Social factors and pain worsening: a retrospective cohort study

Why is low educational attainment linked to worse pain and function in fibromyalgia?

Lower educational attainment has been linked to worse pain in individuals with chronic pain, but the mechanisms of this relationship are not fully elucidated. This observational study analyzed the relationship between educational attainment and pain in patients with fibromyalgia (FM) and the potential psychological mechanisms driving this relationship. We hypothesized that (1) lower educational attainment would be associated with greater pain intensity and interference, and that (2) concerns about pain (CAP), anxiety, and depression would mediate the relationship between educational attainment and pain. A total of 119 adults (93.3% female, 79.7% White, Mage=50.4) with FM completed questionnaires including demographics, Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scales (HADS). Pearson correlations and bootstrapped mediation analyses were conducted to examine the relationships among education, psychological variables, and pain variables. Education was inversely correlated with pain intensity and interference, CAP, anxiety, and depression (p<.05). CAP significantly mediated the relationship between education and pain intensity (95% CI [0.151, 0.026]), while both CAP and depression mediated the effects of education on pain interference (95% CI [0.195, -0.025]; 95% CI [-0.163, -0.004]). However, anxiety did not mediate either relationship. These findings suggest that greater CAP, and in part depression, may be possible mechanisms in the relationships between lower educational attainment and worse pain intensity and interference. This work has important implications in reducing pain disparities and provides direction for psychological treatment, suggesting that both depression and CAP may be critical targets especially for people with lower education attainment. PERSPECTIVES: This study examined the relationship between educational attainment, psychological variables, and pain. Results have implications for psychological intervention aimed at concerns about pain and depression, especially among individuals with low educational attainment.

The costs of chronic pain-Long-term estimates

BACKGROUND

Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain.

METHODS

The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence.

RESULTS

In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss.

CONCLUSION

Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain.

SIGNIFICANCE

This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.