A cross-national study of the course of persistent pain in primary care

Data from the World Health Organizations study of psychological problems in general health care were used to examine the course of persistent pain syn dromes among primary care patients. Across 15 sites in 14 countries, 3197 r andomly selected primary care patients completed baseline and 12-month foll ow-up assessments of pain, other somatic symptoms, and anxiety and depressi ve disorders (the Composite International Diagnostic Interview), and an ass essment of occupational role disability (the Social Disability Schedule). O f patients with a persistent pain condition at baseline, 49% had not recove red 12 months later. The probability of non-recovery varied significantly a cross study centers and was significantly associated with the number of pai n sires at baseline. After adjustment for age, sex, and study center, basel ine anxiety or depressive disorder did not predict non-recovery of persiste nt pain. Among those without a persistent pain disorder at baseline, the ra te of onset was: 8.8% with a significant variability in risk across centers . The baseline characteristics predicting the onset of persistent pain diso rder were psychological disorder, poor self-rated health, and occupational role disability. A persistent pain disorder at baseline predicted the onset of a psychological disorder to the same degree that a baseline psychologic al disorder predicted the subsequent onset of persistent pain. Persistent p ain conditions are common among primary care patients, and the probability of resolution over 12 months is approximately 50%. We found a strong and sy mmetrical relationship between persistent pain and psychological disorder. Impairment of daily activities appears to be a central component of that re lationship. (C) 2001 International Association for the Study of Pain. Publi shed by Elsevier Science B.V. All rights reserved.