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Pain epidemiology


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FM Biyth*. LM March*, LR Jorm*, M Williamson*, MJ Cousins (SPON: S. Beardmore) Univ of Sydney Pain Management and Research Centre, Royal North Shore Hospital, Sydney, NSW 2065, AUSTRALIA

Aim of Investigation: To estimate the prevalence of chronic pain in the adult population of the state of New South Wales (NSW) and describe variations in prevalence according to age, sex and area of residence.

Methods: As part of an annual population health telephone survey by the NSW Health Dept, respondents were asked about chronic pain. A stratified 2-stage cluster sample design and random digit dialing methods were used. Data were collected using computcr-ssisted telephone interview (CATI) methods between August 1997-February 1998.

Results: There were n==17,541 respondents (response rate 70.1%). Chronic pain (i.e. pain lasting for 3 months or more in the previous 6 months) was reported by 17.1% of males and 20.1% of females. More than 60% of males and females with chronic pain reported pain-related interference with daily activities. Chronic pain prevalence was highest in the 65-69 year age group for males (26.4%) and the 80 years and over age group for females (30.5%). Rates of chronic pain varied among areas of residence (10.7%-23.7% for males; 17.7%-23.2% for females).

Conclusions: In the first study of its kind in Australia, chronic pain was shown to be a common problem, and frequently accompanied by interference with daily activities. This is one of few studies internationally which describes geographical variations in pain prevalence.


John Mark Disorbio, Ed.D*, (SPON: D.Bennett, M.D.), Director of Integrated Therapies, a multi-disciplinary outpatient pain clinic, 390 Union Blvd. #230, Lakewood, CO 80228 USA

Aim of Investigation: To provide national norms on the BHI 0-10 ratio pain scale for specific medical diagnoses of low back and upper extremity pain patients.

Methods: The BHI pain complaints scale was administered to both low back and upper extremity pain patients. A total of 777 patients were evaluated. The average pain complaints scores were derived from ten regions of the body.

Results: The average low back patient score from all ten regions of the body were not significantly higher than upper extremity patients. The average low back pain score for low back pain patients was 7.6. The upper extremity patient low back pain score was 5.6. This was a significant difference (p>.0001). Low back pain patients reported significantly higher scores in the lower extremities (p>.001) and genital area (.05). The average pain score reported by upper extremity pain patients in the upper extremity was 7.4. Back pain upper extremity pain complaints were 5.7. Significant difference between groups (p>.001). No difference between groups on pain complaints were found on head, neck, shoulder, chest, stomach and facial pain.

Conclusions: This study is the first attempt to identify standards and norm patient pain perception with specific medical diagnoses. The results reflect specificity of pain intensity related to patient medical diagnoses. Pain intensity scores would be expected to be higher in regions of the body related to their medical diagnoses. However, future research is needed to determine whether this trend consists in all medical diagnoses related to pain.

Acknowledgments: Supported by NCS Assessments. Dr. Disorbio is co-author of the BHI.


Mark Drangsholt. Lloyd MancI*, Linda LeRcschc, Dcpts of Oral Medicine and Dental Public Health Sciences, Univ of Washington, Seattle, WA, 98195-6370, USA.

Aim of Investigation: Compare the sample sizes needed to investigate risk factors for TMD pain using cohort and case-control study designs.

Methods: An exhaustive search of the literature was completed to estimate the prevalence and incidence of TMD pain, and determine study designs and sample sizes used previously. Incidence rates for cohort studies of TMD pain were calculated when not provided. Sample size calculations and simulations using the S1Z program by SERC and NQuery Advisor were completed over a range of values, using the following assumptions: TMD pain prevalence 10%; incidence = 2-4/100 person-years (p.yr.); prevalence of purported risk factors (e.g., depression, bruxism, trauma) = 5-20%, and odds ratios > 2.0.

Results: Under these assumptions, a case-control study is the most efficient study design to investigate risk factors. For 80% power at alpha = 0.05, 140 cases and 140 controls are required. Five of 53 existing case-control studies have sufficient sample size. To conduct a cohort study with the same power requires at least 1800 subjects at baseline. There arc no existing cohort studies with adequate sample size. For persistent TMD pain (incidence a 1/1000 p.yr.); the sample size would need to increase 20-fold for a cohort study, but it would stay roughly the same for a case-control study.

Conclusions: Case-control studies generally provide greater efficiency than cohort studies to evaluate etiologic factors for TMD pain. Studies of persistent TMD pain or other subgroups are greatly favored by this design. These findings may apply to other chronic pain conditions, such as headache and back pain.

Acknowledgments: Supported by CA-60710, DE-08773, and the Univ of Washington Oral Medicine Research Fund.


Alison M Elliott*. Blair H Smith*, W Alastair Chambers, W Caims Smith*, Kay I Penny*, Univ of Aberdeen, Aberdeen AB25 2YA, Scotland, UK.

Aim of Investigation: To quantify and describe the prevalence and distribution of chronic pain in the community.

Methods: A random sample of 5036 patients, aged 25 and over was drawn from 29 general practices in the Grampian region of Scotland and surveyed by a postal self completion questionnaire.

