Musculoskeletal chronic pain in general practice - Studies of health care utilisation in comparison with pain prevalence

Objective-To study the relations between population prevalence of chronic p ain and pain-related diagnoses (musculoskeletal and headaches) in primary h ealth care (PHC) and to examine longitudinal variations in these diagnoses. Design-A population-based mailed survey to catch prevalence data and contin uous computerised diagnosis registration in PHC. Setting-General population in a well-defined Swedish PHC district. Subjects -A random sample of 15% of the population aged 25-74, n=1101. Annual visito rs to district physicians at the health centre. Main outcome measures-Rates of pain-related diagnoses in PHC in relation to population prevalence of c hronic pain. Comparisons of tbe number of individuals (annual visiting rate s) with pain-related diagnoses 1987-1996. Results-Population pain prevalence and pain-related diagnoses in PHC corres ponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-sh oulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. Conclusion-Pain-related diagnoses in PHC reflect partly the occurrence of s elf-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an in creased number of individuals with soft-tissue rheumatism and headaches. Fu ture studies will have to elucidate whether these findings are due to an in crease in morbidity or changes in care-seeking and social conditions.