Background/Objectives: Military identity serves as a foundational lens through which service members navigate the events of everyday military and civilian life. However, the very process that cultivates a sense of unity and purpose can be a double-edged sword in civilian life. Although the prevalence and transition needs are known, few studies have explored how chronic pain specifically disrupts military identity in depth. This qualitative study explores three distinct trajectories through which Veterans with chronic pain experience identity change. Methods: This study used narrative inquiry involving two sets of in-depth interviews with 20 Veterans. Reflexive thematic analysis was employed to describe and differentiate three distinct trajectories of chronic pain. Results: Veterans with chronic pain experience identity change through three overlapping pain trajectories: (1) traumatic injury -> immediate discharge; (2) misdiagnosed/non-traumatic injury -> delayed discharge; and (3) cumulative wear and tear -> gradual discharge. Regardless of trajectory, chronic pain consistently disrupted military identity and forced Veterans to confront tensions between institutional expectations of stoicism and combat readiness and the physical realities of chronic pain during military service. Those interviewed described experiencing fragmented institutional support, uneven access to care, and the systemic invalidation of pain that did not conform to military ideals. Conclusions: These findings underscore the need for Veteran-centred approaches, including responsive services, comprehensive pain science education throughout military careers, early detection of conditions that can lead to chronic pain, and flexible care pathways tailored to the nuances of each pain trajectory and grounded in military culture and lifestyle.

LAY SUMMARY The current study involved interviews people with lived experience of military sexual trauma (MST) who met with Canadian Armed Forces leadership to share their stories with the goal of improving the institution’s response to incidences of MST. The findings explore future pathways that these types of sessions might hold for recovery.

Background Canadian Armed Forces (CAF) Veterans report living with chronic pain at nearly double the rate of comparable Canadians. Currently, little to no research focusses on CAF Veterans engaging in aquatic exercise as a physical activity-based rehabilitation program. To date, there have been eight randomized clinical trials comparing aquatic exercise to land-based exercise on function or disability for people with lower extremity musculoskeletal pain. While meta-analyses reveal no difference between these two groups in pain, function, and quality of life, this body of research is limited by small sample sizes and risks of bias, making it difficult to draw conclusions and apply the evidence of effectiveness in practice. There are opportunities to improve rigor by conducting a fully powered trial, however, there is need for a pilot study prior to a fully powered trial to determine the feasibility of carrying out the interventions and trial procedures. Methods A parallel group pilot randomized controlled trial (RCT) to determine the feasibility of conducting a future fully powered RCT to determine the effectiveness of aquatic exercise versus land-based exercise. Participants will be randomized in a 1:1 ratio to aquatic therapy or land therapy groups. In addition, semi-scripted participant interviews will be conducted in order to understand the acceptability of the interventions and trial methods, as well as barriers, facilitators and strategies for implementation through an interpretive description approach. Discussion While there is some existing evidence on the effectiveness of aquatic exercise for individuals living with pain, there is a need to conduct a more rigorous randomized controlled trial, particularly on CAF Veterans. A decision will be taken as to whether the study is recommended to progress to a full randomized controlled trial which includes the perspective of the organization and healthcare providers that are implementing the study protocol as well as the perspective of the participants. The purpose of a future RCT is to assess the effectiveness of aquatic exercise compared to traditional land-based exercise in order improve pain, physical function, and health-related quality of life for CAF Veterans living with pain. Trial registration: This protocol has been registered in ClinicalTrials.gov ID: NCT005869617 – May 16, 2023. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000D733&selectaction=Edit&uid=U0006MPH&ts=2&cx=t4hlaw