Validation of a Limitations in Daily Activities Scale for Chronic Pain

Overlap of pain-related and general measures of disability among adults with chronic pain

PURPOSE

Chronic pain is known to be correlated with disability. We aimed to determine the overlap between a general self-reported measure of disability and a measure of disability due to pain problems among adults with chronic pain.

MATERIALS AND METHODS

We used data from the National Health Interview Survey (NHIS) and analyzed respondents with chronic pain in the past 3 months. General disability was defined as being limited in the kind or amount of work one can do due to any physical, mental, or emotional problem. Pain-related disability was defined as pain limiting one's activity on "most days" or "every day."

RESULTS

Based on a sample of 6874 respondents with chronic pain, 58% had either kind of disability, including 9% who reported only pain-related, but not general disability; and 27% who reported both types of disability. Respondents reporting only pain-related, but not general disability tended to be younger and had lower rates of obesity, smoking, diabetes, and hypertension than respondents reporting both pain-related and general disability.

DISCUSSION

Among people with chronic pain, most people with disability are experiencing limitations related to pain problems. Assessment of disability without addressing pain interference has likely underestimated the disability burden in this population.

A biopsychosocial examination of chronic back pain, limitations on usual activities, and treatment in Brazil, 2019

Background

Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people.

Objectives

This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services.

Methods

Using Brazil’s National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment.

Results

PNS-2019 data showed that 23.4% (95% CI 22.8–24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment.

Conclusion

The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.

An international study of analgesic dependence among people with pain in the general population

BACKGROUND

Overuse of and dependence on analgesics (including opioids and other pain medications) are major international public health problems.

OBJECTIVE

To identify influences on analgesic dependence among analgesic users in the general populations of different countries.

METHODS

Online surveys of 1,283 people with pain in the UK, USA, Australia, Germany, Egypt and China/Macau/Hong Kong.

RESULTS

Levels of analgesic overuse and dependence were highest in Egypt and lowest in China/Macau/Hong Kong. In every country except Egypt, frequency of pain and frequency of analgesic use were correlated with analgesic dependence, and scores on the Need subscale of the Pain Medication Attitudes Questionnaire (PMAQ) independently predicted analgesic dependence. In the UK, USA, Australia, and Germany, frequency of analgesic use mediated the effects of pain frequency or intensity, and Need scores mediated the effects of frequency of analgesic use. In Egypt, more recent pain, analgesic overuse, and the Emotion and Solicitude subscales of the Survey of Pain Attitudes independently predicted analgesic dependence.

CONCLUSIONS

Across multiple countries, the impact of pain on analgesic dependence was mediated by frequency of analgesic use rather than overuse or abuse, and self-reported need for analgesics was the strongest independent predictor of dependence. Asking people directly about their feelings of needing analgesics could therefore identify those who could be helped to use analgesics less frequently, which should reduce their risk of dependence.