323 - Toxic Exposures and Chronic Overlapping Pain Conditions in a Veteran Cohort: Gender-Specific Insights [...], 2025, Gerstenberger et al

323 - Toxic Exposures and Chronic Overlapping Pain Conditions in a Veteran Cohort: Gender-Specific Insights from the Million Veteran Program

Armand Gerstenberger, Niloofar Afari, Marianna Gasperi

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Chronic overlapping pain conditions (COPCs) include migraine, tension headache, irritable bowel syndrome, chronic back pain, fibromyalgia, chronic fatigue syndrome, and chronic prostatitis. Environmental toxicants may increase COPC risk, but this is underexplored in Veterans.

Analyzing data from the Million Veteran Program, with 542,461 Veterans (91% men), we evaluated the association between self-reported toxic exposures (e.g., Agent Orange, biological/chemical warfare agents [BCWA], anthrax vaccine, pyridostigmine bromide [PB], petroleum combustion products [PCP], pesticides, and open-air burn pits), self-reported pain ratings (0 to 10), and the lifetime prevalence of electronic health record COPCs. Models were adjusted for age, gender, service eras, and military branch.

Prevalence of COPCs ranged from 53.7% for CBP to 1.75% for fibromyalgia, while toxicant exposure ranged from 68.3% for PCP to 5.49% for PB. Women were more likely to have a history of COPCs, and men reported more toxicant exposure than women (both p<.001).

Toxicant exposure was associated with higher pain ratings [average difference (3.42 vs. 4.32; p<.001)]. The strongest association was with BCWA (OR=1.43; 95%CI=1.41-1.46) and PB (OR=1.21; 95%CI=1.16-1.25).

Toxicant exposure was associated with higher odds of COPCs, with BCWA (average AOR=1.67; 95%CI=1.59-1.75), PB (average AOR=1.60; 95% CI=1.50-1.72), and open-air burn pits (average AOR=1.39; 95% CI=1.33 - 1.46) showing the strongest relationship. The strongest link was between FM and PB (AOR=3.04; 95% CI=2.78 - 3.31) and BCWA (AOR=2.59; 95% CI=2.39-2.79).

Results showed stronger relationships between toxicant exposure and COPCs in men (average AOR=1.40 for men vs. 1.31 for women).

Further research should explore the mechanisms underlying these associations.

Link (The Journal of Pain) [Paywall]