Combat Factors Associated With Pain and Opioid Use Among Veterans Interview with:Walter Reed Army Institute of ResearchDr. Robin L. Toblin
LCDR Robin L. Toblin, PhD, MPH (USPHS)
Clinical Research Psychologist
Walter Reed Army Institute of Research

MedicalResearch: What are the main findings of your study?

Dr. Toblin: Our study focused on chronic pain and opioid use in an infantry brigade three months after returning from war. We surveyed 2597 soldiers. The main findings showed that 44.0% reported experiencing chronic pain (pain for three months or longer) and 15.1% reported taking an opioid pain reliever in the past month. We also found that among those using opioids, 44.1% reported no or mild pain. Combat factors were associated with pain and opioid use, especially combat injuries.

Based on that, the key message of our findings is that war is hard on the body. We’re concerned about the level of pain and the levels of opioid use among infantry soldiers.

MedicalResearch: Were any of the findings unexpected?

Dr. Toblin:  We were surprised by the high rate of chronic pain. We know that a lot of soldiers come home injured and that war is hard on the body, but we didn’t expect nearly half of these young, and otherwise healthy, men and women to report chronic pain. We were also surprised that almost half of those using opioids reported no or mild pain given that opioids should generally be prescribed only for moderate to severe pain because of their addictive nature. Our data doesn’t show, though, if that’s due to acute pain, medications working well, or misuse.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Toblin:  A takeaway for clinicians is that while the current Army practice guidelines for the use of opioids to treat chronic pain recommend caution in their prescription, the Army and other services should examine prescription practices to ensure that opioid use is consistent with those guidelines and standards of care. They should also ensure that nonopioid alternatives are considered whenever possible due to their addictive nature. Further, they should continue enacting the recommendations from the Army’s 2010 Pain Management Task Force Report and continue enrolling as many returning soldiers in the Army’s comprehensive pain management program as possible.

For soldiers experiencing pain, they should address their pain as early as possible at military treatment facilities before the pain becomes more difficult to treat. They should also request nonopioid alternatives when possible.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Toblin:  We hope that future studies could examine both use and misuse and the reasons for people’s use within a survey. It would also be helpful if soldiers’ pharmacy and pain management visits could be linked to surveys that addressed pain. Some other research our group hopes to examine using our available data includes how the prevalence and risk factors for chronic pain and opioid use changes over time and the relationship between chronic pain and sleep, another major concern for the Army.


Toblin RL, Quartana PJ, Riviere LA, Walper K, Hoge CW. Chronic Pain and Opioid Use in US Soldiers After Combat Deployment. JAMA Intern Med. Published online June 30, 2014. doi:10.1001/jamainternmed.2014.2726. 

Last Updated on November 4, 2015 by Marie Benz MD FAAD