Comparison of musculoskeletal health in the general population between 2016/17 and 2022/3: A tapered matching study.

The Graded Chronic Pain Scale-Revised (GCPS-R) enables a standardised measure of chronic pain severity. Only sparse data are available on the prevalence of chronic pain stages assessed by the GCPS-R and the predictors of high-impact chronic pain (HICP) in the general European population. A cross-sectional cohort study surveyed 2498 people ≥ 16 years living in Germany in 2025. Self-reported measures were obtained for demographic variables, chronic pain stages and disease load (Patient Health Questionnaire 4 and chronic illness). Potential predictors of HICP (age, gender, education, net income, probable depressive and anxiety disorder, chronic illness) compared to no and mild-impact and to bothersome chronic pain were assessed by adjusted univariate and multivariate logistic regression analyses. Response rate was 37.9%. The prevalence of chronic pain present most or every day prior to 3 months was 11.4 (95% CI, 7.7% to 15.1%) of which 1.1% (-2.9% to 5.0%) with mild impact chronic pain; 3.3% (-0.6% to 7.2%) with bothersome impact chronic pain; and 7.1% (3.3% to 10.9%) with HICP. HICP compared to no and mild chronic pain was predicted in multivariate-adjusted analysis by age, lower educational level, lower income, probable anxiety and/or depressive disorder and chronic illness. Multivariate-adjusted analysis did not show significant associations of HICP with the selected variables when compared to bothersome pain. Biological, psychological and social factors are associated with HICP. Targeted pain services for populations at highest risk for HICP need to be developed. The prevalence of bothersome and high-impact chronic pain rather than prevalence rates of any chronic pain might provide evidence in support of pain specialist care. Identifying risk factors of high-impact chronic pain in specific populations could lead to an improved understanding of the risk factors, causes and consequences of chronic pain. European public health policies could be influenced by gathering data on high-impact chronic pain in other European countries.

Pain is understudied in Africa, and there are no data on high-impact chronic pain from this region. In this study, we assessed the prevalence of unspecified pain, chronic pain, and high-impact chronic pain, and their determinants in Lesotho, Southern Africa. We conducted a household-based, cross-sectional survey among adults aged 18 years or older in 120 randomly sampled villages across Butha-Buthe and Mokhotlong districts in Lesotho. Among the 6039 adults included, the median age was 39 years (interquartile range: 27-58), and 3153 of 6039 participants (52.2%) were female. Overall, 1194 participants (19.8%) had unspecified pain (95% confidence interval [CI]: 18.8-20.8), 909 (15.1%) had chronic pain (95% CI: 14.2-16.0), and 428 (7.1%) had high-impact chronic pain (95% CI: 6.5-7.8) corresponding to 47.1% among the participants with chronic pain. Higher age groups were associated with increasing odds of unspecified pain, chronic pain, and high-impact chronic pain. Male participants were less likely to have unspecified pain (adjusted odds ratio [aOR], 0.65; 95% CI: 0.55-0.76; P < 0.001) and chronic pain (aOR, 0.79; 95% CI: 0.65-0.96; P = 0.019). There was no association between sex and high-impact chronic pain. Furthermore, high-impact chronic pain was associated with arterial hypertension, diabetes mellitus, moderate-to-high risk of depression, moderate-to-high risk of generalized anxiety disorder, and household wealth. The prevalence of chronic pain and high-impact chronic pain was elevated in our study population. Associations with further noncommunicable chronic conditions, such as arterial hypertension and diabetes mellitus, support the need for health systems to provide integrated chronic care which includes pain management.

