Profile of chronic pain patients seen in a pain outpatient setting of a major Southern Brazil' city

Abstracts

JUSTIFICATIVA E OBJETIVOS: Dor crônica afeta aproximadamente 30% da população mundial e a sua epidemiologia ainda é pouco descrita no Brasil. O objetivo deste estudo foi identificar o perfil dos pacientes com dor crônica que procuram atendimento num ambulatório de dor na cidade de Curitiba. MÉTODO: Estudo descritivo transversal retrospectivo, que incluiu 111 pacientes com queixas de dor crônica atendidos no ambulatório de dor do Instituto de Neurologia de Curitiba (INC). RESULTADOS: A maioria dos pacientes foi do sexo feminino, com idade entre 40 e 49 anos e casada. A profissão mais prevalente foram os autônomos que englobam as atividades de cozinheiro, cabeleireiro, vendedor, mecânico, arquiteto, advogado, entre outras. Mesmo com dor, a maioria dos pacientes continuava trabalhando, sendo que alguns vinham de cidades localizadas fora do estado. Entre as dores crônicas a mais prevalente foi a lombalgia, seguida de dor nos membros inferiores, cervicalgia, membros superiores, dor generalizada, cefaleia e dor orofacial. CONCLUSÃO: A dor crônica foi mais prevalente na população feminina e a dor mais prevalente no estudo foi a lombalgia.

Dor; Dor lombar; Epidemiologia

ORIGINAL ARTICLE

Profile of chronic pain patients seen in a pain outpatient setting of a major Southern Brazil' city ^*

Anderson Cipriano^I; Daniel Benzecry de Almeida^II; Janaina Vall^III

^IPhysical Therapist, Member of the Pain Group, Neurology Institute of Curitiba. Curitiba, PR, Brazil

^IINeurosurgeon, Master in Neurosurgery by the University of São Paulo. Coordinator of the Pain Group, Neurology Institute of Curitiba. Curitiba, PR, Brazil

^IIINurse; Doctor in Medical Sciences by the Federal University of Ceará. Coordinator Professor of the League Without Pain of Curitiba. Curitiba, PR, Brazil

Correspondence to

SUMMARY

BACKGROUND AND OBJECTIVES: Chronic pain affects approximately 30% of the world population and its etiology is still poorly described in Brazil. This study aimed at identifying the profile of chronic pain patients looking for assistance in a pain outpatient setting of the city of Curitiba.

METHOD: Descriptive, transversal and retrospective study involving 111 chronic pain patients seen in the pain outpatient setting of the Institute of Neurology of Curitiba (INC).

RESULTS: Most patients were females, aged between 40 and 49 years, and married. Most prevalent professions were autonomous professions encompassing activities such as cook, hairdresser, sales reps, engineers, architects and attorneys, among others. Even with pain, most patients still worked and some came from cities outside the state. Most prevalent chronic pain was low back pain, followed by lower limb pain, cervical pain, upper limbs pain, generalized pain, headache and orofacial pain.

CONCLUSION: Chronic pain was more prevalent among females and most prevalent pain in our study was low back pain.

Keywords: Epidemiology, Low back pain, Pain.

INTRODUCTION

Several studies have been carried out to assess the interference of chronic pain in the lives of people, by evaluating the number and characteristics of affected patients, major pains and resources used to manage them.

Estimated chronic pain prevalence in general population varies from 11.5% to 55.2%, however, according to the International Association for the Study of Pain (IASP), mean prevalence is 35.5%¹. Most epidemiological studies were carried out in developed countries and its prevalence in developing countries is still poorly known. In Brazil, chronic pain is the primary reason for outpatient setting visits², and although there are few epidemiological studies, some researches confirm incidence similar to that estimated by IASP³.

For being a public health problem⁴, epidemiological pain studies in Brazil should be a priority, in spite of the difficulties for such, especially the small number of investigators⁵.

This study aimed at identifying the profile of chronic pain patients seen in a pain outpatient setting of the city of Curitiba.

METHOD

After the Institution's Ethics Committee approval under protocol 085/11, this descriptive, transversal and retrospective study was carried out by evaluating the admission medical records of 111 chronic pain patients, that is, pain persisting for more than three months, seen by the Pain Outpatient Setting of the Neurology Institute of Curitiba (INC), during 2009.

Patients of both genders were included, regardless of age, marital status, profession, occupation or education. Data collection tool was a form with the variables of the study. Pain characteristics were analyzed as to site, irradiation and temporality. Data analysis was descriptive without application of statistical tests.

RESULTS

Most patients were females (67.6%), married (55.0%), aged between 40 to 49 years (32.4%) and 32% had university degrees. Chronic pain was more prevalent in autonomous workers (17.1%), activity which encompassed cooks, hairdressers, sales reps, engineers, architects and attorneys, followed by "housewife" (10.8%). Even with pain, most patients (63.1%) still worked and most lived in Curitiba (73.9%), but there were patients from other cities and even from other states (Table 1).

