Page 78 - Journal of Special Operations Medicine - Fall 2015

Associations Among Back and Extremity Pain
With Alcohol, Tobacco, and Caffeine Use
Among US Air Force Pararescuemen

Craig J. Bryan, PsyD; Andrea L. Wolfe, MS; Chad E. Morrow, PsyD;
James A. Stephenson, PsyD; Jeremy Haskell, PsyD; AnnaBelle O. Bryan, BSPH

ABSTRACT

Background: Caffeine, tobacco, and alcohol are the drug use over a 12-month period found that alcohol and
most widely used substances globally, but the majority tobacco were the most widely used substances, with a
of research on the associations among legal substance prevalence of 90.8% and 56.7%, respectively. Caffein-
use and physical health has focused on the general ated drinks were ranked the fourth most frequently used
population, not elite military personnel. The purpose of substances, with a prevalence of 45.9%. The health ef-
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the current study was to describe patterns of tobacco, fects of these three “legal drugs” have received consid-
alcohol, and caffeine use and to examine the relation- erable scientific attention and are well documented. For
ship of legal substance use with self-reported physical example, caffeine use is associated with a wide variety of
health complaints among US Air Force Pararescuemen outcomes, both positive and negative, ranging from el-
(PJs) and Combat Rescue Officers (CROs). Methods: evating mood and improving psychomotor performance
Participants were 196 US PJs and CROs. Participants to increasing the frequency and intensity of headaches,
completed self-report measures of legal drug use and insomnia, and irritability. From the cumulative infor-
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somatic symptoms. Generalized linear modeling with mation gathered on tobacco use, we now know that
robust maximum likelihood estimation was used for smoking cigarettes and use of smokeless tobacco harms
multivariate regression analyses. Chi-square analyses almost every bodily organ and is the leading contribu-
were conducted for univariate comparisons of categori- tor to preventable causes of death in the United States.
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cal variables. Results: Reported rates of tobacco use Alcohol is related to more than 60 different medical
(28.2%), alcohol consumption (83.2%), and regular conditions, including malignant neoplasms, psychiatric
caffeine consumption (88.8%) were similar to the gen- disorders, cardiovascular diseases, accidental injury, and
eral population. Daily caffeine intake was significantly pain conditions. 2–5
higher among participants reporting they were bothered
a lot by back pain [Wald χ (2) = 11.39; p = .003] and ex- To date, however, the considerable proportion of re-
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tremity pain [Wald χ (2) = 11.39; p = .003], even when search on legal substance use and their associations with
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controlling for age and deployment history. Participants health has focused on the general population and, to
with severe extremity pain also reported drinking ap- a lesser extent, conventional military forces. Compara-
proximately twice as many alcoholic beverages per week tively little research has examined legal substance use
(mean, 5.46; standard error [SE], 0.91) than participants in elite military groups such as Special Duty or Special
who were bothered a little (mean, 2.88; SE, 0.54) or not Operations personnel. Special Duty military personnel
bothered at all (mean, 2.88; SE, 0.52) by extremity pain. include intensively trained individuals who are carefully
Conclusion: Back and extremity pain is associated with selected from the larger military population to conduct
greater caffeine and alcohol consumption among PJs. high-risk missions in “hostile, denied, or politically and/
or diplomatically sensitive environments.” Because of
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Keywords: military; caffeine; alcohol; tobacco; pain; the high physical demands of these occupations, health
Pararescuemen and fitness standards exceed those of the conventional
forces and remain at the forefront of the training and
lifestyles of Special Duty personnel. The high physi-
cal demands placed on Special Duty and Special Op-
Introduction
erations personnel can take a considerable toll, and
Caffeine, tobacco, and alcohol are among the most result in injury patterns that differ from conventional
widely used substances globally, in large part because military forces. For example, although Special Opera-
of their designation as legal substances. For instance, tions personnel have lower injury rates compared with
a recent international study assessing the prevalence of conventional forces, 50% of these injuries are traumatic

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