Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

Studies Comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for Assessment of Pain Intensity in Adults: A Systematic Literature Review

The objective of this paper was to present estimates on the prevalence of musculoskeletal pain of five different anatomical areas and ten anatomical sites, and their consequences and risk groups in the general Dutch population. Cross-sectional data from a population-based study of a sex-age stratified sample of Dutch inhabitants of 25 years and older were used. With a postal questionnaire data was assessed on musculoskeletal pain, additional pain characteristics (location, duration, course), its consequences (utilization of health care, sick leave and limitation in daily life) and general socio-demographic characteristics. The top three of self-reported musculoskeletal pain (point prevalence (Pp) with 95% confidence interval (CI)) was: (1) low back pain, Pp=26.9% (95% CI 25.5–28.3); (2) shoulder pain, Pp=20.9% (95% CI 19.6–22.2); and (3) neck pain, Pp=20.6% (95% CI 19.3–21.9). In most cases the pain was described as continuous or recurrent and mild. In every three out of ten cases the complaints about pain were accompanied by limitations in daily living. Between 33 and 42% of those with complaints consulted their general practitioner about their pain. With the exception of persons who are work disabled, general sociodemographic characteristics cannot be used to identify high risk groups. Musculoskeletal pain is common in all subgroups of the population and has far-reaching consequences for health, work and the use of health care.

Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study

This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer-Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two-stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response rate=70.8%). Chronic pain was reported by 17.1% of males and 20.0% of females. For males, prevalence peaked at 27.0% in the 65--69 year age group and for females, prevalence peaked at 31.0% in the oldest age group (80--84 years). Having chronic pain was significantly associated with older age, female gender, lower levels of completed education, and not having private health insurance; it was also strongly associated with receiving a disability benefit (adjusted OR=3.89, P<0.001) or unemployment benefit (adjusted OR=1.99, P<0.001); being unemployed for health reasons (adjusted OR=6.41, P<0.001); having poor self-rated health (adjusted OR=7.24, P<0.001); and high levels of psychological distress (adjusted OR=3.16, P<0.001). Eleven per cent of males and 13.5% of females in the survey reported some degree of interference with daily activities caused by their pain. Prevalence of interference was highest in the 55--59 year age group in both males (17.2%) and females (19.7%). Younger respondents with chronic pain were proportionately most likely to report interference due to pain, affecting 84.3% of females and 75.9% of males aged 20--24 years with chronic pain. Within the subgroup of respondents reporting chronic pain, the presence of interference with daily activities caused by pain was significantly associated with younger age; female gender; and not having private health insurance. There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, P<0.001) or being unemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage.

Chronic pain in Australia: a prevalence study

The objective of this study was to determine the prevalence of neck pain (NP) in the world population and to identify areas of methodological variation between studies. A systematic search was conducted in five databases (MEDLINE, EMBASE, CINAHL, OSH-ROM, and PsycINFO), followed by a screening of reference lists of relevant papers. Included papers were extracted for information and each paper was given a quality score. Mean prevalence estimates were calculated for six prevalence periods (point, week, month, 6 months, year, and lifetime), and considered separately for age, gender, quality score, response rate, sample size, anatomical definition, geography, and publication year. Fifty-six papers were included. The six most commonly reported types of prevalence were point, week, month, 6 months, year, and lifetime. Except for lifetime prevalence, women reported more NP than men. For 1-year prevalence, Scandinavian countries reported more NP than the rest of Europe and Asia. Prevalence estimates were not affected by age, quality score, sample size, response rate, and different anatomical definitions of NP. NP is a common symptom in the population. As expected, the prevalence increases with longer prevalence periods and generally women have more NP than men. At least for 1-year prevalence Scandinavian countries report higher mean estimates than the rest of Europe and Asia. The quality of studies varies greatly but is not correlated with the prevalence estimates. Design varies considerably and standardisation is needed in future studies.

