Kegel Jessica L, Kazman Josh B, Clifton Daniel R, Emanuele Peter, Nelson D Alan, Deuster Patricia A
Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, United States.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States.
Front Pain Res (Lausanne). 2023 Aug 15;4:1175574. doi: 10.3389/fpain.2023.1175574. eCollection 2023.
Chronic pain and associated interference with daily activities are common in the military and impact Force readiness. Chronic pain affects one-third of service members and is a leading cause of medical non-readiness (MNR) in the military. Research suggests that underlying psychological mechanisms related to trait coping styles and pain interference (PI) affect functional outcomes, but little research exists examining this relationship within an Army population. The purpose of this study was to examine the combined effects of PI and coping on U.S. Army soldier readiness by using annual well-being data from the Global Assessment Tool (GAT) and medical non-readiness (MNR) based on duty restriction records.
The sample comprised 866,379 soldiers who completed the GAT between 2014 and 2017 with no duty restrictions at the time of baseline GAT completion; subjects were observed through 2018 for duty restrictions. Parametric survival regression models with a Weibull distribution predicted demographic-adjusted hazards of MNR by dichotomized PI (no PI/PI) and beneficial/non-beneficial use of GAT coping components (good coping, bad coping, catastrophizing-flexibility, and catastrophizing-hopelessness). Incident MNR was evaluated for all duty restrictions, and stratified by selected body systems (upper extremity, lower extremity, psychiatric).
Among soldiers with PI, hazards were higher in those reporting non-beneficial coping styles (bad coping, hopelessness) and lower in those reporting beneficial coping styles (good coping, flexibility). Across all coping styles, PI/coping interactions were particularly strong for catastrophizing-hopelessness and when examining MNR from psychiatric conditions.
These findings suggest some synergistic associations between pain and coping that may impact pain-related occupational disability. Coping skills may be an effective interventional target for chronic pain reduction/prevention within military programs, such as the Master Resilience Training Course offered to soldiers in the Army. Further research should assess whether early coping style interventions can reduce pain-related outcomes.
慢性疼痛及其对日常活动的相关干扰在军队中很常见，并影响部队的战备状态。慢性疼痛影响三分之一的军人，是军队中医疗未就绪（MNR）的主要原因。研究表明，与特质应对方式和疼痛干扰（PI）相关的潜在心理机制会影响功能结果，但在陆军人群中研究这种关系的研究很少。本研究的目的是通过使用来自全球评估工具（GAT）的年度健康数据和基于任务限制记录的医疗未就绪（MNR），来检验PI和应对方式对美国陆军士兵战备状态的综合影响。
样本包括866,379名在2014年至2017年期间完成GAT且在基线GAT完成时无任务限制的士兵；对这些受试者进行观察，直至2018年，以了解其任务限制情况。采用具有威布尔分布的参数生存回归模型，通过将PI二分法（无PI/PI）以及GAT应对成分的有益/无益使用情况（良好应对、不良应对、灾难化-灵活性和灾难化-绝望感）来预测经人口统计学调整后的MNR风险。对所有任务限制进行了新发MNR评估，并按选定的身体系统（上肢、下肢、精神科）进行分层。
在有PI的士兵中，报告无益应对方式（不良应对、绝望感）的人风险较高，而报告有益应对方式（良好应对、灵活性）的人风险较低。在所有应对方式中，灾难化-绝望感以及检查精神科疾病导致的MNR时，PI/应对方式的相互作用尤为强烈。
这些发现表明疼痛与应对方式之间存在一些协同关联，可能会影响与疼痛相关的职业残疾。应对技能可能是军队项目（如陆军为士兵提供的主韧性训练课程）中减轻/预防慢性疼痛的有效干预目标。进一步的研究应评估早期应对方式干预是否能减少与疼痛相关的结果。
