Pain - there's a lot of it about [Dec 1999; 70-3]

Pain - there's a lot of it about
Survey How many people have chronic pain? What pains and when? How bad was the pain? How much help do people need? Comment

Bandolier is keen to know what is common. A superb study of chronic pain in the community [1] gives a bottom line answer that half of us suffer from chronic pain of some sort.

Survey

The study was done in the Grampian region of Scotland. There were just under 400,000 people in general practices which use the General Practice Administrative System for Scotland (GPASS), a common electronic data handling system that many believe is the best developed in the UK. Practices were invited to participate and about half did, and these covered about a third of the Grampian population. About 5000 questionnaires were sent to people from the practices, of which 4,400 were delivered and 3605 (four out of five) replied.

The definition of chronic pain used was "pain or discomfort, that persisted continuously or intermittently for longer than three months". The questionnaire was piloted and validated.

How many people have chronic pain?

Half of the respondents reported having chronic pain. This increased with age in women and men from about one-third of those aged 25-34 to almost two-thirds in those older than 65 years (Figure 1). Chronic pain is associated with older age, living in rented council accommodation, being retired or being unable to work.

Figure 1: Reported chronic pain by age and sex

What pains and when?

The two most common reasons for chronic pain were back pain, which varied little with age, and arthritis, which rose dramatically with age to afflict a quarter of people in their 60s or older (Figure 2). Angina was also more common in older age groups (Figure 2). Women's problems were more common (5-8%) in the age range 25-54 years than at older ages. Pain from injury and unknown causes was constant with age at about 4.5%.

Figure 2: Type of chronic pain by age

How bad was the pain?

The severity of chronic pain was measured using questions relating to the persistence and severity of the pain and the disability it caused. Patients were then classified into five grades, with grade 0 being pain free. The definitions used to grade the pain, and the proportion of people affected are shown in the Table. A quarter of people with chronic pain had pain that was highly disabling and at least moderately limiting. A further quarter had pain that was of high intensity.

Table: Grade of pain severity in people who reported having chronic pain

Pain grade	Description	Percent of people with chronic pain
Grade 1:	low disability/ low intensity	49
Grade 2:	low disability/ high intensity	24
Grade 3:	high disability/ moderately limiting	11
Grade 4:	high disability/ severely limiting	16

How much help do people need?

This was measured using four questions to try and assess demand for and uptake of health service resources.

Have you sought treatment for your pain or discomfort recently?
Have you sought treatment for your pain or discomfort often?
Have you taken painkillers for your pain or discomfort recently?
Have you taken painkillers for your pain or discomfort often?

Five levels of expressed need were determined from the number of positive responses to these questions, from level 0 (no expressed need; answered no to all four questions) to level 4 (high expressed need; answered yes to all four questions). The level of expressed need is shown in Figure 3 . Higher levels of expressed need were more frequent.

Figure 3: Expressed need in people with chronic pain

Comment

The merits of this study are that it is large, it uses pain definitions based on that of the International Association for the Study of Pain, and for most Bandolier readers, is British. It shows that about half of people in the community suffer chronic pain, and that for about half of those the pain is significant. The indications are that much of the pain is poorly treated and that there is a potentially large demand for more or better pain relief services for the community.

This is sobering stuff, because understandably much of the demand will be in older people, and we are set to have lots more older people in coming decades.

Reference:

AM Elliott et al. The epidemiology of chronic pain in the community. Lancet 1999 354: 1248-52.

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