Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study

Carvalho, Ravena Carolina de; Maglioni, Caio Bustamante; Machado, Gabriel Barbosa; Araújo, João Eduardo de; Silva, Josie Resende Torres da; Silva, Marcelo Lourenço da

doi:10.5935/2595-0118.20180063

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ORIGINAL ARTICLES • BrJP 1 (4) • Oct-Dec 2018 • https://doi.org/10.5935/2595-0118.20180063 copy

Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study

Prevalência e características da dor crônica no Brasil: um estudo nacional baseado em questionário pela internet

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

The prevalence of chronic pain has been increasing in the world, and it is considered the most underestimated health care problem impacting the quality of life. Furthermore, there is little consensus regarding the burden of chronic pain in Brazil. The present study aimed to investigate the prevalence of chronic pain in the general Brazilian adult population, and the socio-demographic, clinical, medical conditions and pain locations on the body.

METHODS:

A cross-sectional Internet-based survey was conducted in a nationally representative sample of Brazil adults to estimate the prevalence, sociodemographic correlates and characteristics of chronic pain in the Brazilian population. Twenty-seven-thousand and three hundred forty-five (27,345) representative residents were contacted.

RESULTS:

From 27,345 individuals, 20,830 (76.17%) presented chronic, recurrent, or long-lasting pain, lasting for at least 6 months. Nearly half of the respondents were 65 years older (48.15%) and the prevalence was higher in females (84,60%) than males (16.40%). The prevalence of primary chronic lower back pain was 59.85%; of primary rheumatoid arthritis was (59.78%) and primary osteoarthritis pain was 69.02%. Half of the respondents with chronic pain experienced daily pain, and average (past 3 months) pain intensity was moderate at 57.28%.

CONCLUSION:

Chronic pain affects more than two-thirds of the population of Brazil. Our findings revealed a high prevalence and severity of chronic pain and suggested that it is a public health problem in Brazil. Risk factors are being a woman, advanced age and low levels of household income. There is a need for improved health policies in Brazil for patients with chronic pain.

Keywords:
Brazil; Chronic pain; Epidemiology; Pain; Prevalence

Characteristics	Groups
Characteristics	Number of participants	% of total
	27,345	100
No pain	6,515	23.83
Chronic, recurrent, or long-lasting pain	20,830	76.17
Pain with a duration of >6 months	17,553	64.19
Pain for less than six months	1,383	5.06
Pain for at least three months	413	1.51
Pain for less than two months	1,481	5.42

Characteristics	Chronic pain	Without chronic pain	OR (95% CI)	p-value
Total sample	17,553 (100)	9,792 (100)
Gender n (%)
Male	2,879 (16.40)	1,768 (18.06)	Reference
Female	14,674 (84.60)	8,024 (81.94)	1.23 (1.05-1.19)	<0.001
Age group (years) n (%)
18-24	1,109 (6.32)	477 (4.87)	Reference
25-34	1,062 (6.05)	481 (4.91)	0.94 (0.81-1.10)	0.500
35-44	1,546 (8.81)	659 (6.73)	1.01 (0.87-1.16)	0.900
45-54	1,727 (9.84)	738 (7.54)	1.01 (0.87-1.15)	0.092
55-64	3,658 (20.84)	2,843 (29.03)	1.80 (1.60-2.03)	<0,001
65 +	8,451 (48.15)	4,594 (46.92)	1.26 (1.12-1.41)	<0,001
Race n (%)
White	14,071 (80.16)	7,923 (80.91)	Reference
Brown	2,854 (16.26)	1,498 (15.30)	0.93 (0.87-0.99)	<0.001
Black	323 (1.84)	211 (2.15)	1.16 (0.97-1.38)	0.097
Yellow	182 (1.04)	93 (0.95)	0.90 (0.70-1.16)	0.448
Indigenous	123 (0.70)	67 (0.68)	0.96 (0.71-1.30)	0.827
Education level n (%)
Some education	5,932 (33.79)	3,266 (33.35)	Reference
High school	4,629 (26.37)	1,781 (18.19)	0.69 (0.65-0.74)	<0.001
Less than high school	1,898 (10.81)	1,451 (14.82)	1.38 (1.28-1.50)	<0.001
Bachelor's degree or higher	5,094 (29.02)	3,294 (33.64)	1.17 (1.10-1.24)	<0.001
Marital status n (%)
Married	8,253 (47.02)	3,833 (39.14)	Reference
Never married	5,826 (33.19)	4,471 (45.66)	1.65 (1.56-1.74)	<0.001
Divorced	1,077 (6.14)	579 (5.91)	1.15 (1.03-1.29)	<0.05
Living with a partner	2,397 (13.66)	909 (9.28)	0.81 (074-0.88)	<0.001
Household income level n (%)
Less than R$999	5,323 (30.33)	3,987 (40.72)	Reference
R$1,000 to R$1,999	5,782 (32.94)	2,483 (25.36)	0.57 (0.53-0.61)	<0.001
R$2,000 to R$4,999	4,765 (27.15)	2,338 (23.88)	0.65 (0.61-0.69)	<0.001
R$5,000 or more	1683 (9.59)	984 (10.05)	0.78 (0.71-0.85)	<0.05
Region n (%)
Southeast	1,3651 (77.77)	7,359 (75.15)	Reference
North	232 (1.32)	103 (1.05)	0.82 (0.65-1.04)	0.103
Northeast	543 (3.09)	334 (3.41)	1.14 (0.99-1.31)	0.063
South	2,342 (13.34)	1,453 (14.84)	1.15 (1.07-1.23)	<0,001
Midwest	785 (4.47)	543 (5.55)	1.28 (1.14-1.43)	<0,001
Employment status n (%)
Working-as a paid employee	5,732 (32.66)	3,431 (35.04)	Reference
Working-self-employed	2,184 (12.44)	1,433 (14.63)	1.09 (1.01-1.18)	<0,05
Not working-on temporary layoff	2,856 (16.27)	1,846 (18.85)	1.08 (1.00-1.16)	<0,05
Not working-retired	2,167 (12.35)	1,483 (15.15)	1.14 (1.05-1.23)	<0,001
Not working-disabled	553 (3.15)	48 (0.49)	0.14 (0.10-0.19)	<0,001
Not working-other	4,061 (23.14)	1,551 (15.84)	0.63 (0.59-0.68)	<0,001
Internet access n (%)
Yes	17,517 (99.79)	9,780 (99.88)	Reference
No	36 (0.21)	12 (0.12)	0.59 (0.31-1.14)	0.118
Metropolitan area n (%)
Non-metro	12,582 (71.68)	7,999 (81.69)	Reference
Metro	4,971 (28.32)	1,793 (18.31)	0.56 (0.53-0.60)	<0,001

