Wednesday, November 12, 2003

Department of Public Health and General Practice, University of Kuopio and Unit of General Practice, Kuopio University Hospital (Drs Mäntyselkä and Kumpusalo); and Department of Social Pharmacy, University of Kuopio (Mr Turunen and Dr Ahonen).

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Chronic Pain and Poor Self-rated Health

Pekka T. Mäntyselkä, MD, PhD; Juha H. O. Turunen, MSc (Pharm); Riitta S. Ahonen, PhD; Esko A. Kumpusalo, MD, PhD

JAMA. 2003;290:2435-2442.

Context Chronic pain is common in Western societies. Self-rated health is an important indicator of morbidity and mortality, but little is known about the relation between chronic pain and self-rated health in the general population.

Objective To analyze the association between chronic pain and self-rated health.

Design, Setting, and Population A questionnaire survey carried out during the spring of 2002 of an age- and sex-stratified population sample of 6500 individuals in Finland aged 15 to 74 years, with a response rate of 71% (N = 4542) after exclusion of those with unobtainable data (n = 38). Chronic pain was defined as pain with a duration of at least 3 months and was graded by frequency: (1) at most once a week; (2) several times a week; and (3) daily or continuously. On the basis of a 5-item questionnaire on self-rated health, individuals were classified as having good, moderate, or poor health. Multinominal logistic regression analysis was used to assess the determinants of health. Analysis included sex, age, education, working status, chronic diseases, and mood.

Main Outcome Measures Perceived chronic pain graded by frequency and self-rated health status.

Results The prevalence of any chronic pain was 35.1%; that of daily chronic pain, 14.3%. The prevalence of moderate self-rated health was 26.6% and of poor health, 7.6%. For moderate self-rated health among individuals having chronic pain at most once a week compared with individuals having no chronic pain, the adjusted odds were 1.36 (95% confidence interval [CI], 1.05-1.76); several times a week, 2.41 (95% CI, 1.94-3.00); and daily, 3.69 (95% CI, 2.97-4.59). Odds for poor self-rated health were as follows: having chronic pain at most once a week, 1.16 (95% CI, 0.65-2.07); several times a week, 2.62 (95% CI, 1.76-3.90); and daily, 11.82 (95% CI, 8.67-16.10).

Conclusion Chronic pain is independently related to low self-rated health in the general population.