Chronic Pain Among Service Members

Using Administrative Data to Strengthen Research and Quality Improvement

by Tisamarie B. Sherry, Carol P. Roth, Mallika Bhandarkar, Kimberly A. Hepner

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Research Questions

  1. How prevalent is chronic pain among active-duty U.S. service members, and what are the potential effects on force readiness?
  2. What factors can complicate chronic pain treatment for this population, such as behavioral health conditions?
  3. What evidence do the U.S. Department of Defense and the Military Health System (MHS) need to target investments to improve chronic pain care and enhance the readiness of the force?
  4. How can MHS administrative data be used to support chronic pain care research and quality improvement for service members?

Chronic pain affects between 31 and 44 percent of active-duty service members and is a leading cause of disability and reduced readiness. Providing high-quality chronic pain care to U.S. military personnel and supporting research to guide chronic pain care quality improvement efforts are priorities for the Military Health System (MHS). MHS administrative data, which capture service members' health care utilization, are an important resource and are already being used to support research and quality improvement initiatives. There are, however, considerable challenges to using these data to accurately measure the prevalence of chronic pain and the quality of chronic pain care provided to service members.

RAND researchers explored how MHS administrative data can be used to assess the prevalence and treatment of chronic pain, and to track improvements in chronic pain care for individual service members and medical readiness across the force.

Key Findings

Pain is the leading cause of disability and reduced readiness for duty in the U.S. military

  • Musculoskeletal conditions and injuries are the most prevalent source of chronic pain for service members and can reduce service members' medical readiness and performance.
  • Conditions that are frequently comorbid with chronic pain, such as traumatic brain injury and behavioral health disorders, can complicate patients' experiences of chronic pain and providers' approaches to pain treatment.
  • Most research on the impact of pain on readiness has not clearly distinguished between acute and chronic pain, but existing evidence indicates that chronic pain compromises functioning and readiness to a greater degree across the force.

The U.S. Department of Defense (DoD) and the MHS have invested in research and adopted evidence-based clinical approaches to treating chronic pain, but quality measurement is essential to monitoring effectiveness

  • In response to emerging evidence, DoD and the MHS have emphasized multimodal, multidisciplinary, stepped treatment for chronic pain that prioritizes nonpharmacologic therapies and non-opioid pain medications.
  • MHS administrative data could provide valuable understanding of the characteristics of the population of service members with chronic pain, the factors that influence their treatment, and the quality of care they receive for chronic pain.

Recommendations

  • DoD and the MHS should continue to invest in chronic pain research, particularly related to military populations and force readiness.
  • DoD and the MHS should explore and validate the accuracy of different approaches to using administrative data to assess chronic pain prevalence and treatment patterns.
  • The MHS should build on its current quality improvement efforts by targeting investments toward the development of chronic pain care quality measures to enhance tracking of patient outcomes and force readiness.

This research was sponsored by the Office of the Secretary of Defense and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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