Prevalence of chronic pain in a metropolitan area of a developing country: a population-based study

Leão Ferreira, Karine A. S.; Bastos, Telma Regina P. D.; Andrade, Daniel Ciampi de; Silva, Aline Medeiros; Appolinario, José Carlos; Teixeira, Manoel Jacobsen; Latorre, Maria do Rosário Dias de Oliveira

doi:10.1590/0004-282X20160156

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ARTICLES • Arq. Neuro-Psiquiatr. 74 (12) • Dec 2016 • https://doi.org/10.1590/0004-282X20160156 copy

Prevalence of chronic pain in a metropolitan area of a developing country: a population-based study

Prevalência de dor crônica em área metropolitana de um país em desenvolvimento: um estudo populacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To estimate the prevalence of chronic pain (CP) in the adult population living in the city of São Paulo, Brazil, and to identify factors associated with CP in developing countries.

Methods

A cross-sectional study using a computer-assisted telephone interview in a two-stage stratified sample of adults living in households.

Results

2,446 subjects were interviewed. The mean age was 39.8 years old. The majority was female and 42.7% had less than 10 years of education. The prevalence of CP was 28.1%. The independent factors associated with CP were female gender (OR = 2.0; p < 0.001), age older than 65 years (OR = 1.4; p = 0.019) and less than 15 years of education (OR = 1.3-1.6; p < 0.04).

Conclusions

The prevalence of CP was high and similar to that which has been reported in developed countries. These results raise awareness about CP and may potentially help clinicians and policy makers to design better health care programs for CP treatment in these populations.

chronic pain; population; prevalence; developing countries

Characteristics	Population (%)	Study sample (%)
Age (years)
18–29	32.51	25.73
30–39	23.11	20.11
40–49	18.61	18.61
50–59	11.95	17.79
60–69	7.64	10.81
> 70	6.17	6.96
Sex
Male	47.66	38.1
Female	52.44	61.9
Education level*
> 7	43.00	24.39
08/out	18.50	16.07
nov/14	26.92	39.88
> 15	11.58	19.66

Sex	Age (years)	Educational level*

		Population (%)		Study sample (%)

		≤ 10 years	>10 years	≤ 10 years	>10 years
Male	18–29	9.27	6.65	2.29	9.91
	30–49	11.74	8.07	5.01	10.80
	≧ 50	7.63	3.16	7.39	4.94
Female	18–29	8.47	8.45	1.70	11.92
	30–49	12.99	9.19	9.53	13.35
	≧ 50	11.40	2.98	14.54	8.61

Sex	Age (years)	Educational level*

		≤ 10 years	>10 years
Male	18–29	4.05	0.67
	30–49	2.34	0.75
	≧ 50	1.03	0.64
Female	18–29	4.99	0.71
	30–49	1.36	0.69
	≧ 50	0.78	0.35

Variable	Respondents

	N	% (weighted)
Sex
Male	927	46.5
Female	1505	53.5
Missing	14	-
Age (years)
18–29	536	32.8
30–44	797	32.0
45–64	759	26.4
≥ 65	340	8.8
Missing	14	-
Work status
Housewife	451	17.5
Unemployed, but have not actively looked for a job	74	4.0
Unemployed, but have actively looked for work	94	5.3
Retired	347	9.9
Employed	1026	43.1
Freelance	338	16.7
Student	69	3.5
Missing	47	-
Nutritional status
Underweight	56	2.3
Normal weight	1172	51.7
Overweight	756	33.4
Obese	304	12.7
Missing	158	-
Years of schooling
Illiterate	97	4.1
1–7 years	510	26.9
8–10 years	406	30.4
11–14 years	930	26.0
≥ 15 years	489	12.5
Missing	14	-

Variable	Prevalence of chronic pain		p

	N	%^*
Chronic pain
Yes	713	28.1	-
Sex
Male	190	20.6	0.001
Female	523	34.7	0.001
Age (years)
18–29	111	22.2	< 0.001
30–44	239	29.3
45–64	269	33.9
≥ 65	94	28.5
Marital status^**
Single	191	23.8	0.021
Married	379	29.1
Separate/divorced	66	39.0
Widower	76	37.9
Religion^**
No religion	65	27.6	0.200
Catholicism	409	26.1
Protestantism	155	33.4
Spiritualism	40	33.7
Others	36	28.0
Work status^**
Housewife	154	33.3	0.078
Unemployed, but have not actively looked for a job	22	24.0
Unemployed, but have actively looked for work	26	21.7
Retired	111	36.0
Employed	258	23.4
Freelancer	118	35.7
Student	15	15.8
Years of schooling^**
Illiterate	35	33.7	0.607
1–7 years	168	29.7
8–10 years	134	29.8
11–14 years	257	25.9
≥ 15 years	119	23.5