Results: The response rate for the study was 82%. The prevalence of self reported chronic pain in the sample was 50.4%, equivalent to 46.5% of the general population. Back pain and arthritis were the most common causes of complaint, and accounted for about a third of all complaints. Logistic regression modelling identified age, gender, employment status and marital status as significant predictors of the presence of chronic pain in the community. Forty-eight percent of those with chronic pain reported it at the least severe level, while sixteen percent reported it at its most severe level. A small percentage of chronic pain sufferers reported no expressed need (17%), but most had a high level of expressed need (42%). Conclusions: Chronic pain is a major problem in the community, affecting up to half of the population. Although the majority of patients reported low levels of seventy most report high levels of expressed need The disparity between levels of reported seventy of chronic pain and the expressed need of patients requires further research to improve our understanding of chronic pain and in time the management of this important problem

Acknowledgments' Supported by The Scottish Office, Home and Health Dept. K/RED/4/C286


G.Emst*. C. Wegener*, M. Hackel*, A. Mehl*, M. Stolaczyk*, H Hagmeister, Humboldt Univ, Virchow-Clmic, Dept for Anesthesi-ology; Berlin, Germany

Aim of Investigation. Abuse of legal drugs (coffee, alcohol, cigarettes) is discussed as a possible risk factor for the chronification of different headaches and chronic low back pain In our survey we test the influence of substance abuse on these chronic pain syndromes

Methods The investigation took part in January 1999 A population sample of 800 inhabitants of Berlin, Germany assigned from the central population register was included First, an information letter was sent to all participants Then, they were interviewed by phone 3 to 5 days later using validated schemes like headache classification (IHS), back pain score, alcohol consumption (Cage Questionnaire), coffee intake, cigarette smoking and body mass index In addition, social and environmental factors were evaluated. The survey was approved by an ethic committee and the data security officer of the local government

Results The response rate was over 75%. Intern validation showed consistent results, no major bias was identified. There was no ma-Jor correlation between pain syndromes and signs of alcohol misuse, cigarette smoking or coffee intake (please see the data and the graphs on the poster)

Conclusions. Earlier reports of a possible correlation between coffee intake and tension type headache are not confirmed by our study There is no relation between substance abuse and pain chronification, despite possible pathophysiological similarities between pain syndromes and substance abuse (e g the serotonmer-gic system)


G Gamble*. A Jones, P Tyrrell*, A Bowen*, D Bowsher, Dept of Genatncs, CSB, Hope Hospital, Eccles Old Road, Salford, M6 8HD, UK

Aim of Investigation' To establish the incidence of shoulder pain after acute stroke and categorise by causation Methods. All consenting consecutive patients admitted over a 10 week period, with acute stroke according to WHO criteria, were interviewed and examined 12 -28 days after initial event Interview included history, Barthel, HAD score, pain diagram and VAS and Bothersome score. Patients with pain had a shoulder radiograph and were allocated to one of 4 groups according to pre determined criteria Aphasic patients were included with an observational study.

Results 16 of 48 patients experienced shoulder pain for longer than 24 hours since their stroke This was thought to be due to regional pathology in 8 cases, central pain in 1 and part of a widespread pain syndrome in another In 3 cases pain was attributable to more than one cause (mixed category)

Conclusions. The true incidence of post stroke shoulder pain is unknown but a recent retrospective audit reported an incidence of 4%. Our early results show a much higher prevalence of 33%. 4 patients (8%) had clinical features suggestive of a central component to their post stroke shoulder pain Follow up studies of larger numbers will determine whether these patients have a different pattern of recovery

Acknowledgments No conflict of interest


Kathryn Garland*, Pauline Gardner. George Mendelson (SPON T F. Little), Caulfield Pain Management and Research Centre, Caulfield General Medical Centre, 260 Kooyong Road, Caulfield, Vie 3162, Australia

Aim of Investigation. To investigate the relationship between pain seventy scores and depressive symptoms in patients attending a multidisciplmary pain management centre, who participated in a 16 week long cognitive-behavioural treatment programme

Methods This was a retrospective study based on written psychological tests completed by 204 patients before and after treatment at a pain clinic. Pain severity was assessed using a 100 mm visual analogue scale The severity of depressive symptoms was evaluated using the Zung Self-Rating Depression Scale

Results Pearson's correlations revealed that pain relief was negatively correlated with the severity of depressive symptoms at the conclusion of the treatment period (p< 01), and that change in the depressive symptoms was also negatively correlated to ratings of pain severity at discharge (p< 05) A further finding was that depressive symptom severity prior to treatment was positively related to pain seventy (p< 05) and to the depressive symptom score (p< 001) at the end of the treatment penod

Conclusions Patients who achieved relatively large reduction in pain seventy during the treatment programme also showed significantly lower depressive symptom scores at discharge, while those who reported a large decrease in depressive symptoms rated their pain severity at lower levels at the conclusion of treatment Further findings revealed that high levels of depression at commencement of treatment were associated with high levels of pain severity and depressive symptoms at discharge Taken together, these findings suggest that high levels of depressive symptoms may be a useful predictor of poor treatment outcome as measured by reduction in pain severity for chronic pain patients entering a cognitive-behavioural treatment programme