Pain category (condition or location)	No. with each pain category^† † Respondents could check multiple pain conditions and locations;	% of each category that was primary pain^‡ ‡ Primary Pain is defined as the pain the respondent would most like to relieve that has lasted at least 6 months. Respondents could choose only 1 pain condition or location as primary pain;	% of each primary pain ^† † Respondents could check multiple pain conditions and locations; category contributing to the overall point prevalence^§ § Percentages were calculated using the number of respondents with CP for at least 6 months as a denominator.
Physician-diagnosed pain condition
Low back pain	5,343	59.85	18
Osteoarthritis	1,614	69.02	6
Rheumatoid arthritis	5,331	59.78	18
Migraine	2,792	35.60	6
Carpal tunnel syndrome	233	21.30	<1
Fibromyalgia	823	54.60	3
Chronic daily headaches or tension-type	833	24.65	1
Diabetic peripheral neuropathy	17	40.09	<1
Ankylosing spondylitis	22	40.12	<1
Cancer-related pain	23	50.13	<1
Psoriatic arthropathy	142	50.79	<1
Postherpetic neuralgia	43	15.24	<1
Trigeminal neuralgia	32	13.18	<1
Others	653	22.65	1
Body location of chronic pain
Head	4,232	32	8
Face/mouth (includes jaw)	1,366	11	1
Neck	4,152	10	2
Upper back	4,564	43	11
Mid back	2,655	25	4
Lower back	7,613	35	15
Body location of chronic pain
Chest (includes angina pectoris)	937	12	1
Stomach/abdomen	2,044	10	1
Pelvis/groin	1,546	8	1
Joints
Hip(s)	4,807	39	11
Knee(s)	6,026	39	13
Ankle	4,344	10	2
Feet	4,565	23	6
Shoulder	5,506	10	3
Elbow(s)	4,108	4	1
Wrist(s)	5,039	35	10
Hand(s)	5,985	19	6
Other joint	437	0	<1
Hip (other than joint pain)	1,478	1	<1
Leg(s) or feet (other than joint pain)	2,544	8	1
Shoulder (other than joint pain)	1,873	9	1
Arm(s) or hand(s) (other than joint pain)	1,878	25	3
Other	951	33	2

Characteristics	Number of participants	% total
Duration of primary chronic pain	17,553	100
At least 6 months but less than 1 year	3,562	20.29
1 year or more	13,991	79.71
Frequency of pain
Daily	8,731	49.74
Not daily, but more days than not	5,282	30.09
2-3 times a week	221	1.26
Once a week	412	2.35
2-3 times a month	722	4.11
Once a month	1,016	5.79
Less than once a month	717	4.08
Others	452	2.58
Average pain intensity in the past 3 months
Mild (0-3)	2,435	13.87
Moderate (4-6)	10,055	57.28
Severe (7-10)	5,063	28.84
Worst pain intensity in the past 3 months
Mild (0-3)	925	5.27
Moderate (4-6)	7,656	43.62
Severe (7-10)	8,972	51.11
Use of medications for the last pain episode
No	2,543	14.49
Painkiller	4,794	27.31
NSAIDs	7,065	40.25
Others	3,151	17.95

Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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[1] Correspondence to: Av. Jovino Fernandes Sales 2600 37130-000 Alfenas, MG, Brasil. E-mail: lourencoms@uol.com.br