Comorbidities, intensity, frequency and duration of pain, daily functioning and health care seeking in local, regional, and widespread pain—a descriptive population-based survey (SwePain)

Abstract

BackgroundThe clinical knowledge of factors related to the spread of pain on the body has increased and understanding these factors is essential for effective pain treatment. This population-based study examines local (LP), regional (RP), and widespread pain (WSP) on the body regarding comorbidities, pain aspects, and impact of pain and elucidates how the spread of pain varies over time.Material and methodsA postal questionnaire that addressed pain aspects (intensity, frequency, duration and anatomical spreading on a body manikin), comorbidities and implications of pain (i.e., work situation, physical activity, consumption of health care and experience of hospitality and treatment of health care) was sent to 9000 adults living in southeastern Sweden. Of these, 4774 (53 %) completed and returned the questionnaire. After 9 weeks, a follow-up questionnaire was sent to the 2983 participants who reported pain in the first questionnaire (i.e. 62 % of 4774 subjects). Of these, 1940 completed and returned the questionnaire (i.e. 65 % of 2983 subjects). The follow-up questionnaire included the same items as the first questionnaire.ResultsThis study found differences in intensity, frequency and duration of pain, comorbidities, aspects of daily functioning and health care seeking in three pain categories based on spreading of pain: LP, RP and WSP. Compared to the participants with RP and LP, the participants with WSP had lower education and worse overall health, including more frequent heart disease and hypertension. In addition, participants with WSP had more intense, frequent, and long-standing pain, required more medical consultations, and experienced more impact on work. The participants with RP constituted an intermediate group regarding frequency and intensity of pain, and impact on work. The participants with LP were the least affected group regarding these factors. A substantial transition to RP had occurred by the 9-week follow-up.ConclusionsThis study shows an association between increased spread of pain and prevalence of heart disease, hypertension, more severe pain characteristics (i.e., intensity, frequency and duration), problems with common daily activities and increased health care seeking. The WSP group was the most affected group and the LP group was the least affected group. Regarding these factors, RP was an obvious intermediate group. The transitions between the pain categories warrant research that broadly investigates factors that increase and decrease pain.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0631-1) contains supplementary material, which is available to authorized users.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

“…The highest, and also similar, prevalence was found for LP and RP-Medium, results that are partly consistent with earlier investigations based on spreading of pain 24,31,40. The observation of the remarkably lower prevalence of WSP relative to those reported by other studies24,31,35,40 was somehow unexpected. The Manchester definition of WSP may account for this variability.…”

“…WSP – a common clinical entity – depends both on the number of pain sites and on their spatial distribution. A minority of subjects with RP-Heavy could have a higher number of pain sites than some of the subjects with WSP24; however, the 95% confidence intervals for the number of pain sites clearly differed between RP-Heavy and WSP. Subsequently, we also captured the duration of pain in months.…”

“…The subjects marked the site of their pain on a body manikin divided into a total of 45 sections on the front and on the back 24. Based on these 45 sections, 23 anatomical regions were determined and a total pain index score, ranging from 0 to 23, was calculated.…”

“…Widespread pain (WSP), in particular, is associated with lower levels of quality of life,28 decreased functionality and work status,29,30 and greater future disability 30. However, recent evidence suggests that not only WSP but also conditions with more limited pain spread can promote significant disabilities in the elderly 24. In fact, the majority of patients with pain cannot be classified into the WSP subgroup, and in order to cover the whole spectrum of “widespreadness”, some studies have used the number of pain sites based on a body manikin 30.…”

“…In fact, the majority of patients with pain cannot be classified into the WSP subgroup, and in order to cover the whole spectrum of “widespreadness”, some studies have used the number of pain sites based on a body manikin 30. As pointed out by Grimby-Ekman et al,24 identifying the number of painful sites may have advantages in epidemiological studies but lacks validity in a clinical setting. Spatial categories of pain used clinically are local pain (LP), regional pain (RP), and WSP 31,32.…”