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Publication Briefs

Study Suggests Gender and Smoking Impact Severity of Musculoskeletal Pain among OEF/OIF Veterans

While nicotine has analgesic properties, studies among civilians suggest that cigarette smoking is a risk factor for the development of chronic pain. Lifetime and current cigarette smoking are highly prevalent among Afghanistan and Iraq era Veterans, and although cigarette smoking is generally lower among women than men, women Veterans have a higher risk of smoking compared with civilian women. Moreover, 28-63% of Veterans from the wars in Iraq and Afghanistan report moderate to severe musculoskeletal or chronic pain, with women Veterans reporting increased pain compared to male Veterans. This study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in Veterans of the wars in Afghanistan and Iraq. Investigators identified 1,090 OEF/OIF Veterans (901 men and 189 women) who resided in the VA mid-Atlantic region. Study participants completed multiple survey items that assessed: pain severity, smoking status, demographic characteristics, combat exposure, weight, as well as symptoms of PTSD and/or depression.


  • After adjusting for demographics and other risk factors (i.e., PTSD, service-connected disability), findings showed that both gender and current smoking status were significantly associated with increased odds of moderate to severe musculoskeletal pain.
  • Male Veteran non-smokers were more likely than female Veteran non-smokers to report moderate to severe pain; however, there were no gender differences in moderate to severe pain among Veteran smokers. Relative to female non-smokers, female Veteran smokers had increased odds of reporting moderate to severe musculoskeletal pain.
  • The proportion of Veterans using VA healthcare (36%) did not differ significantly by gender, nor did the prevalence of lifetime smoking (46%).


  • The stronger relationship between smoking and pain in women supports the need for further research that can inform gender-based risk factors for pain in Veterans who are cigarette smokers.


  • This cross-sectional survey did not allow for any causal conclusions.
  • Musculoskeletal pain severity was assessed with a single item. Future research would benefit from detailed, multi-method assessment of pain and pain-related functional impairment.

This study was partly funded by HSR&D. Dr. Bastian is Director of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, West Haven, CT. Drs. Straits-Tröster; and Calhoun are part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.

PubMed Logo Green K, Wilson S, Dennis P, Runnals J, Williams R, Bastian L, Beckham J, Dedert W, Kudler H, Straits-Tröster K, Gierisch J, and Calhoun P. Cigarette Smoking and Musculoskeletal Pain Severity among Male and Female Afghanistan/Iraq Era Veterans. Pain Medicine. March 14, 2017; Epub ahead of print.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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