Elsevier

Mayo Clinic Proceedings

Volume 90, Issue 1, January 2015, Pages 139-147
Mayo Clinic Proceedings

Symposium on pain medicine
The Epidemiology and Economic Consequences of Pain

https://doi.org/10.1016/j.mayocp.2014.09.010Get rights and content

Abstract

Pain is considered a major clinical, social, and economic problem in communities around the world. In this review, we describe the incidence, prevalence, and economic burden of pain conditions in children, adolescents, and adults based on an electronic search of the MEDLINE and EMBASE databases for articles published from January 1, 2000, through August 1, 2014, using the keywords pain, epidemiology, burden, prevalence, and incidence. The impact of pain on individuals and potential risk factors are also discussed. Differences in the methodology and conduct of epidemiological studies make it difficult to provide precise estimates of prevalence and incidence; however, the burden of pain is unquestionably large. Improved concepts and methods are needed in order to study pain from a population perspective and further the development of pain prevention and management strategies.

Section snippets

Defining the Incidence and Prevalence of Pain

Describing the epidemiology of pain is challenging because of the subjective nature of the symptoms and a lack of consensus regarding specific diagnoses and definitions of conditions. Identifying true “incident” (or first-ever) episodes of pain, especially musculoskeletal pain, is problematic because of recall over a lifetime. Many pain conditions are episodic, with a large proportion of patients reporting symptoms that resolve and then recur with varying time periods in between. The true

Pain in Children and Adolescents

Pain conditions in children and adolescents have become the focus of an increasing amount of scientific literature in recent years.3, 4 The occurrence of pain in children takes on added importance in light of the growing evidence that implicates pain in childhood or adolescence as a predictive factor for pain in adulthood.5, 6, 7 Children experiencing pain may miss school and withdraw from social activities and are at risk for the development of negative health behaviors such as physical

Health Impacts of Pain

Pain conditions, especially chronic pain, place a substantial burden on patients and their families. In most patients, it negatively affects overall perceptions of general health, interferes considerably with everyday activities, is associated with depressive symptoms, and dramatically and negatively affects relationships and interactions with others.21, 40 Interference with functioning and well-being appears to be significantly associated with increasing pain severity.21, 41

For the purposes of

Risk Factors for Pain

Identifying factors that are related to the onset of pain conditions in the population is difficult because differences in study methodology and reporting markedly impact the estimates of incidence. For this review, we focus on the main categories of risk factors: age, sex, social (group) factors, and individual factors. In general, there is a lack of available evidence on risk factors for pain. Future studies are required that consider all aspects of the pain experience from both an individual

Individual Economic Burden

Chronic pain has an undeniable impact on a patient’s quality of life; however, there are also financial consequences. Caring for those with chronic pain can also lead to financial costs, with the mean cost per adolescent experiencing chronic pain in the United Kingdom being approximately £8000 per year, including direct and indirect costs.55 Patients may also find themselves needing to pay for activities that they can no longer perform, such as housekeeping.56

It has been estimated that

The Challenges of Pain Epidemiology Research

Despite restricting the focus of this review to 1-year incidence and 1-month prevalence periods, the range of incidence and prevalence estimates for pain conditions reported in the literature is still large. These differences in estimates, often for the same condition, could be due to a variety of methodological issues inherent to pain epidemiology research. As discussed previously, the lack of a case definition or diagnosis makes identifying cases difficult, especially in population-based

Conclusion

Pain represents a major clinical, social, and economic problem across all ages, with estimates of the monthly prevalence ranging from 1.0% to over 60.0%. In addition, pain conditions appear to have the greatest negative impact on quality of life compared with other health problems, and they contribute the most to disability around the world. The impact of pain on economies is enormous, with the total cost of pain estimated to be up to 3.0% of the GDP. The annual cost of pain is greater than the

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    For editorial comment, see page 4

    Grant Support: Dr Maher’s research fellowship is funded by the Australian Research Council. Dr Kamper’s research fellowship is funded by the National Health and Medical Research Council of Australia.

    Individual reprints of this article and a bound reprint of the entire Symposium on Pain Medicine may be available for purchase from our website www.mayoclinicproceedings.org.

    The Symposium on Pain Medicine will continue in an upcoming issue.

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