Better Understanding of Pain Intensity Variables in Women Veterans Needed

Demographics, not comorbidities, more likely to drive association of female gender with moderate-to-severe pain intensity.

PALM SPRINGS, Calif. — As more women serve in the U.S. military, pain management providers need better awareness of clinical and demographic correlates of pain to create better practice and policy recommendations to serve their unique health needs.

“The proportion of women in the military has increased dramatically during the past 15 years. As a result, women represent the fastest growing segment of Veterans Health Administration (VHA) utilizers,” Diana M. Higgins, PhD, of the VA Boston Healthcare System and Boston University School of Medicine, said during a poster session at the 2015 American Pain Society Annual Meeting.

To better understand the way gender influences pain intensity among veterans with musculoskeletal disorders (MSDs), Higgins and colleagues performed a retrospective review of electronic health records from the VA. 

They assessed patient demographic and clinical characteristics for more than 4 million patients with an MSD diagnosis (women, N=253,363; men, N=3,874,625) as indicated by International Classification of Diseases, 9th Revision (ICD-9) codes, who had two or more outpatient visits within 18 months between 2001 and 2011. 

They then performed Chi-square tests, t-tests, and logistic regression analyses to examine bivariate relationships between variables including demographics, medical and mental health diagnoses, BMI, and scores on the pain intensity numeric rating scale (NRS).

When gender was the only covariate, women were more likely than men to report moderate to sever pain intensity (OR=1.39; 95% CI: 1.37,1.40), the researchers found. 

However, when all covariates were taken into account, women were less likely to report moderate-to-severe pain intensity (adjusted odds ratio=0.93; 95% CI: 0.92, 0.94), a finding contrary to previous studies, the researchers noted.

Adding demographic variables such as race/ethnicity, age and marital status, shifted the higher likelihood of moderate-to-severe pain intensity in MSD from women to men.

Two gender-specific profiles of patients at higher risk for moderate-to-severe pain intensity emerged when demographic and comorbidity variables were taken into account:

  • Women veterans were younger, more likely to be racial/ethnic minorities, more likely to be unmarried, and more likely to have mental health diagnoses 
  • Women were also more likely to have nontraumatic joint disease, back pain and migraines, whereas men were more likely to have osteoarthritis
  • Overall, male veterans with moderate to severe pain were more likely to be unmarried/divorced/widowed, non-white, younger than age 40 years, underweight or obese, and have depression, anxiety disorders, post-traumatic stress disorder, alcohol and drug use disorders, migraine, type 2 diabetes and hepatitis C viral infection.

Demographics, and not comorbidities, were more likely to drive the association of gender with moderate to severe pain, the researchers concluded.

“The gender differences found in the current study suggest that women veterans are an important and unique subgroup of the veteran population, which should be considered with respect to clinical and policy implications,” Higgins said. 


  1. Higgins DM et al. #148. “Gender differences in correlates of pain intensity among veterans with musculoskeletal diagnoses.” Presented at: APS 2015. May 13-16, 2015. Palm Springs, California.