Häuser Winfried, Wolfe Frederik, Henningsen Peter, Schmutzer Gabriele, Brähler Elmar, Hinz Andreas
Department of Medical Psychology and Medical Sociology, Universität Leipzig, Ph,-Rosenthal-Str, 55, D-04103 Leipzig, Germany.
BMC Public Health. 2014 Apr 13;14:352. doi: 10.1186/1471-2458-14-352.
Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys.
A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses.
2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]).
Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.
慢性疼痛是一个主要的公共卫生问题。在人群调查中，尚未评估针对疾病负荷进行调整后的慢性疼痛阶段对社会负担的影响。
对4360名年龄≥14岁、具有德国人群代表性的人群进行了横断面调查。收集的测量指标包括人口统计学变量、慢性疼痛的存在情况（基于国际疼痛研究协会的定义）、慢性疼痛阶段（通过慢性疼痛分级问卷）、疾病负荷（通过自我报告的合并症问卷）以及社会负担（通过自我报告的过去12个月内的就诊次数、住院天数和病假/残疾天数，以及当前的失业情况）。通过泊松回归和逻辑回归分析，检验了在调整人口统计学变量和疾病负荷后慢性疼痛阶段与社会负担之间的关联。
共收到2508份回复。19.4%（95%置信区间16.8%至22.0%）的参与者符合慢性非致残性非恶性疼痛的标准。7.4%（95%置信区间5.0%至9.9%）符合慢性致残性非恶性疼痛的标准。与无慢性疼痛相比，非致残性疼痛的病假/残疾天数的率比（RR）为1.6，致残性疼痛为6.4。在调整年龄和疾病负荷后，RR分别增至1.8和6.8。与无慢性疼痛相比，非致残性疼痛的就诊率比为2.5，致残性疼痛为4.5。在调整年龄和疾病负荷后，RR降至1.7和2.6。与无慢性疼痛相比，非致残性疼痛的住院天数率比为2.7，致残性疼痛为11.7。在调整年龄和疾病负荷后，RR降至1.5和4.0。较低的教育水平（优势比OR 3.27 [95%置信区间1.70 - 6.29]）、致残性疼痛（OR 3.30 [95%置信区间1.76 - 6.21]）和疾病负荷（OR 1.70 [95%置信区间1.41 - 2.05]）可预测失业情况。
慢性疼痛阶段、疾病负荷以及社会不平等均导致了社会负担。慢性疼痛流行病学研究中的疼痛测量应包括慢性疼痛分级和疾病负荷。