Variable	Adjusted odds ratio	p
Sex
Male	1
Female	2.0	< 0.001
Age (years)
18–29	1.0
30–44	1.5	0.145
45–64	1.8	0.357
≥ 65	1.4	0.019
Years of schooling completed^*
Illiterate	1.5	0.116
1–7 years	1.4	0.028
8–10 years	1.6	0.030
11–14 years	1.3	0.040
≥ 15 years	1.0

Variable	Survey respondents		Prevalence of chronic pain* (%)	OR	p	Adjusted OR^**	p

	N	%^***
Spinal diseases	541	18.8	53.7	4.0	< 0.001	3.8	< 0.001
Headaches/migraine	484	20.4	44.7	2.6	< 0.001	2.3	< 0.001
Anxiety/other psychiatric disorder	340	13.0	53.9	3.7	< 0.001	3.3	0.001
Depression	245	8.9	56.9	3.9	0.001	3.3	0.003
Diabetes	202	6.7	46.0	2.3	0.001	1.8	0.008
Arthritis	153	4.5	61.7	4.4	< 0.001	3.5	< 0.001
Rheumatism	128	4.6	61.7	4.5	0.001	3.4	0.007
Surgery (< 1 year before)	178	7.2	42.6	2.0	0.046	1.9	0.094
Osteoporosis	78	2.3	56.4	3.4	0.001	2.6	0.005
Fracture (< 1 year before)	71	2.6	45.5	2.2	0.107	2.1	0.153
Fibromyalgia	71	2.2	68.5	5.8	0.010	4.7	0.031
Heart diseases (< 1 year before)	69	2.9	59.7	4.0	0.007	3.7	0.007
Endometriosis	40	1.4^****	46.0	1.6	0.170	1.6	0.278
Work-related musculoskeletal disease	52	1.5	49.5	2.5	0.021	2.2	0.022
Traumatic injury (< 1 year before)	48	1.7	45.2	2.1	0.049	2.5	0.026
Cancer	32	1.0	42.7	1.9	0.119	1.7	0.210
Muscular disorder	22	0.9	72.5	6.9	0.003	6.4	0.016
Sequelae of stroke	18	0.9	63.4	4.5	0.094	4.9	0.129

Variable	N	%
Pain location
Head (excluding neck)	104	15.0
Chest	94	17.2
Back (including neck)	161	21.1
Arms and hands	93	12.2
Legs and feet	166	22.5
Multiple places	95	12.0
Pain treatment (past 12 months)
Medicines
Yes	428	58.5
No	285	41.5
Prescription medicines
Yes	304	39.1
No	409	60.9
Non-drug therapies
Yes	154	16.5
No	559	83.5
Physiotherapy
Yes	66	6.7
No	647	93.3
Acupuncture
Yes	33	3.2
No	680	96.8
Massage
Yes	43	5.0
No	670	95.0
Physical exercise
Yes	19	2.1
No	694	97.9
	Mean (SD)	Median (Q1-Q3)
Intensity of pain (past 24 hours)
Average	6.8 (2.4)	7.0 (5.0–9.0)
Worst	7.7 (2.4)	8.0 (6.0–10.0)
Lowest	5.1 (2.4)	5.0 (3.0–7.0)
Intensity of pain (past 3 months)
Average	6.9 (2.5)	7.0 (5.0–9.0)
Pain duration (months)	55.8 (84.1)	24 (10–60)

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[1] Correspondence: Daniel Ciampi de Andrade; Divisão de Clínica Neurológica do Hospital das Clínicas da FMUSP; Secretaria da Neurologia, Instituto Central; Av. Dr. Enéas de Carvalho Aguiar, 255 / 5º andar / sala 5084; 05403-900 São Paulo SP, Brasil; E-mail: ciampi@usp.br