M. Haddad. D. Gharbi, M. Abdelmoula, I Fennira, M Abbassi, R Ha)n, A Laatar, M Ellouze, M. Maiek, I Turki, R Tngui

Aim Investigation To define recruitment and management of chronic pain patients in the Pain Center of Tunis after two years of activity (from its inauguration on November 1996 to November 1998)

Methods Descnptive and statistical study

Results' (work on hand) Pain Center of Tunis is actually an out-patient Dept The staff of professional health is multidisciplm-ary, constituted by 2 general practitioners, 2 neurological specialists, 2 rheumatological specialists, 1 cancer specialist, 1 psychiatric specialist, 1 psychologist, 1 physical therapist, 3 nurses About 900 patients have consulted during the two years of the Center 40% of patients consult for a chronic neurologic pain. 35% of patients consult for a chronic rheumatological pain 25% of patients consult for a chronic cancer pain

Conclusion Pain Center of Tunis appears to respond to a real request of management of chronic pain


Beth Hahn*'. Sunil Dogra2, Susan Kmg-Zeller*2 (SPON W.S Blau2), 'Glaxo Wellcome Inc, Five Moore Dnve, RTP, NC 27709, USA, Anesthesiology Pain Management Center, Univ of North Carolina, Chapel Hill, NC, 27599, USA

Aim of Investigation To assess the impact of chronic pain on patients' medical resource utilization, work ability, and family responsibilities

Methods A postal survey containing questionnaires assessing pain symptoms, demographics, economic impact, and quality of life was sent to a random sample of 500 members of the American Chronic Pain Association

Results The response rate was 47% (N=236) A total of 18% had been hospitalized, 23% had an emergency room visit, 51% had a hospital clinic or outpatient visit, 63% had diagnostic tests, and 91% had a doctor office visit for pain in the previous 12 months Few patients worked full-time (15%), and nearly half were disabled by chronic pain During the previous month, 57% had experienced at least one day in which they were unable to work or participate in their main activity, and 69% had cut back activities for at least a portion of a day Among patients who had lost a job, resigned from work, or were disabled, the burden on spouses increased Spouses had to take on a job/extra work to support the family (35%), take time off to care for the patient (43%), assume financial tasks (37%) or take on additional household responsibilities (89%)

Conclusions These results demonstrate that the impact of chronic pain on the medical care system, patients, and their families is substantial


Jan P H. Hamers'. Manci P E J M van Gogh*, Huda Huljer Abu-Saad', Bert J Zomer2, Paul J W Vogelaar2, 'Dept of Nursing Science, Maastricht Univ, PO Box 616, 6200 MD Maastricht, The Netherlands, Univ Hospital Nijmegen, The Netherlands

Aim of Investigation to explore the prevalence of pain in HIV-patients, to investigate how patients do experience this pain, and to explore which methods they use to alleviate their pain Methods This study employed a cross-sectional design Ambulatory HIV-patients (n=61) received a questionnaire that consisted of 52 questions regarding patients' charactenstics, different aspects of pain experience, and pain-relieving interventions. The response rate was high 92% (n=56) Of the sample 80% were male The mean age was 38 years (SD=7) Of the 56 subjects 38 (68%) were patients with HIV, while 18 (32%) were patients with AIDS. Results The prevalence of pain was 50%. There was no statistically significant difference in prevalence of pain between HIV-patients and AIDS-patients According to the subjects in pain, 57% of all pain was caused by infections related to HIV, 39% was caused by stress Pain in the stomach was most frequently mentioned (36%), followed by pain in their shoulders (29%) and lower extremities (25%). The mean VAS (0-100mm) score for the average pain intensity in the last 7 days was 49 (SD=22), the VAS score for the most severe pain was 65 (SD=24) The mean VAS score for the most severe pain was highest in AIDS-patients 76 (SD=17), p<0.05. Furthermore, 37% of all subjects in pain also complained about senous sleep problems due to their pain The intervention 'take rest' was used most often for pain relief, followed by distraction techniques and relaxation techniques Non-opioid analgesics were prescnbed only in 14% of the patients, opioid medication was not prescnbed in any case Finally, the subjects mentioned that they were supported in the management of their pain mainly by non-professional (family, friends) care-givers

Conclusion Pain is a senous problem in patients with HIV disease However, the use of analgesics in pain the pain management is practice in only a small part of the ambulatory HIV-patients As a result, there is a senous nsk that pain is under-treated


William D. Hammonds. Nancy Thompson*, The Center for Pain Medicine, Dept ofAnesthesiology, School of Medicine and the Dept of Behavioral Sciences and Health Education, Rollms School of Public Health, Emory Univ, Atlanta, Georgia, USA

Aim of the Investigation To investigate the association between chronic disabling back pain and physical or sexual abuse

Methods' In a matched case control study design, 67 patients with chronic disabling back pain and 67 patients from the general medical clinic of the same Univ group practice were matched on age plus or minus 5 years. Depression was determined by testing with the short form of the Beck Depression Inventory A history of abuse was determined by questionnaire completed by cases and controls Odds ratios for the exposures of interest were determined using conditional logistic regression with the PHREG program in SAS

Results Psychometric testing showed that 74 63% of cases were depressed compared to 5 97% of controls When controlling for gender, education, and marital status the odds ratios for the association between abuse and chronic disabling back pain are as follows

Exposure of interest Odds Ratio (95% CI) p-value Physical abuse 2533(1198-5357) 0015 Sexual abuse 3044(1276-7260) 0012 Physical and sexual abuse 3 475 (1 228-9 836) 0019

Conclusion This study investigated the association between physical or sexual abuse and chronic disabling back pain. The association was statistically significant That association was stronger with sexual than physical abuse, and stronger still in patients with a history of both These findings provide evidence that non biologic factors play a role in chronic disabling pain This association merits further investigation into the medical and public health implications


S W Harkms, F M. Bush. J N Harkms, W G. Hamngton TMJ-Orofacial Pain Center and Dept of Gerontology, VA Commonwealth Univ, Richmond, VA 23298, USA.

