Chronic pain and frequent use of health care

&NA; Little is known about the relationship between chronic pain status and overall use of healthcare. We examined whether disabling chronic pain was associated with more frequent use of healthcare in three settings: primary care, emergency departments, and hospital admissions. We used data from Computer‐Assisted Telephone Interviews (CATI) of 17,543 residents in New South Wales, Australia aged 16 and over who were randomly sampled using a population‐based two‐stage stratified sample and random digit dialling methods. The overall response rate was 70.8%. Compared to chronic pain respondents with no or limited pain‐related disability, those with most pain‐related disability reported more: primary care visits in the last 2 weeks and last 12 months (adjusted mean number of visits 0.59 vs 0.40 and 10.72 vs 4.81, both P<0.005); hospital admissions (0.46 vs 0.18, P<0.005); and emergency department visits (0.85 vs 0.17, P>0.005). In modelling, having chronic pain per se, or having chronic pain with any level of activity interference predicted health care use after adjusting for age, gender, self‐rated health, psychological distress, comorbidity and access to care. Higher levels of pain‐related disability predicted health care use more than other pain status variables. There was a strong association between pain‐related disability and greater use of services. Further work is needed to understand the nature of this association. Given the fluctuating course of chronic pain over time, there is a significant segment of the population that may be at risk of developing higher levels of disability associated with increased use of services.

[1]  E. Volinn,et al.  Small area analysis of lumbar spine surgery in South Australia. , 1993, The Australian and New Zealand journal of surgery.

[2]  A. Korten,et al.  Predictors of GP service use: a community survey of an elderly Australian sample , 1998, Australian and New Zealand journal of public health.

[3]  Louisa Jorm,et al.  The NSW Health Survey Program: Overview and methods, 1996-2000 , 2001 .

[4]  Smith Bh,et al.  Chronic pain and the use of conventional and alternative therapy. , 2003, Family practice.

[5]  S. Leeder,et al.  Selection bias from sampling frames: telephone directory and electoral roll compared with door—to—door population census: results from the Blue Mountains Eye Study , 1977, Australian and New Zealand journal of public health.

[6]  E. Bergstralh,et al.  Comparison of self-reported and medical record health care utilization measures. , 1996, Journal of clinical epidemiology.

[7]  A. Jette,et al.  The Validity of Self-reported Physician Utilization Measures , 1984, Medical care.

[8]  R. Kessler,et al.  Short screening scales to monitor population prevalences and trends in non-specific psychological distress , 2002, Psychological Medicine.

[9]  R. Kessler,et al.  The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being , 2003, Psychological Medicine.

[10]  M. Nordin,et al.  Health Care Utilization for Low Back Pain in Belgium: Influence of Sociocultural Factors and Health Beliefs , 1995, Spine.

[11]  D. Cherkin,et al.  Effects of Practice Style in Managing Back Pain , 1994, Annals of Internal Medicine.

[12]  S. Reijneveld The cross-cultural validity of self-reported use of health care: a comparison of survey and registration data. , 2000, Journal of clinical epidemiology.

[13]  J. Garrett,et al.  Reporting of Acute Low Back Pain in a Telephone Interview|Identification of Potential Biases , 1995, Spine.

[14]  G. Ejlertsson,et al.  Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study. , 1999, Journal of epidemiology and community health.

[15]  T. Koepsell,et al.  A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. , 1999, Spine.

[16]  A. M. Harvey Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms , 1995 .

[17]  F. Blyth,et al.  Chronic pain in Australia: a prevalence study , 2001, Pain.

[18]  A Norrish,et al.  Validity of self-reported hospital admission in a prospective study. , 1994, American journal of epidemiology.

[19]  E. Wagner,et al.  Chronic pain and use of ambulatory health care. , 1991, Psychosomatic medicine.

[20]  H. Merskey,et al.  Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. , 1994, Pain. Supplement.

[21]  S. Coughlin Recall bias in epidemiologic studies. , 1990, Journal of clinical epidemiology.

[22]  S. Chrubasik,et al.  A survey on pain complaints and health care utilization in a German population sample. , 1998, European journal of anaesthesiology.

[23]  R. Andersen,et al.  Societal and individual determinants of medical care utilization in the United States. , 1973, The Milbank Memorial Fund quarterly. Health and society.

[24]  C. Callahan,et al.  Accuracy of self-reported health services use and patterns of care among urban older adults. , 1999, Medical care.

[25]  Patterns and costs of post‐acute care: a longitudinal study of people aged 60 and over in Dubbo , 1996, Australian and New Zealand journal of public health.