Study: Childhood war exposure leaves lasting pain

BUFFALO, N.Y. – Children who experience malevolent wartime living conditions, and wartime violence in particular, are more likely than adolescents or young adults to develop chronic pain later in life, according to a new study by a University at Buffalo researcher.

The paper published in the Journal of Health and Social Behavior provides new insights into warfare’s lifelong health consequences, particularly for noncombatants, with critical policy implications related to post-war recovery efforts.

“Psychological distress and PTSD are elevated for children and account for a substantial proportion of increased pain prevalence among those exposed to war,” says Rui Huang, a graduate student in the UB Department of Sociology and Criminology, and the paper’s corresponding author. “Post-war recovery efforts should recognize this concern in ways that help policymakers develop effective programs.

“Reducing distress and PTSD could meaningfully reduce chronic pain and related disability later in life.”

Because war affects people differently across age cohorts, Huang says that interventions should be both culturally and age appropriate.

“For those who were of primary or secondary school age during wartime, strengthening educational access and quality during and after the conflict may help prevent negative outcomes later in life,” says Huang. “For those who were young children during wartime, interventions that promote healthy coping may be especially beneficial, given that children are more likely to adopt unhealthy behavioral responses to war, such as tobacco use.”

War exposure generates risk factors that can disrupt socioeconomic trajectories and instigate unhealthy coping behaviors. But it also produces often overlooked resilience factors that may promote better health, such as social engagement. Huang’s study looked at both risk and resilience to examine chronic pain as an outcome and how the pathways vary with age cohort.

Although over a quarter of the world’s 400 million children live in war-affected areas, studies on the long-term health consequences of war often concentrate on veterans in Western countries. Those studies rarely address chronic pain, a leading cause of disability worldwide that has greater personal and societal costs than any other prevalent chronic condition. 

Huang’s research used data from the 2018 Vietnam Health and Aging Study (VHAS), a longitudinal study that explores the long-term social and health impacts of the American war on the Vietnamese population to document how early-life exposure contributes to enduring pain. VHAS involved face-to-face interviews with 2,447 men and women in three provinces purposely chosen because they represent different spectrums of war exposure and bombing intensity.

“War generates both risks and resilience, so it’s important for policymakers to not only address health risks, but to also invest in promoting survivors’ resilience, which may yield long-lasting benefits,” says Huang. “The strikingly high overall prevalence of pain among older Vietnamese suggests an urgent need for pain prevention and management in Vietnam and in other conflict-affected countries with similar histories of mass military mobilization,” she says.