Abstract
BackgroundChronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys.MethodsA cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses.Results2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]).ConclusionChronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.
Highlights
Chronic pain is a major public health problem
Prevalence of chronic pain and of chronic pain stages 28.4% of the respondents reported constant or frequently recurring pain in the last 3 months. 5.3% of these persons reported malignant pain. These persons were excluded from further analyses. 26.9% reported pain of any severity in the Short Form Health Survey (SF)-8 not associated with malignancies during the last 4 weeks and met the Married/living together
Pain societies and researchers have made considerable efforts to promote the awareness of the public that chronic pain is a major health problem [2,3,4]
Summary
Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. The high prevalence of chronic pain and its negative societal burden provide justification for regarding chronic pain as a public health priority [2,3]. Prevalence estimates of chronic pain in population studies range from 11% to 64% in [3,4]. Problems with the classification of chronic pain exclusively based on duration have been discussed. Studies with primary care patients suggested that a distinction between acute and chronic pain based on 3-month or 6-month duration may be arbitrary [7,8]. Additional criteria than duration such as disability should be considered when classifying chronic pain [8]. Instruments to differentiate between non-disabling and disabling pain have been developed [9], but were not used by most surveys on chronic pain in the general population [2,4]
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