Pain that does not interfere with daily life—a new focus for population epidemiology and public health?

Abstract

BackgroundThe Global Burden of Disease study [20] has highlighted just how much disability is attributable to common syndromes of chronic pain such as back pain and osteoarthritis. Yet prevention of chronic pain remains low in national public health priorities in most countries.One reason may be that epidemiological research into causality and risk factors for disease onset, which has driven and underpinned public health transformation of the occurrence of diseases such as lung cancer and cardiovascular disease, has not provided an evidence base for population-level strategies and action to reduce the risk of chronic disabling pain. In this topical review, we consider the potential for epidemiological research on chronic pain to shift its customary focus in order to support a more practical public health target, namely to reduce population levels of pain interference so that people with chronic pain can better engage in life.Pain-related interference has been defined as 'perceived disruption in daily activities, relationships, roles, and employment resulting from pain' [9]. Chronic or recurrent pain is reported by around one-third of the adult population, but up to half state that their pain does not interfere with daily life [27,48]. Many people, therefore, have chronic pain that does not interfere with their lives, and there is the potential to identify modifiable factors associated with non-interference.Population-based epidemiological research can contribute to this by quantifying characteristics associated with interference-free pain and investigating how people in community settings maintain an interference-free life despite continuing pain. In this topical review we consider the current contribution of epidemiological studies to this objective. We A C C E P T E D Copyright Ó 8 8 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited. 2018 2 start by introducing the measurement of pain interference and the scope of our literature search, before summarizing our findings. We discuss the wider context of research into noninterfering pain, and propose a research agenda for epidemiological studies. Measuring pain interference Questions about how pain interferes with daily life, in general or in specific areas such as mobility or sleep, have long been incorporated in self-report instruments. Examples include: one item in the Medical-Outcomes-Survey Short-Form 36 on the extent to which recent pain has interfered with social or domestic work [53]; three items in the Brief Pain Inventory [49] about interference with social and emotional components of daily life; and 41 items in the open-access bank created by the Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) initiative [3]. These questions target 'life as it is', as compared with tests of physical function or measures of impairment. Items on interference in the PROMIS-PI databank have high internal consistency and are strongly unidimensional [3]. These interference meas...

Healthy working life expectancy at age 50 for people with and without osteoarthritis in local and national English populations

“…These symptoms are likely to be influenced by various lifestyle, socioeconomic, workplace, and social factors 31 – 33 . Health-related quality of life is closely related to pain severity, and pain interference is strongly associated with work disability and premature work loss 34 , 35 . However, supportive workplaces can improve return to work, sickness absence, and presenteeism outcomes for people with chronic conditions 32 , 36 .…”

Behavioral Conceptualization and Treatment of Chronic Pain

“…This is not necessarily the case, and pain does not inevitably lead to disability. There is a relatively large subgroup of individuals who report chronic pain that does not interfere with daily life, ranging between 5% to 28% depending on the broadness of the definition of pain used (Jordan et al 2019). On the other hand, roughly 5% report pain with high impact on daily functioning.…”

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