/pdf/the-prevalence-of-neck-pain-in-the-world-population-a-2eorrm81jk.pdf

The prevalence of neck pain in the world population: a systematic critical review of the literature

Epidemiological studies help to establish the health status in a country and allow a better allocation of economic resources. This survey estimated pain prevalence in Catalonia (Spain), analysed its relationship with demographic variables and evaluated pain-associated disabilities. The study was carried out in 1964 adults via phone interviews asking about any pain complaint they experienced in the last 6 months, regardless of its intensity and duration. Overall pain prevalence was 78.6%, significantly lower in men, with a trend to decrease with age. Back (50.9%), head (42%) and legs (36.8%) were the most affected locations. Less educated people reported, in general, higher prevalences. Pain described to be most annoying was related to musculoskeletal disease (26.2%) and migraines (16.5%). Pain was either very severe or unbearable in 33% of the sample, with women and older people reporting higher intensities. Personal and social activities were affected in 25.4% of cases and in 10.4% they became virtually impossible. Both the limitation of activity and the need for bed rest, which occurred in 19.6% of those who suffered pain, were more common amongst unemployed people, whereas 10.2% of workers had to take days off work due to pain, and 3.3% were fully incapacitated by it. In conclusion, the prevalence of pain was clearly higher among women, with an inverse relationship to age. Back pain and headaches were most prevalent and pain was rated as very severe to unbearable in one third of the patients. Pain-associated disabilities were a frequent finding. The present survey reports that pain is a substantial problem in the Catalonian population and generally reflects the characteristics of data previously reported in Anglo-saxon and Scandinavian countries.

/pdf/an-epidemiological-comparison-of-pain-complaints-in-the-3scif0k0ti.pdf

An epidemiological comparison of pain complaints in the general population of Catalonia (Spain).

Pain is the clinical symptom most difficult to evaluate. Although clinical trials methodology have permitted assessment of pain objectively through rating scales, these strategies have not been used in clinical setting. The present study was undertaken to determine if visual analogue scales could be useful in the measurement of postoperative pain in usual medical practice. The study comprised 212 patients with abdominal, orthopedic or gynecological surgical procedures within the previous 24 h. Patients evaluated their pain using a verbal rating scale (VRS) of five points or a visual analogue scale (VAS) of 10 cm. The investigators also evaluated patient pain through a VAS. The results obtained showed that a high correlation between VRS and VAS could be established in all patients (p less than 0.001). The VAS of patients and researchers were also found to be highly correlated (p less than 0.001). When values of each group were compared by pain intensity a total agreement of VAS scores at low pain level could be established, but differences were found at high pain intensity levels, suggesting that physicians scored lower than patients when pain was severe to unbearable. It is concluded that VAS could be a reliable method to assess pain in clinical setting.

Acceptability of visual analogue scales in the clinical setting: a comparison with verbal rating scales in postoperative pain.

https://www.jpsmjournal.com/article/S0885-3924(01)00415-8/pdf

How does the general population treat their pain? A survey in Catalonia, Spain.

https://scielo.isciii.es/pdf/gs/v17n2/original1.pdf

El dolor de espalda en la población catalana: prevalencia, características y conducta terapéutica

BACKGROUND There are few studies evaluating the presence of pain in hospitalized patients. Different authors have suggested interest in epidemiological studies to establish the characteristics of pain at a hospitalary level. The present study was initiated to determine the prevalence of pain in acute and chronic patients admitted to hospital and to establish the relation of the pain with the prescription of analgesics. METHODS Pediatric, acute and chronic adult patients pertaining to a hospital in Sabadell (Barcelona) were included in the study. Patients from resuscitation, ICU, neonatology and the emergency wards were excluded. The variables studied were presence of pain and the existence of analgesic prescription. The first was determined by interview with the patient, while the second was obtained directly from the clinical history. RESULTS Fifty-five percent of the 217 adult patients with acute pathology manifest pain and in 45% of them total analgesics had been prescribed. The prevalence of pain was 61% among the 41 pediatric patients and 35% among the 98 adults with chronic disease. Prescription of analgesics was observed in 51 and 39%, respectively in the above groups of patients. The relation between the presence of pain and antialgic prescription was variable according to the groups. It must be emphasized that 50% of acute adult patients with pain did not have prescription of analgesics. Pain was present in all the pediatric patients with some analgesic prescribed. Sixty-eight percent of the chronic patients with prescribed analgesics also experienced pain. CONCLUSIONS The prevalence of pain in the hospital environment is high, not only in pediatric but also in adult and geriatric patients. The high number of patients who do not receive analgesics despite pain and those in whom the treatment does not totally eradicate the symptoms is of note. Analgesic therapy must acquire greater revelance in hospitalary assistance.

Bassols A

Papers

An epidemiological comparison of pain complaints in the general population of Catalonia (Spain).

Acceptability of visual analogue scales in the clinical setting: a comparison with verbal rating scales in postoperative pain.

How does the general population treat their pain? A survey in Catalonia, Spain.

El dolor de espalda en la población catalana: prevalencia, características y conducta terapéutica

The Prevalence of pain in hospitalized patients