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. 1999 Aug;53(8):503–509. doi: 10.1136/jech.53.8.503

Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study

H I Andersson, G Ejlertsson, I Leden, B Schersten
PMCID: PMC1756941  PMID: 10562870

Abstract

STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms.

 

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Selected References

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  1. Andersson H. I., Ejlertsson G., Leden I., Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993 Sep;9(3):174–182. doi: 10.1097/00002508-199309000-00004. [DOI] [PubMed] [Google Scholar]
  2. Antonov K., Isacson D. Use of analgesics in Sweden--the importance of sociodemographic factors, physical fitness, health and health-related factors, and working conditions. Soc Sci Med. 1996 Jun;42(11):1473–1481. doi: 10.1016/0277-9536(96)87321-7. [DOI] [PubMed] [Google Scholar]
  3. Ballina Garcia F. J., Hernandez Mejía R., Martín Lascuevas P., Fernandez Santana J., Cueto Espinar A. Epidemiology of musculoskeletal complaints and use of health services in Asturias, Spain. Scand J Rheumatol. 1994;23(3):137–141. doi: 10.3109/03009749409103046. [DOI] [PubMed] [Google Scholar]
  4. Bates M. S., Edwards W. T. Ethnic variations in the chronic pain experience. Ethn Dis. 1992 Winter;2(1):63–83. [PubMed] [Google Scholar]
  5. Brattberg G., Thorslund M., Wikman A. The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain. 1989 May;37(2):215–222. doi: 10.1016/0304-3959(89)90133-4. [DOI] [PubMed] [Google Scholar]
  6. Bucquet D., Curtis S. Socio-demographic variation in perceived illness and the use of primary care: the value of community survey data for primary care service planning. Soc Sci Med. 1986;23(7):737–744. doi: 10.1016/0277-9536(86)90122-x. [DOI] [PubMed] [Google Scholar]
  7. Bush P. J., Rabin D. L. Who's using nonprescribed medicines? Med Care. 1976 Dec;14(12):1014–1023. doi: 10.1097/00005650-197612000-00005. [DOI] [PubMed] [Google Scholar]
  8. Campbell S. M., Roland M. O. Why do people consult the doctor? Fam Pract. 1996 Feb;13(1):75–83. doi: 10.1093/fampra/13.1.75. [DOI] [PubMed] [Google Scholar]
  9. Dean K. J., Holst E., Wagner M. G. Self-care of common illnesses in Denmark. Med Care. 1983 Oct;21(10):1012–1032. doi: 10.1097/00005650-198310000-00007. [DOI] [PubMed] [Google Scholar]
  10. Edén L., Ejlertsson G., Lamberger B., Leden I., Nordbeck B., Sundgren P. Immigration and socio-economy as predictors of early retirement pensions. Scand J Soc Med. 1994 Sep;22(3):187–193. doi: 10.1177/140349489402200305. [DOI] [PubMed] [Google Scholar]
  11. Egan K. J., Katon W. J. Responses to illness and health in chronic pain patients and healthy adults. Psychosom Med. 1987 Sep-Oct;49(5):470–481. doi: 10.1097/00006842-198709000-00004. [DOI] [PubMed] [Google Scholar]
  12. Eggen A. E. Pattern of drug use in a general population--prevalence and predicting factors: the Tromsø study. Int J Epidemiol. 1994 Dec;23(6):1262–1272. doi: 10.1093/ije/23.6.1262. [DOI] [PubMed] [Google Scholar]
  13. Ektor-Andersen J., Janzon L., Sjölund B. Chronic pain and the sociodemographic environment: results from the Pain Clinic at Malmö General Hospital in Sweden. Clin J Pain. 1993 Sep;9(3):183–188. doi: 10.1097/00002508-199309000-00005. [DOI] [PubMed] [Google Scholar]
  14. Grimsmo A., Siem H. Factors affecting primary health care utilization. Fam Pract. 1984 Sep;1(3):155–161. doi: 10.1093/fampra/1.3.155. [DOI] [PubMed] [Google Scholar]
  15. Hibbard J. H., Pope C. R. Gender roles, illness orientation and use of medical services. Soc Sci Med. 1983;17(3):129–137. doi: 10.1016/0277-9536(83)90246-0. [DOI] [PubMed] [Google Scholar]
  16. Ingham J. G., Miller P. M. Self-referral to primary care: symptoms and social factors. J Psychosom Res. 1986;30(1):49–56. doi: 10.1016/0022-3999(86)90065-6. [DOI] [PubMed] [Google Scholar]
  17. Potter R. G., Jones J. M. The evolution of chronic pain among patients with musculoskeletal problems: a pilot study in primary care. Br J Gen Pract. 1992 Nov;42(364):462–464. [PMC free article] [PubMed] [Google Scholar]
  18. Rekola K. E., Keinänen-Kiukaanniemi S., Takala J. Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician. J Epidemiol Community Health. 1993 Apr;47(2):153–157. doi: 10.1136/jech.47.2.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Roberts R. O., Bergstralh E. J., Schmidt L., Jacobsen S. J. Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol. 1996 Sep;49(9):989–995. doi: 10.1016/0895-4356(96)00143-6. [DOI] [PubMed] [Google Scholar]
  20. Thomas K. J., Carr J., Westlake L., Williams B. T. Use of non-orthodox and conventional health care in Great Britain. BMJ. 1991 Jan 26;302(6770):207–210. doi: 10.1136/bmj.302.6770.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Verbrugge L. M., Ascione F. J. Exploring the iceberg. Common symptoms and how people care for them. Med Care. 1987 Jun;25(6):539–569. [PubMed] [Google Scholar]
  22. Von Korff M., Wagner E. H., Dworkin S. F., Saunders K. W. Chronic pain and use of ambulatory health care. Psychosom Med. 1991 Jan-Feb;53(1):61–79. doi: 10.1097/00006842-199101000-00006. [DOI] [PubMed] [Google Scholar]
  23. Wessling A. Continuous recording of drug prescribing in Sweden 1974-1983. Methods and examples of utilization of data. Eur J Clin Pharmacol. 1987;33(1):7–13. doi: 10.1007/BF00610372. [DOI] [PubMed] [Google Scholar]
  24. Yelin E., Bernhard G., Pflugrad D. Access to medical care among persons with musculoskeletal conditions. A study using a random sample of households in San Mateo County, California. Arthritis Rheum. 1995 Aug;38(8):1128–1133. doi: 10.1002/art.1780380816. [DOI] [PubMed] [Google Scholar]

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