Elsevier

The Lancet

Volume 354, Issue 9186, 9 October 1999, Pages 1248-1252
The Lancet

Articles
The epidemiology of chronic pain in the community

https://doi.org/10.1016/S0140-6736(99)03057-3Get rights and content

Summary

Background

Chronic pain is recognised as an important problem in the community but our understanding of the epidemiology of chronic pain remains limited. We undertook a study designed to quantify and describe the prevalence and distribution of chronic pain in the community.

Methods

A random sample of 5036 patients, aged 25 and over, was drawn from 29 general practices in the Grampian region of the UK and surveyed by a postal self-completion questionnaire. The questionnaire included case-screening questions, a question on the cause of the pain, the chronic pain grade questionnaire, the level of expressed needs questionnaire, and sociodemographic questions.

Findings

3605 questionnaires were returned completed. 1817 (50·4%) of patients self reported chronic pain, equivalent to 46·5% of the general population. 576 reported back pain and 570 reported arthritis; these were the most common complaints and accounted for a third of all complaints. Backward stepwise logistic-regression modelling identified age, sex, housing tenure, and employment status as significant predictors of the presence of chronic pain in the community. 703 (48·7%) individuals with chronic pain had the least severe grade of pain, and 228 (15·8%) the most severe grade. Of those who reported chronic pain, 312 (17·2%) reported no expressed need, and 509 (28·0%) reported the highest expressed need.

Interpretation

Chronic pain is a major problem in the community and certain groups within the population are more likely to have chronic pain. A detailed understanding of the epidemiology of chronic pain is essential for efficient management of chronic pain in primary care.

Introduction

Chronic pain is recognised as a common problem within the community, and is known to affect general health,1 psychological health,2, 3, 4 and social and economic well-being.5, 6 Chronic pain is one of the most common reasons why people seek medical care; patients with chronic pain use health services up to five times more frequently than the rest of the population.7, 8 Chronic pain also results in many days lost from work.9 Nevertheless, our understanding of the epidemiology of chronic pain remains limited. Several previous studies of the prevalence of chronic pain have been based on patients attending pain clinics,10, 11 but these patients represent one extreme of the population with chronic pain and are not likely to be representative of the general population.12, 13

Good community-based epidemiological studies have been difficult to do. Many approaches used to estimate the prevalence of chronic pain have had limitations, such as the use of non-specific measurement instruments.9, 14 Some studies have concentrated on patients with specific pain-related diagnoses, such as back pain, fibromyalgia, and chronic musculoskeletal pain,2, 15, 16 and others have been small.14 Previous estimates of the prevalence of chronic pain in the general population have ranged from 2% to 45%.2, 3, 9, 14, 16, 17, 18

We present results from an epidemiological study of chronic pain, designed to quantify and describe the prevalence of chronic pain in the community, according to age, sex, and sociodemographic status.

Section snippets

Participants and procedures

The International Association for the Study of Pain defines chronic pain as “pain that persists beyond normal tissue healing time, which is assumed to be 3 months”.19 This definition does not allow for intermittent pain, so for the purposes of this study we defined chronic pain, after pilot testing, as “pain or discomfort, that persisted continuously or intermittently for longer than 3 months”.

The study was done in the Grampian region of northeast Scotland. All practices that used the General

Results

Of the 5036 individuals randomly selected, 425 were excluded from the survey by general practitioners (figure). The reason for exclusion was not always given. 267 exclusions were explained: 72 patients had died; 99 were no longer registered with the practice; 18 had terminal illness; 43 were demented, frail, or very elderly; nine had mental illness; 12 were in hospital; and 14 were excluded for other reasons. Of 4611 questionnaires mailed, 176 questionnaires were not delivered because the

Discussion

This study shows that chronic pain is a major problem in the community, with about half of the sample reporting chronic pain; after standardisation we estimate that 46·5% of the general population have chronic pain. This figure is higher than previous estimates of chronic-pain prevalence in general population studies.2, 3, 9, 14, 16, 17, 18 This discrepancy is likely to reflect differences in the research methods and case definitions used; differences that previously accounted for the majority

References (25)

  • J Latham et al.

    The socioeconomic impact of chronic pain

    Disabil Rehabil

    (1994)
  • D Locker

    Disability and disadvantage

    (1983)
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