United States National Pain Strategy for Population Research: Concepts, Definitions, and Pilot Data.

UNLABELLED: National Pain Strategy population research objectives include: estimating chronic pain prevalence, studying pain treatment with electronic health care data, and developing metrics to assess progress in reducing chronic pain impact. In this article, the National Pain Strategy Population Research Workgroup reviews concepts relevant to achieving these aims. High-impact chronic pain was defined as persistent pain with substantial restriction of life activities lasting 6 months or more. In pilot work, we tested a brief assessment of high-impact chronic pain, and used electronic health records data to describe pain-related health care. A mail survey of adult health plan enrollees (N = 770) reported that 14% had high-impact chronic pain. Relative to persons with lower-impact chronic pain, those with high-impact chronic pain were more often frequent users of health care for pain, reported lower quality of life, greater pain-related interference with activities, and more often reported pain at multiple anatomic locations. Analyses of health care data (N = 289,464) reported that pain patients had higher health care costs compared with others and that pain services were typically delivered in primary care. These results support the feasibility of developing data on chronic pain through national health interview surveys and large electronic health care databases. PERSPECTIVE: Pilot analyses supported the feasibility of brief chronic pain assessments suitable for national health surveys and use of electronic health care databases to develop data regarding trends in the delivery of pain treatments, costs, and effectiveness. These methods are relevant to achieving the aims of the US National Pain Strategy.

Defining gender disparities in pain management.

BACKGROUND: Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors. QUESTIONS/PURPOSES: The purposes of this review were to (1) identify reasons for differences in pain prevalence between men and women, (2) assess whether musculoskeletal pain conditions are differently treated in men and women, and (3) identify reasons for sex/gender disparities in pain treatment. METHODS: A MEDLINE search was conducted using the terms "pain" or "musculoskeletal pain" and "gender differences" or "sex differences" with "health care," "health services," and "physician, attitude." Articles judged relevant were selected for inclusion. WHERE ARE WE NOW?: Higher pain prevalence in women is consistently observed but not well understood. The relative contributions of sex differences in pain mechanisms and gender differences in psychosocial factors (eg, coping, social roles) to explaining differences in prevalence are not yet clear. Gender disparities in the amount of healthcare use for pain may be partially explained by the experience of higher-intensity pain in women. Pain intensity also seems to be a major factor influencing treatment, especially the prescription of medications for acute pain. However, clinicians' gender stereotypes, as well as the clinician's own gender, appear to influence diagnostic and treatment decisions for more persistent pain problems. WHERE DO WE NEED TO GO?: The ultimate goal is optimal pain control for each individual, with gender being one difference between individuals. HOW DO WE GET THERE?: Further research is needed to address all three major purposes, with particular attention to whether gender-specific pain treatment may sometimes be warranted.

Relationship of pain and symptoms to pubertal development in adolescents.

Temporomandibular disorder (TMD) pain, abdominal pain, migraine and tension-type headache are more prevalent in women than in men. This study assessed the relationship of back pain, headache, abdominal pain, TMD pain, and the presence of multiple pain conditions to gender and pubertal development in a cross-sectional, population-based survey of adolescents. We also examined the association between pubertal development and depressive and somatic symptoms, factors often associated with pain in adults. We hypothesized that prevalence of all pain conditions, as well as rates of other symptoms, would increase as puberty progresses in females, but not males. Subjects (3,101 boys and girls, 11-17 years old, selected from an HMO population) reported on the presence of each pain condition in the prior 3 months and completed scales assessing pubertal development, and depressive and somatic symptoms. Data were analyzed using descriptive statistics and multivariate logistic regression. Prevalence rates were weighted for factors affecting response. Prevalence of back pain, headache and TMD pain increased significantly (odds ratios, OR=1.4-2.0, P<0.001) and stomach pain increased marginally with increasing pubertal development in girls. Rates of somatization, depression and probability of experiencing multiple pains also increased with pubertal development in girls (P<0.0001). For boys, prevalence of back (OR=1.9, P<0.0001) and facial pain (OR=1.5, P<0.01) increased, stomach pain decreased somewhat and headache prevalence was virtually unchanged with increasing maturity. For both sexes, pubertal development was a better predictor of pain than was age. Thus it appears that pain, other somatic symptoms and depression increase systematically with pubertal development in girls.