The Epidemiology of Pain: An Australian Study.
The Results of a Telephone Survey in Brisbane.
By Simon L Strauss, Fiona H Guthrie*, and Fred Nicolosi*.
*At
the time (1986) this research was undertaken both these authors were
candidates for the degree of Master of Business Administration at the
University of Queensland. No funding was available other than from the
authors. Correspondence to Simon Strauss
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Summary of Findings
This report presents the results of a telephone survey on the prevalence rate of pain, the distribution of pain rates and the characteristics of pain according to selected demographic variables, and the treatment
undertaken by persons experiencing pain.
The key findings are as follows:
- the pain prevalence rate for households was 355 per 1000 head of population.
- the pain prevalence rate for households in the two weeks preceding the survey was 317 per 1000 head of population.
- the individual pain prevalence rate was 191 per 1000 head of population.
- the individual pain prevalence rate in the two weeks preceding the survey was 164 per 1000 head of population.
- as household size increased in the sample the pain prevalence rate decreased.
- as age increases the pain prevalence rate increases.
- Females have higher pain prevalence rates than males over all age 80 groups.
- the majority of respondents reported suffering from back pain
- the majority of respondents described their pain as discomforting (the second point of a five point scale based on the McGill Pain Questionnaire).
- the cause of pain for the majority of respondents was of unknown or spontaneous origin.
- the majority of respondents had suffered from pain for three years or more.
- the pain is generally experienced either continuously or on a daily basis.
- of those reporting pain, 86% had experienced this pain in the last two weeks.
- the majority of respondents (70%) visited a health professional for treatment. This health professional was a doctor in 80% of cases.
- respondents undertaking self-treatment or no treatment did so because they considered health professionals could not help.
The results of this survey are consistent with those from both overseas and those much larger studies reported recently in the popular Australian press.
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Full Paper
Introduction
The epidemiology of pain prevalence rates in western communities is beginning to be extensively studied.
The
Nuprin Pain Report (1) was a telephone survey of 1254 Americans
completed in 1985. This represented a cross-section of the adult
population in the United States.
In Canada, Crook et al (2)
interviewed the inhabitants of 500 households chosen from the roster of
a group family practice and in Sweden, Brattberg et al (3) conducted a
combination of a postal and telephone survey of 1009 randomly chosen
individuals.
This study investigates pain prevalence rates in a randomly selected sample of the Australian population.
Method
A random telephone survey of 265 households in the Central Brisbane Telephone Zone and the Outer Metropolitan Zones was undertaken in October/November 1987. This sample was based on an estimated prevalence rate of self reported pain of 20%.
The telephone numbers were
drawn from the Brisbane telephone directory. The sampling units
(households) were selected by choosing the 10th telephone number of the
middle column on every third page, starting at a page chosen by a
number from a random number table. Obvious business telephone numbers
were excluded, and the next private telephone number substituted. This
substitution introduces some bias in the probability of selection. One
follow up phone call was made to any number which was not answered
initially.
Those people who co-operated in the survey were asked
whether they or any other member of their household over 15 years of
age "were currently experiencing pain or regularly troubled with pain".
If a negative answer was received the interviewer asked for brief
demographic data only (sex and age of each person in the household over
fifteen years of age) and the survey terminated.
If a positive
response was received the full pain questionnaire was completed for
each person in the household currently experiencing pain or regularly
troubled with pain.
Whenever possible attempts were made to obtain the data directly from the person with the pain complaint.
Respondents
were asked to identify the location(s) of the pain, its intensity, its
frequency, whether it had been experienced in the last two weeks, the
circumstances surrounding onset, the length of time since onset,
whether they currently visited a health professional for the
paincondition or used self or no treatment, and whether the treatment
sought was effective.
The results were tabulated to address:
household and individual pain prevalence rates; a comparison of the
demographic characteristics of the pain and the no pain populations;
demographic characteristics of the pain population; pain
characteristics; and the treatment sought.
Results
The household and individual pain prevalence rates are presented in Figure
1. Of the 265 households included in the survey, 94 households had at
least one person who was currently experiencing pain or was regularly
troubled with pain, amounting to a household pain prevalence rate of
355 per 1000 head of population (35.5%). If it is assumed that all of
the households that refused to participate in the survey or could not
be reached were free of pain then the minimum household pain prevalence
rate would be 188 per 1000 head of population (18.8%).
Of the 94
households in which at least one person was currently experiencing pain
or regularly troubled with pain, there were 84 households in which one
or more persons reported that a pain condition had been experienced
within the two weeks preceding the survey. This amounted to a household
pain prevalence rate for pain in the two weeks preceding the survey of
317 per 1000 head of population (31.7%). The corresponding minimum pain
prevalence rate (defined as above) is 168 per 1000 head of population
A
total of 614 individuals participated in the survey. Of these 117
individuals reported that they were currently experiencing pain or
regularly troubled with pain amounting to an individual pain prevalence
rate of 191 per 1000 head of population (19.1%). A minimum individual
pain prevalence rate can be calculated by extrapolating the number of
individuals in the co-operating households to the number of households
contacted overall. This provides an estimated number of individuals of
1158 and a minimum pain prevalence rate of 101 per 1000 head of
population (10.1%).Of the 117 individuals reporting that they were
currently experiencing pain or regularly troubled with pain, 101 had
experienced this pain within the two weeks preceding the survey
amounting to an individual pain prevalence rate of 164 per 1000 head of
population (16.4%). The corresponding minimum pain prevalence rate was
87 per 1000 head of population (8.7%).