Aim of Investigation To determine if study of a possible relation among the number ofmusculoskeletal (MS) pain sites and nsk for depression (CES-D) supports the previous conclusion (Dworkin et al)ofa somatic manifestation of psychological distress when pain occurs in multiple body locations

Methods' The study population was 9,441 (62 3% female, mean age 56 1, range 32-86 years) civilians of the 1984-85 National Health Nutntion Epidemiologic Follow-up Study. Data were obtained by interview and questionnaire

Results 37.5% had pain over the last week and a history of pain of at least a year MS pain complaints ranged from one to six (neck-back, hip, knee, joint pain or swelling) The number of pain complaints was predictive of CES-D scores, neuroticism, Visual Analog Scale pain intensity, use ofantidepressants and anxiolytics and limitations in activities of daily living The presence of a pain complaint was strongly positive for the affect and the somatic sub-scales of the CES-D After controlling for demographics, the nsk for depression was approximately 30% for persons in pain having four or more MS pain sites.

Conclusions' The present results of increased number of MS pain complaints is consistent with the results of this previous study involving chronic pain across different body systems, indicating greater somatization with multiple pain complaints Our findings are also consistent with the premise that the impact of pain in relation to negative moodVaffect on daily activities leads to emotional distress and suffenng


Steven A King. MD. John V Timko*, Division of Pain Medicine, Temple Univ Sch ofMed, 3401 N. Broad St, Philadelphia, PA 19140, USA

Aim of Investigation To examine the extent to which pain is a problem among patients referred to a psychiatric consulta-tion/liaison service

Methods' One hundred inpatients referred to a C/L service were studied At the time of the initial evaluations by the service, patients were asked whether they had pain, and if so, the location of pain and how long it was present Information on demographics, reasons for consultations, and the use of analgesic medications was also collected

Results Fifty-nine (59%) of the patients reported having pain at the time of the initial evaluation Seventeen of these patients were in a postoperative penod Only 6 patients were referred to the service for pain Of the patients with pain, 26 had received one or more doses of an opioid analgesic and 15 one or more doses of a nonsteroidal antimflammatory drug (NSAID) or acetammophen during the 48 hour penod preceding the evaluation Of the patients who did not have pain, only 2 had received an opioid analgesic during this time penod and 4 an NSAID or acetammophen

Conclusions Pain is a common problem among patients referred to a consultation/liaison service though consults are infrequently requested for this it The patterns of analgesic medication usage suggest that the absence of pain is not the result of appropriate care and that many patients may not be receiving adequate pain management The results indicate that health care professionals who care for these patients need to inquire about and appropriately assess pain


Margareta Leijon. Kristma Alexanderson, Gunnel Hensmg, Per Bjurulf, Dept of Health and Environment, Dept of Social Medicine, Faculty of Health Sciences, S-581 85 Lmkopmg, Sweden

Aim of Investigation To study gender trends in sickness absence due to musculoskeletal pain diagnoses and its changes in 1985-87

Methods A prospective population-based study of all new sick-leave spells exceeding seven days in 1985-87 in the county of Ostergotland, Sweden Participants were all sick-leave insured persons aged 16-65, 107 000 women and 100 000 men Sickness absence with "all diagnoses" was compared to "all musculoskeletal pain diagnoses", the latter group was also divided into three sub-groups

Results More women than men were sick-listed in "all diagnoses" in 1985. There were corresponding gender differences in sickness absence with musculoskeletal pain diagnoses except with the diagnosis "low back pain" Sick-listing with musculoskeletal pain diagnoses increased for both women and men from 1985 to 1987, but the increase was consistently much higher for women, especially for younger women

Conclusion This population-based prospective three-year study showed that there was a great increase in the incidence of sickness absence due to musculoskeletal pain diagnoses in the county of Ostergotland, Sweden from 1985 to 1987 for both men and women. This increase was much higher for women than for men, especially in "neck/shoulder pain" Women also had a much higher percentage increase of sick-leave days/sick-leave insured person and sick-leave days/sick-listed person in "all diagnoses" as well as in "all musculoskeletal pain diagnoses" and in three diagnostic sub-groups


AR Mafi*, MA Asghan. SM Mohammadi*, Occupational Health Services of National Iranian Oil Company, P 0 Box 14155-7137, Tehran, Iran

Aims of the investigation To investigate (1) the overall prevalence of the reported experience common pain during the past 6 months, (2) the prevalence of chronic persistent pain and (3) the prevalence of recurrent pain over the past 6 months among the employees of a big industrial company in Iran

