Abstract
BackgroundPeople with musculoskeletal pain seek more healthcare than the general population, however little is known about the long-term effect on healthcare use. The aim of this study was to examine the consequences of number of musculoskeletal pain sites on long-term care-seeking and healthcare-related costs and explore how health anxiety influences this relationship.MethodsWe conducted a Danish population-based longitudinal cohort study of 4883 participants combining self-reported survey data from 2008 with ten-year follow-up data from national health registers. Using a causal inference framework, we examined associations between number of pain sites (range 0–7)/level of health anxiety (high/low level) and face-to-face healthcare contacts/healthcare-related costs. Data were analyzed using negative binomial regression with generalized estimating equations. Regression models were adjusted for sex, age, duration of pain, level of education, comorbidity, personality traits, risk of depression, marital status, physical job exposure, and previous healthcare utilization.ResultsFor each additional pain site general healthcare contacts (Incidence Rate Ratio (IRR): 1.04 (95% CI: 1.03–1.05)), healthcare-related costs (IRR: 1.06 (95% CI: 1.03–1.08) and musculoskeletal healthcare contacts (IRR: 1.11 (95% CI:1.09–1.14) increased. Those with high levels of health anxiety at baseline had a slightly higher number of general healthcare contacts (IRR 1.06 (1.01–1.11), independent of number of pain sites. However, level of anxiety did not influence the effect of number of pain sites on any healthcare use or cost outcomes.ConclusionsWe found evidence for a causal association between increasing number of pain sites and greater healthcare use and cost, and high levels of health anxiety did not increase the strength of this association. This suggests that number of pain sites could be a potential target for biopsychosocial interventions in order to reduce the need for future care-seeking.
Highlights
People with musculoskeletal pain seek more healthcare than the general population, little is known about the long-term effect on healthcare use
The aim of this study was to examine the consequences of number of musculoskeletal pain sites on long-term care-seeking and healthcare-related costs and explore whether health anxiety influences this relationship
Main results Based on a causal inference framework, this populationbased cohort study found that for every additional pain site a participant reported at baseline, over the subsequent 10 years their healthcare-contacts for any reason, healthcare-related costs and musculoskeletal-related healthcare contacts
Summary
People with musculoskeletal pain seek more healthcare than the general population, little is known about the long-term effect on healthcare use. The choice to seek care due to pain has been conceptualized by different theories, with the dominant conceptual framework of health services use being the ‘health behavioral model’ [9]. This model describes care-seeking as a function of individual and contextual predisposing factors, enabling/impeding factors, and perceived need for care [9, 10], driven by an individual’s subjective concerns about health, perception of need and health beliefs rather than an objective, evaluated need [11, 12]. Care-seeking could be viewed as a process [12, 14,15,16] that involves personality, psychological factors and beliefs/knowledge (e.g. fear avoidance, health anxiety, risk perceptions, stress, self-efficacy), comorbidity, type/nature of symptoms/diagnosis (e.g. location, duration, intensity, disability), and social factors [14, 17,18,19,20]
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