The impact of chronic pain in the community

Background. Chronic pain is known to be very common in the community. Less is known about the epidemiology of more significant or severe chronic pain. The impact of chronic pain in the community, in terms of general health, e mployment and interference with daily activity, has not been quantified. Objectives. The aim of this study was to describe the prevalence and distri bution in the community of chronic pain defined as 'significant' and 'sever e', and to explore the impact of chronic pain on health and activity. Methods. A questionnaire survey was carried out of a sample drawn from the general population in the Grampian region of Scotland. Questionnaires were sent to a random sample of 4511 individuals aged 25 years and over, stratif ied for age and gender, selected from the practice lists of 29 general prac tices (total practice population 136 383). The study instrument included a case definition questionnaire, from which were identified individuals with 'any chronic pain' (pain of at least 3 months duration). The instrument als o included a level of expressed need questionnaire and the chronic pain gra de questionnaire, from which were derived definitions for 'significant chro nic pain' (based on the reported need for treatment and professional advice ) and 'severe chronic pain' (based on reported intensity and pain-related d isability). The SF-36 general health questionnaire and demographic question s were also included. Results. Of the sample, 14.1% reported 'significant chronic pain', and this was more prevalent among women and older age groups. A total of 6.3% repor ted 'severe chronic pain', and this was more common in older age groups. On multiple logistic regression modelling, female gender, housing tenure, emp loyment category and educational attainment were found to be independently associated with both 'significant' and 'severe' chronic pain. The presence of 'any', 'significant' and 'severe' chronic pain had progressively more ma rked adverse associations with employment, interference with daily activiti es and all measured dimensions of general health. Conclusions. Comparison of the epidemiology of 'significant chronic pain' a nd 'severe chronic pain' with 'any chronic pain' allows an understanding of the more clinically important end of the chronic pain spectrum. These resu lts support the suggestion that chronic pain is multidimensional, both in i ts aetiology and in its effects, particularly at this end of the spectrum. This must be addressed in management and in further research.