Methods In 1998,1154 male employees completed a 44-item questionnaire In addition to demographic and work-related information, the questionnaire provided data on prevalence rates of experience of common pain, chronic persistent pain and recurrent pain over the past 6 months

Results Of the total sample, 452 subjects (39%) reported a pain experience over the past 6 months Of these, 163 subjects (or 14% of the total sample) reported chronic persistent pain and 176 subjects (or 15% of the original sample) reported recurrent pain in the pnor 6 months Approximately, 17% of the original sample (193 subjects) reported that they take medication for pain relief The two groups of chronic persistent and recurrent pain were compared for taking pain-related medications, educational levels, marital status and current work status, using chi-square analyses No significant differences emerged between the two groups Analyses of variance were performed to compare the 3 groups of chronic persistent pain (N=163), recurrent pain (N=I76) and no pain (N= 815) on age. While subjects in no pain group were significantly younger than those in the chronic persistent group or recurrent group, there was no significant age difference between the two groups of chronic persistent and recurrent pain

Conclusions The 6 months prevalence rates for common pain condition, chronic persistent pain and recurrent pain were 39%, 14% and 15%, respectively These findings are more or less compatible with the results reported in other studies, mostly those conducted in the Western societies, indicating that chronic persistent pain and recurrent pain are common in the adult populations


George Mendelson. Caulfield Pain Management and Research Centre, Caulfield General Medical Centre, 260 Kooyong Road, Caulfield, Vie 3162, Australia

Aim of Investigation The purpose of this study was to determine the frequency of suicidal ideation among patients attending a mul-tidisciplmary pain management clinic, and to examine whether such ideation is associated with specific psychosocial or clinical charactenstics

Methods This was a retrospective study utilising data collected during the initial assessment of 504 patients Information was obtained both from the clinical interview and from psychological tests administered to each patient Suicidal ideation was assessed from the patient's response to question 19 of the Zung Self-Rating Depression Scale, viz "1 feel that others would be better off if I were dead " The presence and degree of suicidal ideation were examined in relation to selected demographic, clinical and psychological charactenstics using appropriate statistical techniques

Results There were 379 patients (75.2%) who responded "never or a little of the time" to the cntenon question Eighty patients (15 9%) answered "some of the time," 19 patients (3 8%) answered "good part of the time," and 26 patients (5 2%) indicated that they had such feeling "most or all the time " Suicidal ideation was positively correlated with pain severity (measured on the Visual Analogue Scale and the McGill Pain Questionnaire), hostility (as measured by the Hostility and Direction of Hostility Questionnaire), and the overall score on the Zung scale, but not with any other clinical or psychological variables, including the diagnosis of a depressive disorder

Conclusions' These findings indicate that one quarter of patients with chronic pain referred to a specialist pain treatment facility acknowledge the presence of suicidal ideation Pain seventy and hostility were positively correlated with suicidal ideation This may be present in patients who do not appear to be clinically depressed The presence of suicidal ideation should be routinely assessed as part of the initial evaluation of patients with chronic pain, so as to identify individuals at risk and allow appropriate and timely therapeutic intervention.


Tito R. Mendoza*, Chyi Chou*, Charles S Cleeland (SPON. C S Stratton Hill), Pain Research Group, WHO Collaborating Centre In Supportive Cancer Care, Univ of Texas M D Anderson Cancer Center, 1100 Holcombe Blvd Box 221 Houston, Texas 77030 USA

Aim of Investigation The goal of this study was to delineate the seventy of the most common symptoms expenenced by cancer patients. We also descnbe how pain relates to symptoms commonly reported by cancer patients

Methods A cancer-related symptom inventory developed by the Pain Research Group was used to assess symptom severity Demographic and clinical data (disease diagnosis, stage of disease, performance status) were also collected from over 450 patients at the M.D Anderson Cancer Center

Results: Patients reported pain as a domain distinct from other cancer-related symptoms Cognitive/affective and fatigue/weakness are the other dimensions of symptoms identified across cancer diagnosis. Other common symptoms such as diarrhea, nausea and shortness of breath were closely related to the type of cancer diagnosis. Some symptoms showed significant seventy at both the moderate and severe level of pain. Other symptoms such as vomiting, diarrhea, bleeding and sores were significantly severe only when the level of pain is also severe

Conclusions: This study demonstrates that symptoms can be grouped into three major dimensions when patients report cancer-related symptoms. These dimensions can be construed as 'pain', 'mental (cognitive/affective)' and 'physical (fatigue/weakness)' The study also showed that these other dimensions are closely related with the severity of pain Understanding the relationship of pain to other cancer-related symptoms provides a framework for optimal symptom treatment strategies

Acknowledgments Supported by unrestncted educational grant from Ortho Biotech, Inc and Special Institutional Grant #21 from the Amencan Cancer Society.


C. S Mukhet]!. A. Sarkhel, T K Banerjee, S Sen, Pacific Point -Centre for Pain Relief, 57/14 Ballygunj Circular Road, Calcutta -700 019, India.

Aims of Investigation As part of a larger survey, to investigate the prevalence, nature and relationships of central post-stroke pain (CPSP) in a community-based sample.

