Epidemiology of Pain

Original Editor - Alberto Bertaggia.

Top Contributors - Alberto Bertaggia, Rachael Lowe, Jo Etherton and Amanda Ager  

Introduction

As of today, it is difficult to define the epidemiology of pain because of its subjective nature of the symptoms and the lack of consensus for specific diagnoses and conditions, therefore it is hard to talk about evidences for the true incidence of most pain conditions[1].

People can experience pain as an acute acute, chronic, or intermittent condition, or a combination of the three[2]. Specifically, chronic pain is a complex condition embracing physical, social and psychological factors, consequently leading to disability, loss of independence and poor quality of life (QoL)[3]. It seems clear there is the need for Public Health to address pain as a disease itself[4][5], rather than a simple symptom, in order to provide better interventions for the management and the prevention of pain[6].

Epidemiology

As stated above, there is a lack of evidences for the incidence of pain[1]. Despite this, a world-scale epidemiolgy report of 2008 produced by Tsang et al. shows an age-standardized prevalence of chronic pain conditions in the previous 12 months of 37.3% in developed countries and 41.1% in developing countries, with an overall prevalence of 38.4%[7]. The pictures belows shows the crude prevalence of any pain condition in previous 12 months (%) among various countries[7] with data from the Tsang et al. 2008's report.

Crude prevalence of any pain condition in previous 12 months (%).
Crude prevalence of any pain condition in previous 12 months (%).
A 2006 study state that approximately 20% of the adult European population were having chronic pain with fewer than 2% of sufferers ever attend a pain clinic and one-third of the chronic pain sufferers were currently not being treated[3].

Furthermore, it has been estimated that 1 in 5 adults suffer from pain and that another 1 in 10 adults are diagnosed with chronic pain each year globally[8]

Socio-demographic factors associated with chronic pain

Gender

Adult female individuals show a higher preponderance for chronic pain, associated with lower pain thersholds and tolerance[9]. Furthermore, pain episodes are more frequent and of longer duration in women than men[10][11]. However, the greatest gender differences are seen in the prevalence of chronic pain syndromes[12].

There is still debate as to whether this sex difference is due to the underlying biological mechanisms of pain or the contribution of psychological and social factors[11].

Age

There is not a clear relationship between age and onset of pain conditions[13][14], but, generally speaking, there is a higher prevalence of chronic pain in older age[15]. Regarding this, recent studies have found that pain remains a prevalent and serious problem in older age, demonstrated by the following data: the prevalence of chronic pain in older people (>65 years) living in the community ranges from 25.0% to 76.0%, while the prevalence of chronic pain in older people living in residential care is much higher and ranges from 83.0% to 93.0%[16].

Given that the world's population aged >65 is likely to double in the next 40 years, treatment needs to take cognisance of pain-related co-morbidities and polypharmacy[6].

Socio-economic status

Population-based studies of chronic pain have consistently shown that chronic pain occurrence is inversely related to socio-economic status[17][18] with evidence that people living in adverse socioeconomic circumstances experience more chronic pain and greater pain severity[19][20], independent of other demographic, and clinical factors.

However, because of differences in methodology, this types of comparison should be interpreted with caution[1].

Other individual factors

  • Occupational factors have been associated with the onset of musculoskeletal pain, such as high job demands, job insecurity, sedentary work position, job dissatisfaction, low levels of social support in the workplace, and whole-body vibration[21][22].
  • Lifestyle factors such as smoking, obesity, and poor health status may also play a role in the development of pain conditions[23].
  • Psychosocial variables thought to have impact on pain prevalence include stress, anxiety, depression, low self-esteem, and the presence
    of chronic health problems[24][21].

Economic impact of pain

Pain surely worsen the quality of life of sufferers, but it also represents an economic burden, both for individuals and health care systems.

Individual costs are constituted from direct costs (e.g. paying for medical care) and indirect costs (e.g. paying for activities people are no longer able to perform)[1][25]. Among the indirect costs, lost work productivity represents the majority of overall costs associated with low back pain[26]. It has been estimated that individuals with moderate to severe chronic pain lose an average of 8 days of work every 6 months, and 22% lose at least 10 workdays[27].

Furthermore, workforce is in continuous ageing in many countries, and this could lead to a major economic impact whether these individuals will need to retire due to painful health conditions[28].

Patients with pain conditions consume close to twice as much health care resources as the general population[1]. The management of pain requires a range of services, for which the costs are substantial, althought it differs based on country and condition. Numbers are anyway huge, with some examples like Belgium health care system spending between 83 and 164 billion of euros in 2004 and UK's NHS paying 1 billion pounds in 1998 only for low back pain[29].


Resources

Physiopedia PAIN category. 


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