Epidemiology of Pain

Original Editor - Alberto Bertaggia.

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Introduction[edit | edit source]

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[edit | edit source]

As stated above, there is a lack of evidence 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 (%).

The 2017 Global Burden of Disease study found that the age standardised rates for point prevalence of neck pain was 3551.1 per 100 000.[8] The highest burden for neck pain was found in Norway, Finland, and Denmark.[8] A 2006 study states 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.[9]

Socio-demographic factors associated with chronic pain[edit | edit source]

Gender[edit | edit source]

Adult female individuals show a higher preponderance for chronic pain, associated with lower pain thersholds and tolerance[10]. Furthermore, pain episodes are more frequent and of longer duration in women than men[11][12]. However, the greatest gender differences are seen in the prevalence of chronic pain syndromes[13].

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[12].

Age[edit | edit source]

There is not a clear relationship between age and onset of pain conditions[14][15], but, generally speaking, there is a higher prevalence of chronic pain in older age[16]. 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%[17].

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[edit | edit source]

Population-based studies of chronic pain have consistently shown that chronic pain occurrence is inversely related to socio-economic status[18][19] with evidence that people living in adverse socioeconomic circumstances experience more chronic pain and greater pain severity[20][21], 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[edit | edit source]

  • 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[22][23].
  • Lifestyle factors such as smoking, obesity, and poor health status may also play a role in the development of pain conditions[24].
  • Psychosocial variables thought to have impact on pain prevalence include stress, anxiety, depression, low self-esteem, and the presence
    of chronic health problems[25][22].

Economic impact of pain[edit | edit source]

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][26]. Among the indirect costs, lost work productivity represents the majority of overall costs associated with low back pain[27]. 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[28].

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[29].

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[30].

Resources[edit | edit source]

Physiopedia PAIN category. 

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 Henschke N, Kamper SJ, Maher CG. The epidemiology and economic consequences of pain. Mayo Clin Proc. 2015 Jan;90(1):139–47.
  2. Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770.
  3. 3.0 3.1 Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;10(4):287–333.
  4. McGee SJ, Kaylor BD, Emmott H, Christopher MJ. Defining chronic pain ethics. Pain Med. 2011 Sep;12(9):1376–84.
  5. Tracey I, Bushnell MC. How Neuroimaging Studies Have Challenged Us to Rethink: Is Chronic Pain a Disease? The Journal of Pain. 2009 Nov;10(11):1113–20.
  6. 6.0 6.1 Hecke O van, Torrance N, Smith BH. Chronic pain epidemiology and its clinical relevance. Br J Anaesth. 2013 Jan 7;111(1):13–8.
  7. 7.0 7.1 Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008 Oct;9(10):883–91.
  8. 8.0 8.1 Safiri S, Kolahi AA, Hoy D, Buchbinder R, Mansournia MA, Bettampadi D et al. Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017. BMJ. 2020;368:m791.
  9. International Association for the Study of Pain: Unrelieved pain is a major global healthcare problem. available at: http://www.iasp-pain.org/files/Content/ContentFolders/GlobalYearAgainstPain2/20042005RighttoPainRelief/factsheet.pdf
  10. Wiesenfeld-Hallin Z. Sex differences in pain perception. Gender Medicine. 2005 Sep;2(3):137–45.
  11. Macfarlane TV, Glenny A-M, Worthington HV. Systematic review of population-based epidemiological studies of oro-facial pain. Journal of Dentistry. 2001 Sep 1;29(7):451–67.
  12. 12.0 12.1 Unruh AM. Gender variations in clinical pain experience. Pain. 1996 Jun;65(2–3):123–67.
  13. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, et al. Studying sex and gender differences in pain and analgesia: A consensus report. PAIN. 2007 Nov;132, Supplement 1:S26–45.
  14. Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006 Jan 5;35(3):229–34.
  15. Thomas E, Mottram S, Peat G, Wilkie R, Croft P. The effect of age on the onset of pain interference in a general population of older adults: Prospective findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain. 2007 May;129(1–2):21–7.
  16. Elliott AM, Smith BH, Penny KI, Cairns Smith W, Alastair Chambers W. The epidemiology of chronic pain in the community. The Lancet. 1999 Oct 9;354(9186):1248–52.
  17. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013 Mar;42 Suppl 1:i1-57.
  18. Blyth FM. Chronic pain – Is it a public health problem?: Pain. 2008 Jul;137(3):465–6.
  19. Poleshuck EL, Green CR. Socioeconomic Disadvantage and Pain. Pain. 2008 Jun;136(3):235–8.
  20. Brekke M, Hjortdahl P, Kvien TK. Severity of musculoskeletal pain: relations to socioeconomic inequality. Social Science & Medicine. 2002 Jan;54(2):221–8.
  21. Eachus J, Chan P, Pearson N, Propper C, Smith GD. An additional dimension to health inequalities: disease severity and socioeconomic position. J Epidemiol Community Health. 1999 Jan 10;53(10):603–11.
  22. 22.0 22.1 Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):769–81.
  23. Côté P, van der Velde G, David Cassidy J, Carroll LJ, Hogg-Johnson S, Holm LW, et al. The Burden and Determinants of Neck Pain in Workers. Eur Spine J. 2008 Apr;17(Suppl 1):60–74.
  24. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001 Feb;60(2):91–7.
  25. King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: A systematic review: Pain. 2011 Dec;152(12):2729–38.
  26. Kronborg C, Handberg G, Axelsen F. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients. Eur J Health Econ. 2009 Feb;10(1):5–13.
  27. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008 Feb;8(1):8–20.
  28. Reid KJ, Harker J, Bala MM, Truyers C, Kellen E, Bekkering GE, et al. Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Curr Med Res Opin. 2011 Feb;27(2):449–62.
  29. Schofield DJ, Shrestha RN, Passey ME, Earnest A, Fletcher SL. Chronic disease and labour force participation among older Australians. Med J Aust. 2008 Oct 20;189(8):447–50.
  30. Phillips CJ. Economic burden of chronic pain. Expert Rev Pharmacoecon Outcomes Res. 2006 Oct;6(5):591–601.