Method' Door to door locality survey of 4,600 families in Calcutta Follow-up detailed medical assessment of positive cases

Results- 37 of the 17,000 people surveyed were found to have suffered from a cerebrovascular accident (stroke) 17 (F - 12, M - 5) of this cohort had suffered or were suffenng from post-stroke pain Patterns of pain descnption were recorded The majonty (65%) descnbed a moderate response to treatment. The incidence of pre-stroke stressful events was high in both the CPSP (59%) and non-CPSP (50%) groups The incidence of post-stroke depression or dysthymia was 41% in the CPSP group as compared to 40% in the non-CPSP group | Conclusions Our community sample, albeit small, has an abnor- < mally high incidence (46%) of CPSP compared to a reported range -3 of 2-8% Previous studies have not reported a relationship to sex (our study - F M - 2 4 1) Sample size, retrospective analysis, racial/cultural factors and community sample variables may be contributory Interestingly, the presence ofdepression/dysthymia or pre-stroke life events is not significantly correlated with CPSP The authors have not found any comparable Indian data, a larger study encompassing a population of 500,000 is under way


R. Roy. C Holland, M R Thomas, J Garmger, Dept of Psychology, The Univ of Manitoba, Winnipeg, Manitoba, R3T 2N2 Canada

Aim of Investigation This study investigated the reported pain severity, duration and behavioral impact of headaches at the start and mid-menstrual cycle for 200 young women (age range 18-20 years old)

Methods: Two hundred Univ women were recruited through the Univ Introductory Psychology courses who reported headaches on a weekly basis Approximately half were taking oral contraception and half were not All subjects were administered the same questionnaire twice, once at the start of their menstrual cycle and again at mid menstrual cycle The questionnaire consisted of 1) demographic pain questions, 2) The West Haven Yale Multidimensional Pain Inventory (WHYMPI), 3) Pain Attitudes Inventory, 4) The Pain Disability Index, 5) The Beck Depression Inventory (BDI), 6) The Beck Anxiety Inventory (BAI), 7) The Hypocondryisis Scale (MMPI-2), and 8) The Rosenberg Self-esteem Scale

Results There were a number of significant differences in psychological functioning for the women on the basis of the timing of their menstrual cycle As well there were marked differences reported in headache severity and duration with a high correlation between estrogen level and reported pain severity of headaches There were significant behavioral responses to pain as a function of menstrual cycle

Conclusions This sample of Univ aged women supported the literature hypotheses that menstrua] cycle (indirect measure of estrogen levels) is significantly associated with self reported headache pain severity as well as related pain behaviors Implications for future research on menstrua] cycle headache treatment are discussed


Roland Schneider*. Bemhard Alcher. Dept ofMed Sciences, Boehnnger Ingelheim Pharma KG, D-88397 Biberach, Germany

Aim of Investigation To assess per capita intake of analgesics in Germany as compared with other countnes and over time to determine differences between single and combined preparations Methods International comparison of pharmacies' purchases since 1980 and country- and time-specific identification of ingredients, using international pharmacopeias Conversion into counting units (CU) and per-capita intake

Results In 1995, per-capita intake of analgesics was highest in the USA (152 CU/capita, Sweden 140, France 107, Australia 93, Canada' 65, Belgium 73, Germany (West) 63, Switzerland 29) Combined analgesics Sweden 50, France 25, Australia 25, Germany (West) 19, USA 11, Switzerland 7, Canada 3 In some countnes, intake of analgesics has increased over the past 15 years (Sweden +54%, France -r53%, Australia +118%, Canada-+51%) In Switzerland, Belgium and Germany (West), no increase was observed Per-capita intake of caffeine-containing analgesics decreased in Germany (1980 32 CU, 1995 15CU) A similar decrease has been observed for multiple compounds containing caffeine. Phenacetin-contammg preparations have lost their significance in Germany in the mid-1980s

Conclusions The analysis indicates that per-capita intake of analgesics in Germany, including combined preparations, ranges in the lower mid-region with respect to both the international companson and time It must be taken into account that despite the same per-capita intake in countries, the actual intake in individual countries may be distributed over a smaller number of people Thus, per-capita intake is a mean value


Arunas Scmpokas. Dept of Neurology, Kaunas Medical Univ, Mickeviciaus 9, 3000 Kaunas, Lithuania

Aim of Investigation The present study was designed to evaluate the back pain problems in the neurological outpatient clinic

Methods Patients were examined applying interview and commonly adopted pain and physical investigation scheme Back pain was subdivided in the groups according to age, sex, levels of disturbance and a type of pain perception Results Back pain was the cause of 26 02% of all admissions or 29 29% of all primary visits registered in the pnvate neurological ambulatory clinic during 3 years period Among 256 patients with back pain 65 45% were women, and 30-39 both 40-49 age groups were the largest ones - 27 34% and 24.61% of patients accordingly. The distribution of back pain patients between sex was quite equal in the groups till 50 (56 33% women), but very different among elderly (77 55% women) Low back pain (53 65%) was the largest level group versus neck pain (36 13%) and thoracic pain (10 22%) groups The distribution between sex was quite equal in all level groups till 50, but very different among elderly, especially in thoracic pain group (90% women) Neuropathic type of back pain prevailed among men (56 52%) in cervical level and among women (72 00%) in low back level. Nociceptive type of pain was more frequent among young men (51 02%) comparing with very frequent among elderly women (84 21%) in low back pain level, and more frequent among all women (78 46%) in cervical level Conclusions' 1 Back pain was the common problem of the neurological outpatient practice and covered approximately 30% of all primary visits. 2. The main group was related to low back pain problems and exceeded 53% of all admissions 3 Nociceptive type of back pain prevailed among women in low back pain both cervical level 4 Neuropathic type of back pain was common for men in cervical level and for women in low back pain level


