War
veterans N=693
Comparison
group N=652
n (%)
n (%)
RR
Adj RR (95% CI)
0-3
451 (65.08)
477 (73.16)
1.00
-
4-6
169 (24.39)
127 (19.48)
1.40
1.47 (1.12-1.93)
7-10
58 (8.37)
43 (6.60)
1.42
1.46 (0.95-2.26)
11+
15 (2.16)
5 (0.77)
3.17
2.89 (1.01-8.28)
Widespread Pain
Number of body areas
In the 63-item symptom questionnaire, for which results are presented in the Symptoms
chapter, there were a number of pain-related symptoms which were reported statistically
significantly more frequently by the Gulf War veterans relative to the comparison group.
They include headaches (60% vs 49%, adj RR 1.19, 95% CI 1.08-1.31), pain without
swelling or redness in several joints (46% vs 36%, adj RR=1.27, 95% CI 1.11-1.44), itchy or
painful eyes (38% vs 29%, adj RR=1.27, 95% CI 1.09-1.48) and stomach cramps (19% vs
11%, adj RR=1.67, 95% CI 1.27-2.19). A number of additional pain-related symptoms were
reported more frequently by Gulf War veterans however these differences just failed to
achieve statistical significance; they were chest pain (21% vs 15%, adj RR 1.25, 95% CI
0.99-1.58) and general muscle aches or pains (63% vs 57%, adj RR 1.07, 95% CI 0.98-1.17).
The most frequently reported pain-related health symptoms in both study groups were
general muscle aches or pains, headaches and low back pain; each reported by more than
half of all participants.
5.9.2
Key findings
A large proportion of Gulf War veteran and comparison group participants have been
adversely affected by pain in the 6 months prior to the follow up study. More than 40% of all
participants reported being kept from their usual activities because of pain for one or more
days in the six month period. For the same time period, almost 1 in 5 Gulf War veterans and
1 in 6 comparison group participants reported pain that was graded as being high in
disability and moderately or severely limiting. Gulf War veterans were slightly less likely than
comparison group participants to be pain free in the last six months, and slightly more likely
to score a higher Chronic Pain Grade, however these differences between groups did not
meet statistical significance.
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In the four week period prior to the follow up study, Gulf War veteran participants were,
again, very slightly less likely to report no pain, and slightly more likely to report some
interference with their normal work activities as a result of pain.
From a list of 19 body areas, Gulf War veterans were one and a half times more likely than
comparison group participants to report pain in four to six body areas in the previous seven
days, and more than two and half times more likely to report 11 or more body areas of pain.
These differences between groups, in number of body areas affected by pain, were
statistically significant.
Gulf War veterans were statistically significantly more likely than the comparison group to
report a number of pain-related health symptoms in the past month; they included
headaches, pain without swelling or redness in several joints, itchy or painful eyes and
stomach cramps. The most frequently reported pain-related health symptoms in the past
month, for both study groups, were general muscle aches or pains, headaches and low back
pain; each reported by more than half of all participants.
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