The epidemiology and impact of chronic pain in the community
Aims: To describe the distribution and determinants of chronic pain in the community, and to assess its impact in physical, psychological and social dimensions. Design: Postal questionnaire survey. All elements of the questionnaire were tested for acceptability, reliability and validity in preliminary studies. Subjects and Setting: Two random samples of individuals from 29 general practices in Grampian, stratified for age (over 25) and gender. One sample (n=5,036) was drawn from the Community Health Index (CHI) and the other (n=4,175) was drawn from practice computer prescribing records. Outcome Measures: A Case Definition Questionnaire, the Chronic Pain Grade questionnaire, the SF-36 general health questionnaire and basic demographic questions. Results: Response rate was 84%. The sample prevalence of "any chronic pain" was 50%, and was higher among women and older age-groups. The prevalence of "significant chronic pain" was 14% in the CHI sample, and the prevalence of "severe chronic pain" was 6%. Employment status and level of the academic attainment were independently associated with the presence of chronic pain. Back pain (15%) and arthritis (14%) were the two most commonly reported causes of chronic pain in the CHI sample. Chronic pain of all causes had a significant on all dimensions of health, and on interference with work and daily activities. Social class, employment status and level of educational attainment were independently associated with greater pain-related interference with usual activities. Conclusions: A comprehensive profile of chronic pain in the community is provided. The prevalence and impact were high, as suggested by previous studies, and age and gender associations were largely confirmed. Detailed clinical and socio-demographic associations with chronic pain provide important information on areas where intervention or prevention might be effective. Common patterns of severity and impact suggest that the cause of chronic pain is relatively unimportant in determining the response to it. Areas for future research are suggested.