O. Sertel*, S.Ozyalcin. A.Yucel, S.Erdine, Dept. of Algology, Medical Faculty of Istanbul, Istanbul Univ Capa 34390, Istanbul-Turkey

Aim of Investigation: To investigate the distribution of Turkish Chronic Pain Patients (CPP) in two types of chronic pain (headache vs non-headache) across levels of gender, education, marital status, emotional expression, secondary gain, current family stress, childhood stress, and current major psychopathology Also to assess the differences between headache and non-headache patients' pain duration (in years), and pain intensity (in VAS), as a function of emotional expression, secondary gain, and psycho-pathology.

Method: 18 men and 102 women CPP were psychologically assessed through the Functional Analysis Interview developed by Owens and Ashcroft, and dispersed into each demographic and psychosocial category accordingly. The dispersion had also been validated in the sessions of case discussions.

Results The two groups were distributed evenly over all the categories except for emotional expression. There were significantly more patients with emotional expression in headache group than those in non-headache group. Pain duration and intensity did not change as a function of emotional expression, secondary gain and psychopathology Two groups could only be differentiated in terms of pain duration

Conclusion: Regardless of the pain type, the participants seem to be mostly females, married, primary school or Univ graduates. They seem more likely to be repressing their emotions than expressing, and benefiting from secondary gain Psychopathology seems to be masked by chronic pain They are prone to traumatic family stress just as they are to childhood stress Two groups cannot be differentiated by any of demographic or psychosocial categories except for emotional expression and pain duration


Vladimir Shoukhov. Jonathan Harper, Foundation for Evidence-Based Medicine, Moscow, Russia, Centre for Evidence Based Pharmacotherapy, Aston, UK

Aim of Investigation. To characterise comparatively analgesic utilisation in Russia

Results Analgesic preferences in Russia show major differences compared to developed western countries The results of a pharma-coepidemiological study of analgesic use in Russia show that the market for oral preparations in out-patient clinical practice and the OTC sector, continues to be dominated by three preparations -acetylsalicylic acid (33%), dypirone (30%) and paracetamol (23%) Combination analgesics constitute a further 30% In companson, the range of analgesics used in hospital practice is wider, the share of dypirone constitutes 51%, tnmependme (a synthetic opioid designed in the Soviet Union) - 20%, tramadol - 17%, morphine HC1 - 10% and papaveratum - 9% A comparison of 1997 and 1998 shows very little change in usage patterns The only major change in usage trend noted was that tramadol increased its share from 12% to 17% Major differences noted in Russian analgesic preference compared to developed countries were that prolonged action opioid forms were absent in clinical practice; combination analgesics were more widely utilised, the out-patient/OTC market share ofibuprofen, a recognised safe and effective NSAID, was less than 2%, dypirone continues to be widely utilised (although it can be argued that the usage ofparen-teral forms of dypirone in hospital practice can be justified for short-term, moderately severe postoperative pain relief) The high utilisation of oral dipyrone in the out-patient and OTC sector raises major public health concerns, particularly when one considers that the Russian OTC sector (constituting 45% of the total pharmaceutical market) is under regulated


Pia Sweet. Magdi Hanna, Kate Elliott*, Debbie Hammond*, Mi-chelle Fung*. Pain Relief Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, UK

Aim of the Investigation. To investigate the prevalence of pain in medical in-patients in King's College Hospital Methods The medical wards, as distinct from surgical, in King's College Hospital were identified, and patients on these wards were invited to answer a simple questionnaire Data was collected on age, sex, diagnostic category, duration of hospital admission and duration of pain The pain at the time of interview was assessed using the Present Pain Intensity (PPI), a 10 cm visual analog scale (VAS), and a 0-10 numerical analog scale (NAS) at rest and on movement Information on pain quality was obtained using the short form of the McGill Pain Questionnaire (SF-MPQ) The effect of pain on sleep and movement was assessed and analgesic medication and its effect was recorded

Results: 188 medical patients were identified, but 47 patients were too ill, confused or did not consent to answer questions. 141 questionnaires were completed. 80 patients (57%) reported pain during their hospital admission, whereas 61 (43%) had no pain. Of the patients who reported pain, the median age was 64 (range 19-89), and the sexes were equally represented. The median duration of stay in hospital of patients with pain was 6 days (range 1-150). The PPI of these patients was mild or discomforting (62.5%) and distressing, horrible or excruciating (21.25%). 57% of these patients had had pain for more than one week. The median NAS at rest was 3.0 (range 0-10) and the median NAS on movement was 6.0 (range 0-10). The median VAS was 3.75 (range 0-10).The median sensory component of the SF-MPQ was 6.0 (range 1.0-21.0) and the median affective component of the SF-MPQ was 3.0 (range 0.0-12.0).

Conclusion: Pain is widespread in hospitalised medical patients. In a significant minority distressing or excruciating pain was experienced for at least one week. A comprehensive pain policy is required for those patients who form the majority of routine hospital admissions.