There is limited knowledge on whether and how health care access restrictions imposed by the coronavirus disease of 2019 pandemic have affected utilization of both opioid and nonpharmacological treatments among US older adults living with chronic pain. We compared prevalence of chronic pain and high impact chronic pain (ie, chronic pain limiting life or work activities on most days or every day in the past 6 months) between 2019 (pre-pandemic) and 2020 (first year of pandemic) and utilization of opioids and nonpharmacological pain treatments among adults aged ≥65 years enrolled in the National Health Interview Survey, a nationally representative sample of noninstitutionalized civilian U.S. adults. Of 12 027 survey participants aged ≥65 (representing 32.6 million noninstitutionalized older adults nationally), the prevalence of chronic pain was not significantly different from 2019 (30.8%; 95% confidence interval [CI], 29.7%-32.0%) to 2020 (32.1%; 95% CI, 31.0%-33.3%; p = .06). Among older adults with chronic pain, the prevalence of high impact chronic pain was also unchanged (38.3%; 95% CI, 36.1%-40.6% in 2019 versus 37.8%; 95% CI, 34.9%-40.8% in 2020; p = .79). Use of any nonpharmacological interventions for pain management decreased significantly from 61.2% (95 CI, 58.8%-63.5%) in 2019 to 42.1% (95% CI, 40.5%-43.8%) in 2020 (p < .001) among those with chronic pain, as did opioid use in the past 12 months from 20.2% (95% CI, 18.9%-21.6%) in 2019 to 17.9% (95% CI, 16.7%-19.1%) in 2020 (p = .006). Predictors of treatment utilization were similar in both chronic pain and high-impact chronic pain. Use of pain treatments among older adults with chronic pain declined in the first year of coronavirus disease of 2019 pandemic. Future research is needed to assess long-term effects of coronavirus disease of 2019 pandemic on pain management in older adults.

Chronic pain, one of the most common reasons adults seek medical care (1), has been linked to restrictions in mobility and daily activities (2,3), dependence on opioids (4), anxiety and depression (2), and poor perceived health or reduced quality of life (2,3). Population-based estimates of chronic pain among U.S. adults range from 11% to 40% (5), with considerable population subgroup variation. As a result, the 2016 National Pain Strategy called for more precise prevalence estimates of chronic pain and high-impact chronic pain (i.e., chronic pain that frequently limits life or work activities) to reliably establish the prevalence of chronic pain and aid in the development and implementation of population-wide pain interventions (5). National estimates of high-impact chronic pain can help differentiate persons with limitations in major life domains, including work, social, recreational, and self-care activities from those who maintain normal life activities despite chronic pain, providing a better understanding of the population in need of pain services. To estimate the prevalence of chronic pain and high-impact chronic pain in the United States, CDC analyzed 2016 National Health Interview Survey (NHIS) data. An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents. These findings could be used to target pain management interventions.

Objectives:To estimate the prevalence of chronic pain (CP) and high-impact chronic pain (HICP) in a sample of the general adult population in Saudi Arabia.Methods:This is a cross-sectional online survey (N=24,265). Forty data collectors from 5 regions of Saudi Arabia approached people to complete the questionnaires through different social media applications, using a validated survey in Arabic language.Results:Chronic pain and HICP prevalences in the Saudi adult population were found to be 46.4% (CP) and 4% (HICP), with a higher prevalence among women and elderly. Chronic back pain was the most reported pain location. Half of the respondents reported dissatisfaction with pain services. Greater prevalence of HICP was found among women, elderly, unemployed, and those with low-income status. Patients with HICP were more likely to have more healthcare utilization and have more negative impacts on their physical and psychological wellbeing.Conclusion:Chronic pain and HICP are common in Saudi Arabia, especially among females and elderly, suggesting a public health problem. This calls for collaborative efforts at various levels of the social hierarchy to ensure the provision of effective management of CP in Saudi Arabia.

A descriptive analysis of secondary data. The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. The US National Pain Strategy introduced a focus on high-impact chronic pain-that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. 3.

Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study

Public health interventions to prevent financial stressors and reduce chronic pain and high-impact chronic pain (HICP) are important to potentially improve the health of the US population. The objectives of our study were to provide an update on the prevalence of chronic pain and HICP and to examine relationships between financial stressors and pain. We used data from a cross-sectional sample of adults aged ≥18 years (n = 31 997) collected by the 2019 National Health Interview Survey. We constructed bivariate and multivariate models to examine chronic pain and HICP in relation to financial worries, employment with wages, income, sociodemographic characteristics, number of chronic health conditions, and body mass index. In fully adjusted multivariate regression models, having no employment with wages was strongly associated with increased risk for chronic pain (adjusted odds ratio [aOR] = 1.3; 95% CI, 1.2-1.5) and HICP (aOR = 1.6; 95% CI, 1.4-1.9). Worries about paying medical bills was associated with chronic pain (aOR = 1.1; 95% CI, 1.0-1.2) and HICP (aOR = 1.1; 95% CI, 1.0-1.3). Being unable to pay medical bills was associated with chronic pain (aOR = 2.1; 95% CI, 1.9-2.3) and HICP (aOR = 2.3; 95% CI, 2.0-2.6). Compared with having more income, having less income relative to the federal poverty level was associated with increased risk for chronic pain and HICP. We found a strong relationship between financial worries, employment for wages, income, and self-reported chronic pain and HICP independent of poor physical health and body mass index. Interventions to reduce chronic pain and HICP should address economic instability and financial stressors.

Prevalence of Chronic Pain among School-aged Children in the United States During the First Year of the COVID-19 Pandemic: A Nationally Representative Study

Exploring the prevalence and construct validity of high-impact chronic pain across chronic low-back pain study samples

Chronic pain (i.e., pain lasting ≥3 months) is a debilitating condition that affects daily work and life activities for many adults in the United States and has been linked with depression (1), Alzheimer disease and related dementias (2), higher suicide risk (3), and substance use and misuse (4). During 2016, an estimated 50 million adults in the United States experienced chronic pain, resulting in substantial health care costs and lost productivity (5,6). Addressing chronic pain and improving the lives of persons living with pain is a public health imperative. Population research objectives in the National Pain Strategy, which was released in 2016 by the Interagency Pain Research Coordinating Committee, call for more precise estimates of the prevalence of chronic pain and high-impact chronic pain (i.e., chronic pain that results in substantial restriction to daily activities) in the general population and within various population groups to guide efforts to reduce the impact of chronic pain (3). Further, a 2022 review of U.S. chronic pain surveillance systems identified the National Health Interview Survey (NHIS) as the best source for pain surveillance data (7). CDC analyzed data from the 2019-2021 NHIS to provide updated estimates of the prevalence of chronic pain and high-impact chronic pain among adults in the United States and within population groups defined by demographic, geographic, socioeconomic, and health status characteristics. During 2021, an estimated 20.9% of U.S. adults (51.6 million persons) experienced chronic pain, and 6.9% (17.1 million persons) experienced high-impact chronic pain. New findings from this analysis include that non-Hispanic American Indian or Alaska Native (AI/AN) adults, adults identifying as bisexual, and adults who are divorced or separated are among the populations experiencing a higher prevalence of chronic pain and high-impact chronic pain. Clinicians, practices, health systems, and payers should vigilantly attend to health inequities and ensure access to appropriate, affordable, diversified, coordinated, and effective pain management care for all persons (8).

Drawing on advances in chronic pain metrics, a simplified Graded Chronic Pain Scale-Revised was developed to differentiate mild, bothersome, and high-impact chronic pain. Graded Chronic Pain Scale-Revised was validated among adult enrollees of 2 health plans (N = 2021). In this population, the prevalence of chronic pain (pain present most or every day, prior 3 months) was 40.5%: 15.4% with mild chronic pain (lower pain intensity and interference); 10.1% bothersome chronic pain (moderate to severe pain intensity with lower interference with life activities); and 15.0% high-impact chronic pain (sustained pain-related activity limitations). Persons with mild chronic pain vs those without chronic pain showed small differences on 10 health status indicators (unfavorable health perceptions, activity limitations, and receiving long-term opioid therapy), with nonsignificant differences for 7 of 10 indicators. Persons with bothersome vs mild chronic pain differed significantly on 6 of 10 indicators (eg, negative pain coping beliefs, psychological distress, unfavorable health perceptions, and pain-related interference with overall activities). Persons with high-impact chronic pain differed significantly from those with mild chronic pain on all 10 indicators. Persons with high-impact chronic pain, relative to those with bothersome chronic pain, were more likely to have substantial activity limitations (significant differences for 4 of 5 disability indicators) and more often received long-term opioid therapy. Graded Chronic Pain Scale-Revised strongly predicted 5 activity-limitation indicators with area under receiver operating characteristic curve coefficients of 0.76 to 0.89. We conclude that the 5-item Graded Chronic Pain Scale-Revised and its scoring rules provide a brief, simple, and valid method for assessing chronic pain.