The demographic
characteristics of the survey population were compared using the chi
square statistic the variable of sex was not statistically significant
in discriminating between the pain and no pain groups. However the pain
and no pain groups differed significantly on the variables of age
(p<0.001) and household size (p<0.001). The pain population
tended to be older and live in smaller households in comparison to the
no pain population.
For all persons surveyed pain prevalence
rates increase with age. Females have higher pain prevalence rates
across all age groups except for the 15-30 year interval where the rate
is equal.
The overall responses to the pain characteristics investigated are reported below.
The
location of most severe pain for the majority of respondents was the
back (33%), followed by head and neck (24%), and leg (22%). The scale
used in the question about pain intensity was based on the Short Form
McGill pain questionnaire. The majority of respondents described their
pain condition as discomforting. For 45 percent of respondents their
pain condition was distressing or worse.
The circumstances
surrounding the onset of the pain condition were of unknown or
spontaneous origin for the majority of respondents (34%). Work related
injuries accounted for 21 percent of responses; nearly 85 percent of
respondents had experienced their pain condition for longer than 12
months and 67 percent had experienced their pain condition for longer
than 3 years; and the frequency of pain occurrences was continuous for
23 percent of respondents and daily for 30 percent of respondents. The
category of "other" includes respondents with random or seasonal
occurrences of pain.
The majority of respondents sought the
assistance of health professionals for the treatment of their pain
condition (70%). Of the remaining 30 percent, equal numbers used self
or no treatment. Doctors were the most commonly consulted health
professionals (84%).
Discussion
It was not always
possible for the pain questionnaire to be answered by the person with
the pain condition. In about half the cases the pain questionnaire was
answered by the person with the pain. Cross tabulations show that this
percentage varied across age groups with the lowest percentage of
persons reporting their own pain in the 15-30 year age group. This fact
introduces some bias and is a commonly encountered problem in telephone
health surveys(4).
However there is some evidence that proxies
can provide useful estimates of subjective experiences such as pain
when they live with the sufferer (5).
The Nuprin Pain Report (1)
does not report overall pain prevalence rates. The study investigated
seven specific types of pain and their prevalence in the preceding 12
months. The most common type of pain was headache (73%) followed by
backache (56%). These were also the most common pain conditions in this
study. The magnitude of the prevalence rates differ however; as the
Nuprin study included pain which had been experienced for even one day
in the preceding 12 months.
The study by Brattberg et al (3)
asked respondents "do you have/have you had any pain or discomfort in
any part of your body?". Sixty six percent of respondents had
experienced such pain or discomfort. It is difficult to relate this
result to the present study as again the question asked is quite
different. However the direction of other results is similar to those
found in this study. present pain or discomfort which had lasted for
more than 6 months was reported more frequently than pain which had
persisted for less than 6 months. Of those respondents whose pain had
persisted for longer than 1 month at least 75 percent reported pain
intensity as "like being stiff after exercise" or worse.
The initial question posed by Crook et al (2) was "are you or any member of your family ... often troubled with pain?".
This
was similar to the initial question posed in this survey of "are you or
any member of your household currently experiencing pain or regularly
troubled with pain?" The results obtained by Crook et al are very
similar to those obtained in this study. The household pain prevalence
rate reported by Crook et al for the two weeks preceding the survey was
35.2% and the minimum household pain prevalence rate was 26.2%. The
corresponding results in this study were 31.7% and 16.8%.
The
individual pain prevalence rate reported by Crook et al for the two
weeks preceding the survey was 16.1% and in this study was 16.4%. The
various prevalence rates in the studies cited above and in the present
paper indicate large variations. These variations relate to the type of
questions asked and the survey technique employed. Nevertheless all
studies show high prevalence rates which must be cause for concern.
Notwithstanding any possible biases due to the limitations naturally
imposed by a telephone survey, this study reveals an alarmingly high
prevalence of pain in an Australian community. Even an at worst result
calculation indicates a household pain prevalence rate of 18% and an
individual pain prevalence rate of 10%. In human terms a number of
people in the community have pain which affects their quality of life.
The economic cost to all of us must be considerable.
(1) Sternberg RA. Survey of pain in the United States: the Nuprin pain report. The Clinical Journal of Pain 1986; 2: 49-53.
(2) Crook J, Rideout E, Browne G. The prevalence of pain
complaints in a general population. pain 1984; 18: 299-314.
(3)
Brattberg G, Thorslund M, Wikman A. The prevalence of pain in a general
population. The results of a postal survey in a county of Sweden. pain
1989; 37: 215-222.
(4) Raj D. The design of sample surveys. Sydney: McGraw-Hill Book Company, 1972: 260-262.
(5) O'Brien J, Francis A. The use of next-of-kin to estimate pain in cancer patients. pain 1988; 35: 171-178.
