Protective Effects of Optimism on Onset of Post-Deployment Pain in - - PowerPoint PPT Presentation

Protective Effects of Optimism on Onset of Post-Deployment Pain in U.S. Army Personnel

Afton L. Hassett, Psy.D.,1 Joseph A. Fisher, Ph.D.,2,3 Loryana L. Vie, Ph.D.,2,3 Daniel J. Clauw, M.D.,1 and Martin E. P. Seligman, Ph.D.2

1University of Michigan, Chronic Pain and Fatigue Research Center 2University of Pennsylvania, Positive Psychology Center 3Research Facilitation Laboratory

Grant Number: 68709 UNCLASSIFIED The views expressed in this presentation are those of the authors and do not reflect the

• fficial policy or position of the Department of the Army, DOD, or the U.S. Government.

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Chronic post-deployment pain is common - observed in 40-80% of veterans deployed to Afghanistan or Iraq.1-4

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• Veterans are 40% more likely to experience pain.5
• Up to 51.2% report pain severity to be moderate to severe.3
• Over half experience pain almost every day, if not constantly.3
• 29% have reported pain in all four limbs (widespread pain).6

1) Cifu et al. J Rehabil Res Dev. 2013;50:1169-76. 2) Lew et al. J Rehabil Res Dev. 2013;50:xi-xiv. 3) Toblin et

• al. JAMA Intern Med. 2014;174:1400-01. 4) Gironda et al. Pain Med. 2006;7:339-343. 5) Nahin. J. Pain

2017;18:247-54. 6) Helmer et al. Pain Med 2009;10:11724-82.

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Chronic pain in veterans is associated with significant psychological, social and behavioral problems.

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l Comorbid PTSD, depression and/or substance abuse.1-6 l Traumatic brain injury/post-concussive symptoms.1,2 l Greater healthcare utilization.4-5 l Diminished quality of life or well-being.5

1) Cifu et al. J Rehabil Res Dev. 2013;50:1169-76. 2) Lew et al. J Rehabil Res Dev. 2013;50:xi-xiv. 3) Toblin et

• al. JAMA Intern Med. 2014;174:1400-01. 4) Lang et al., Mil Med 2016;181:50-5. 5) Helmer et al. Pain Med

2009;10:11724-82. 6) Forman-Hoffman et al. J Pain 2007;8:954-961.

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Risk factors for post-deployment pain have been studied, but little is know about protective factors.

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l Demographic factors: greater age, being married.1 l Combat factors: injury during combat, combat intensity.1-2 l Psychological distress: especially PTSD.1,3

1) Toblin et al. JAMA Intern Med. 2014;174:1400-01. 2) Cifu et al. J Rehabil Res Dev. 2013;50:1169-76. 3) Stratton et al. J Pain 2014;15: 1023-1032.

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Study Purpose: To assess protective factors for the development of new post-deployment pain.

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Pre-deployment assessments of health and well being

• Pain free

(head, joint, back)

• Optimism

Deployment

• Iraq or

Afghanistan

• Combat stress
• Injury

Post-deployment health assessment

• New pain

(head, joint, back)

Study Design

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• Pre-Deployment:

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Periodic Health Assessment – most recent within 12 months of deployment

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Global Assessment Tool – most recent within 12 months of deployment

• Deployment:

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Contingency Tracking System –Army Active/Guard/Reserve deployment (0 to 18 months) between 2010 and 2014 that included time in Afghanistan or Iraq

• Post-Deployment:

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Periodic Health Assessment – Most recent within 15 months following deployment return

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Post-Deployment Health Assessment – Most recent within 6 months following deployment return

• Additional model and data availability constraints.

Data Requirements

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n = 21,390 soldiers

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Sample Characteristics

7 Sample N = 21,390 No New Pain n = 13,413 (62.7%) New Pain n = 7,977 (37.3%) Sex: Male = 87.9% Male = 88.1% Male = 87.4% Age: Mean (SD) 29.3 (8.5) 28.5 (8.1) 30.5 (8.9) Branch: Regular = 36.7%, Guard = 42.3%, Reserve = 21.0% Regular = 36.4%, Guard = 41.7%, Reserve = 21.9% Regular = 37.3%, Guard = 43.2%, Reserve = 19.5% Location: Afghanistan = 77.4%, Iraq = 22.6% Afghanistan = 75.9%, Iraq = 24.1% Afghanistan = 79.9%, Iraq = 20.1% Education: < HS = 9.1%, HS = 58.1%, > HS = 13.7%, ≥ Bachelor = 19.1% < HS = 8.9%, HS = 58.7%, > HS = 13.2%, ≥ Bachelor = 19.2% < HS = 9.4%, HS = 57.0%, > HS = 14.6%, ≥ Bachelor = 19.0% Optimism: Mean (SD) 3.9 (0.75) 3.9 (0.74) 3.8 (0.77)

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Logistic Regression Results: Predicting New Pain

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• Note. Mod. = Moderate. aReference group = Low optimism. Non-significant model variables: income, alcohol use, blood pressure, number of prior

deployments, and education (at levels HS, >HS) Sample size = 21,390 soldiers. * p < 0.05, ** p < 0.01, *** p < 0.001.

OR (95% CI) Model 1 – Optimism Continuous Model 2 – Optimism Tertilesa

Optimism 0.89 (0.86, 0.93)*** Mod.: 0.81 (0.68, 0.96)* High: 0.70 (0.59, 0.83)*** Age 1.40 (1.35, 1.45)*** 1.40 (1.35, 1.45)*** Gender - Female 1.22 (1.12, 1.34)*** 1.22 (1.12, 1.34)*** Education - ≥ Bachelor 0.80 (0.71, 0.91)*** 0.80 (0.71, 0.91)*** Branch - Guard Reserve 0.90 (0.84, 0.96)** 0.74 (0.68, 0.80)*** 0.90 (0.84, 0.96)** 0.74 (0.68, 0.80)*** Location - Iraq 0.81 (076, 0.87)*** 0.81 (0.76, 0.87)*** Nicotine 1.15 (1.08, 1.23)*** 1.15 (1.08, 1.23)*** Skin (hives/rash) 1.40 (1.16, 1.69)*** 1.40 (1.16, 1.69)*** Chronic pain 2.55 (1.80, 3.61)*** 2.55 (1.80, 3.62)*** Combat stress 1.13 (1.11, 1.16)*** 1.13 (1.11, 1.16)*** Injury 2.18 (2.03, 2.33)*** 2.17 (2.03, 2.33)***

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Study Conclusions

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l Mean optimism was associated with a 11% reduced odds of developing

new post-deployment pain.

l High vs. low levels of optimism were associated with a 30% reduced

• dds of developing new post-deployment pain.

l Reducing instances of new pain post-deployment is critical as 37% of

soldiers report at least one new area of pain.

l The results of this study suggest that future research targeting increasing

levels of optimism could be warranted.

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• Thank you to all who have served and continue to serve our country

and protect us from harm.

Thank you!