CA: A Cancer Journal for Clinicians publishes information about the prevention, early detection, and treatment of cancer, as well as nutrition, palliative care, survivorship, and additional topics of interest related to cancer care.

High-impact chronic pain significantly affects quality of life and poses burdens on healthcare systems. Public health strategies that shift modifiable risk factors at the population level may reduce its impact. A cross-sectional analysis was conducted using a population intervention model to estimate how changes in physical activity and body mass index might affect prevalence of high-impact chronic pain, using data from 166,926 UK Biobank participants. High-impact chronic pain was defined by the presence of chronic pain along with reduced health-related quality of life, measured using the Euroqol EQ-5D-5L instrument. The effects of shifts in risk factors varied across different levels of confounder adjustment were assessed. Increasing vigorous physical activity by two days per week and 20 min per session was associated with a reduction in high-impact chronic pain prevalence from 18.1% to 16.7% after adjusting for socio-demographic factors, and to 17.6% after further adjustment for comorbidities. A reduction in body mass index of 7% was associated with a reduction in high-impact chronic pain prevalence from 18.9% to 16.8% (unadjusted) and to 17.5% after full adjustment. Effects were consistent across subgroups defined by age, sex, and socioeconomic deprivation. These results provide estimates of how targeted population shifts might impact the prevalence of high-impact chronic pain, based on observed associations. This could help inform the development of public health strategies that promote physical activity and healthy weight at the population level to address the burden of high-impact chronic pain. PERSPECTIVE: This study estimates how population-wide changes in physical activity and BMI could reduce the prevalence of high-impact chronic pain. The findings support public health approaches that address shared environmental and social risk factors, rather than individual-level interventions.

High impact chronic pain (HICP) is a recently proposed concept for treatment stratifying patients with chronic pain and monitoring their progress. The goal is to reduce the impact of chronic pain on the individual, their family, and society. The US National Pain Strategy defined HICP as the chronic pain associated with substantial restrictions on participation in work, social, and self-care activities for at least 6 months. To understand the meaning and characteristics of HICP from the younger (<65 years old) and older adults (≥65 years old) with chronic pain, our study examined patients' perceived pain impact between the two age groups. We also characterize the degree of pain impact, assessed with the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI), between adults and older adults with HICP. We recruited patients at a tertiary pain clinic. The survey included open-ended questions about pain impact, the Graded Chronic Pain Scale-Revised to identify patients' meeting criteria for HICP, and the Patient-Reported Outcomes Measurement Information System (PROMIS®) 8-item PI short form (v.8a). A total of 55 younger adults (65.5% women, 72.7% HICP, mean age = 55.0 with SD of 16.2) and 28 older adults (53.6% women, 64.3% HICP, mean age = 72.6 with SD of 5.4) with chronic pain participated in this study. In response to an open-ended question in which participants were asked to list out the areas of major impact pain, those with HICP in the younger group most commonly listed work, social activity, and basic physical activity (e.g., walking and standing); for those in the older group, basic physical activity, instrumental activity of daily living (e.g., housework, grocery shopping), and participating in social or fun activity for older adults with HICP were the most common. A 2 × 2 ANOVA was conducted using age (younger adults vs. older adults) and HICP classification (HICP vs. No HICP). A statistically significant difference was found in the PROMIS-PI T-scores by HICP status (HICP: M = 58.4, SD = 6.3; No HICP: M = 67.8, SD = 6.3), but not by age groups with HICP. In conclusion, perceived pain impacts were qualitatively, but not quantitatively different between younger and older adults with HICP. We discuss limitations and offer recommendations for future research.