Most prevalent pain was low back pain (21.1%), followed by lower limbs pain (15.8%), cervical pain (13.2%), upper limbs pain (12.3%), generalized pain (9.6%), headache (7.0%) and orofacial pain (5.3%), being that 15.8% of patients referred abdominal, chest and hemibody pain. Some patients referred more than one pain site (Table 2).

DISCUSSION

Chronic pain affects a large part of the world population, both in developed and in developing countries. However, more detailed studies are needed on its real prevalence in developing countries, such as Brazil, which would contribute for the establishment of social and health policies and goals for adequate pain prevention and management.

Our study has evaluated chronic pain patients only, however specifically focusing on patients treated in a pain outpatient setting of the city of Curitiba, with limited and regional relevance, thus it cannot be extrapolated for the rest of the country.

However, a study carried out in Israel and involving 4859 patients confirms IASP data on chronic pain prevalence. This study has observed that 29.9% of patients had chronic pain in general associated to co-morbidities, sleep disturbances and psychiatric disorders⁶.

Our study has shown higher pain prevalence in females, which is in line with most epidemiological studies on the subject. Women suffer more with pain, probably due to hormonal and psychological problems⁷. A study carried out in Japan has identified this pain sensitivity difference between genders⁸, reason why gender-specific therapies should be considered for pain management.

The older the age, the higher the prevalence of pain, especially caused by arthritis⁹. In our study, the age group affected the most by chronic pain was not the elderly population, however with higher female prevalence and probable diagnosis of fibromyalgia¹⁰, the age group between 40 and 49 years was the most common, coincidentally the age group of menopause-related hormonal disorders.

A study analyzing 3182 patients in the South of Brazil has shown that, in addition to most frequent chronic pain being low back pain, it is seen especially in women and its incidence increases with age. In addition, it is more prevalent in less educated and married people¹¹, but our study has shown that most chronic pain patients had university degrees. It is possible that our sample has suffered regional interference and influence of the Health Institution profile where data were collected, because, in general, Southern Brazil population is more educated as compared to other states, especially to Northern and Northeastern states, and also because hospitals of the Single Health System receive more less educated people.

Evaluation involving 505 employees of a university of Paraná has observed that 61.4% of women had chronic pain, especially headache, low back pain and lower limbs pain⁵, while a study carried out in Bahia, including 2297 people, has shown that low back pain was present in 14.7% of smokers and less educated people³. A possible explanation for less educated people feeling more pain is that they have less knowledge about the importance of adequate pain evaluation and management and less financial conditions, they frequently self-medicate and have less access to health services.

Studies have also shown that pain affects professional productivity and social life¹². A study carried out in Turkey with 1600 hospital employees has shown that 65.8% of them had low back pain, especially health professionals¹³, and that administrative and production area employees, after autonomous workers, were the most affected by chronic pain. Studies carried out more than 15 years ago have shown that low back pain was very common in industrial production areas¹⁴, medical leave was frequent and at that time, risk factors were still unknown.

Currently, even knowing some of them, the situation has not changed. Pain is very common also in sedentary jobs, such as administrative activities¹⁴. In our study, most patients were still working even with pain, because medical leave generates many problems, especially financial, social and emotional.

There are also other major issues involved with chronic pain, such as secondary gain. In general it is common that patients whose low back pain has been controlled with adequate management insist in remaining away from work, receiving financial benefits and the attention of relatives and friends.

Because low back pain is one of the most frequent occupational pains, it is important to prevent it by educational measures especially aimed at women who adopt inadequate postures during their labor activities^15,16.

Our study has shown pain prevalence in "housewife" patients, showing that this part of the population needs special attention from health professionals and institutions. There are still few health policies and programs and they deserve further attention because preventive actions are more effective and less expensive than treatment.

Although this study has shown some important aspects with regard to the epidemiology of pain felt by patients who looked for the outpatient setting in the period when medical records were analyzed, their relevance is decreased because they represent the reality of a circumscribed sample and data cannot easily be extrapolated to a national scenario encompassing patients from geographic locations very different from that analyzed by this study. Also, the objective was not to focus on pain diagnostic method, pathophysiology and treatment of patients included in the research, which certainly would enrich results and discussion, bringing new aspects to this important subject.

CONCLUSION

Chronic pain was more prevalent among females and most prevalent pain in our study was low back pain.

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*

Recebido do Instituto de Neurologia de Curitiba. Curitiba, PR.

Publication Dates

• Publication in this collection
  10 Feb 2012
• Date of issue
  Dec 2011

History

• Accepted
  06 Dec 2011
• Received
  27 June 2011