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Chronic pain: epidemiological studies in a general population
Department of Community Health Sciences, Lund University, Sweden.ORCID iD: 0000-0001-9283-5096
1998 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to study the epidemiology of chronic pain (> 3 months duration) and factors associated to pain prevalence, prognosis, health care and medication in a general population. A cross-sectional mailed survey to a random population sample (n = 1806) was followed by a clinical examination and a prospective study of three selected groups. Pain related diagnoses from primary health care was monitored and compared with pain prevalence. The most important findings were: - a high total prevalence of chronic pain, 55.2%, without gender difference but varying by age and socioeconomic level. About one fourth (12.8%) reported high pain intensity and functional impairments. Women experienced pain at more locations and with higher intensity. - in a multivariate analysis increasing age, female gender, low education, high work strain, depression and insomnia were associated with chronic pain. - widespread pain showed a worse 2- year prognosis compared with neck shoulder pain. - musculoskeletal location of pain dominated, myalgia and myofascial pain being the most common symptom descriptions. - co-morbidity with chronic pain was common. More hypertensives and an increased level of serum uric acid associated to widepread pain indicated possible metabolic connections to pain. - smoking (current and previous) was associated with low-back and widespread pain. - chronic pain had a substantial influence of primary health care-seeking and medication; high pain intensity being the most important predictor of care and medication. - pain related diagnoses in primary health care increased between 1987 and 1996. Chronic pain, mainly with musculoskeletal location, is a community health problem. A multi-factorial approach in prevention and treatment on the basis of present knowledge is necessary.

Place, publisher, year, edition, pages
Lund: Univ. , 1998. , 142 p.
Keyword [en]
chronic pain, epidemiology, health care
National Category
Public Health, Global Health, Social Medicine and Epidemiology Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hkr:diva-968ISBN: 91-628-2935-1 (print)OAI: oai:DiVA.org:hkr-968DiVA: diva2:224979
Public defence
1998-04-29, Segerfalksalen, Wallenberg Neuro Centre, Lunds Universitet, Lund, 09:00 (Swedish)
Opponent
Supervisors
Note

ISRN LUMEDW/MECH-1025-SE

Available from: 2009-06-24 Created: 2009-06-23 Last updated: 2014-01-15Bibliographically approved
List of papers
1. Widespread musculoskeletal chronic pain associated with smoking: an epidemiological study in a general rural population
Open this publication in new window or tab >>Widespread musculoskeletal chronic pain associated with smoking: an epidemiological study in a general rural population
1998 (English)In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, Vol. 30, no 3, 185-191 p.Article in journal (Refereed) Published
Abstract [en]

Data on smoking and pain symptoms from a random sample (n = 1806) of a general population were used to evaluate the association between chronic pain at various locations and smoking. In both genders current smoking was associated with reports of increased pain in low back, neck and with multiple locations. In a multiple logistic regression analysis current smoking was associated with an increase in widespread chronic musculoskeletal pain (OR 1.60, CI 1.04-2.46, in relation to non-smokers) and chronic low back pain (OR 1.58, CI 1.13-2.20, in relation to non-smokers). A dose-response relationship was found between the daily cigarette consumption and the prevalence of chronic low back pain. Smoking is associated not only with low back pain but also with chronic widespread musculoskeletal pain. No conclusive decrease in pain prevalence was found after quitting smoking. Further studies are necessary to elucidate an aetiologic relationship between smoking and chronic pain.

Keyword
chronic pain, smoking, epidemiology
National Category
Public Health, Global Health, Social Medicine and Epidemiology Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-959 (URN)10.1080/003655098444129 (DOI)000075720700008 ()9782546 (PubMedID)
Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2014-01-15Bibliographically approved
2. Characteristics of subjects with chronic pain, in relation to local and widespread pain report: a prospective study of symptoms, clinical findings and blood tests in subgroups of a geographically defined population
Open this publication in new window or tab >>Characteristics of subjects with chronic pain, in relation to local and widespread pain report: a prospective study of symptoms, clinical findings and blood tests in subgroups of a geographically defined population
1996 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 25, no 3, 146-154 p.Article in journal (Refereed) Published
Abstract [en]

The relation between reported chronic pain and clinical findings was studied by comparing survey data six months before and eighteen months after a clinical examination. Studied individuals (n = 165) were randomly selected from subsamples of an initial survey (n = 1806) to a general population. Among individuals reporting chronic pain 85% were assessed to have chronic pain at the examination. Diagnoses were found in 22% of examined pain individuals. Myofascial pain syndrome and myalgia were the most common findings. Compared with located neck-shoulder pain, widespread pain had a greater impact on the individual, a worse prognosis regarding pain duration and working capacity, and revealed a raised serum urate level of unclear significance. Although no specific cause of pain is found in individuals with widespread pain it is important to identify and treat this group due to the great effects on functional capacity and the worse prognosis.

Keyword
chronic pain, uric acid, prognosis, widespread pain
National Category
Public Health, Global Health, Social Medicine and Epidemiology Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-956 (URN)10.3109/03009749609080005 (DOI)A1996UP87600006 ()8668957 (PubMedID)
Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2014-01-15Bibliographically approved
3. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.
Open this publication in new window or tab >>Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization.
1993 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 9, no 3, 174-182 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.

Keyword
epidemiology, chronic pain, gender
National Category
Public Health, Global Health, Social Medicine and Epidemiology Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-957 (URN)8219517 (PubMedID)
Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2014-01-15Bibliographically approved
4. Musculoskeletal chronic pain in general practice: studies of health care utilisation in comparison with pain prevalence
Open this publication in new window or tab >>Musculoskeletal chronic pain in general practice: studies of health care utilisation in comparison with pain prevalence
1999 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 2, 87-92 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.

Keyword
chronic pain, primary care, visits
National Category
Family Medicine Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-966 (URN)10.1080/028134399750002700 (DOI)000081708600007 ()10439491 (PubMedID)
Available from: 2009-06-23 Created: 2009-06-23 Last updated: 2014-01-15Bibliographically approved
5. Impact of chronic pain on health care seeking, self care, and medication: results from a population-based Swedish study
Open this publication in new window or tab >>Impact of chronic pain on health care seeking, self care, and medication: results from a population-based Swedish study
1999 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 53, no 8, 503-509 p.Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.

Keyword
chronic pain, health care, alternative care, medication
National Category
Family Medicine Medical and Health Sciences
Identifiers
urn:nbn:se:hkr:diva-894 (URN)000081705800013 ()10562870 (PubMedID)
Available from: 2009-06-10 Created: 2009-06-09 Last updated: 2014-01-15Bibliographically approved

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