M. R. Thomas, P. Rzeszutek, R. Roy, L. Jarrett, D. Konyk, Dept. of Psychology, The Univ of Manitoba, Winnipeg, Manitoba, R3T 2N2 Canada.

Aim of Investigation: To compare frequencies of self reported pain locations, and severity for the previous week (N=385) from three generations within the same families. Subjects were 77 young adults (age range 18-20 years old), 154 parents (mean age range 40's) and 154 grandparents (mean age range 60's). Methods: Univ subjects were recruited through the Univ Introductory Psychology courses who in turn recruited both their parents and two grandparents (one from each parent where possible). All participants filled out the same questionnaire. The questionnaire consisted of: 1) demographic pain questions, 2) The West Haven Yale Multidimensional Pain Inventory (WHYMPI), 3) Pain Attitudes Inventory, 4) The Pain Disibility Index, 5) The Beck Depression Inventory (BDI), 6) The Beck Anxiety Inventory (BAI), 7) The Hypocondryisis Scale (MMP1-2), 8) The Family Environment Scale (FES), 9) The Family Assessment Measure, FAM), and 10) The Rosenberg Self-esteem Scale.

Results: Reported pain during the past week was very common across all three age cohorts from within the same families. Within families across three generations the most common reported pain location for the young adults was headache (70's percent), in contrast for the middle aged parents, back pain was reported with the highest frequency (30's percent). Significant age cohort effects were found in reported frequencies for headache, back and joint pain. There were also differences in reported severity for different pain locations as a function of age cohort.

Conclusions: The self reported data from this Canadian, extended family, sample supported the literature findings that frequencies and locations of self reported pain are influenced by both family membership and age cohorts effects. Implications ofinter-gener-ational influences on self reported pain and possible implications for pain diagnosis and treatment are discussed. Overall, frequencies for headache in young adults is higher than in comparison to parents and grandparent. However, corresponding dysfunction and disability is low.


K. T. Tighe, M. E. Bone, V. J. Dawson, Pain Management Dept, Osbome Building, Leicester Royal Infirmary, Leicester LEI SWW, UK

Introduction: In addition to referrals to the outpatient pain clinic, the Chronic Pain Service in Leicestershire receives requests for management ofinpatients.

Method: Over a twelve month period, from January 1st to December 31st 1998, all inpatient referrals to the Chronic Pain Service were recorded at Leicester Royal Infirmary (997 beds) and Leicester General Hospital (760 beds). Results: Demographic detail of the 309 inpatients seen together with details of referring specialties and treatment are presented below.

Demographic Info
Age (median range)



Non Caucasian

62 yrs(14-92)




Referring Specialty %
















Diagnosis %














Treatment %

Nerve Blocks TENS/Acup/Physio




Follow up %
1st Consultation only

1 Follow up

2 Follow up

3 Follow up

3 Follow up

Outpatient follow up







Drugs %









There was a predominance of female patients with a wide range of patient age; all Specialties used the service, with the medical and surgical specialties placing most requests. 34% of patients had musculoskeletal pain and 20% had pain from malignant disease. Some patients received more than one type of treatment.

Conclusion: The in patient referral service for chronic pain is well utilised by all hospital specialties in Leicestershire. A wide range of treatments are offered and outcomes are favourable.


Eero Vuorinen and Anneli Vainio, Pain Clinic, Karhula Hospital, 48600 Karhula, Finland, and Dept of Anesthesia, McGill Univ, Montreal, Quebec H3A 1A1, Canada

Aim of Investigation: to assess the prevalence and severity of 14 common symptoms in a non-selected population of cancer patients at the early stages of the disease and 2) to obtain knowledge about specific symptom profiles of different cancers during the first year after diagnosis.

Method: A cohort of all incident cancer cases diagnosed during the two-year period of January 1, 1991 to December 31, 1992 at the Health Care District Kymenlaakso (190.000 inhabitants) in Finland was extracted from the Finnish Cancer Registry (FCR). All patients who were alive at the moment of data extraction were mailed a questionnaire every 6 months during 3 years. In this paper, the results of the mailings of the first year will be reported.

Results: 1379 new cancer cases were diagnosed, 935 patients still alive received the questionnaire and 723 (77%) returned it. Analysed were 521 questionnaires (202 were empty or incomplete). Mean delay from the diagnosis to the mailing of the questionnaires was one year (range 6-18 months.) The most frequent symptoms were fatigue (52%), pain (32%) and weight loss (28%), Lung cancer patients suffered most, having 4.2 symptoms per patient, compared with 2.5 symptoms in the total patient population. Fatigue, swelling, insomnia, constipation and confusion were most frequent in lung cancer patients whereas nausea and vomiting and weight loss dominated in gastrointestinal cancers. Diarrhoea was most prevalent in haematological cancers together with sweating, which was reported by breast and prostate cancer patients as well.


Pedro F. Bejarano', Marta Isabel Diaz2, Pain Medicine Section, Dept ofAnesthesiology, Fundacion Santa Fe de Bogota', and Faculty of Psychology, Univ El Bosque, Bogota (Colombia).

Aim: The goal is to establish the incidence of stress at workplace, identifying possible "burnout" syndrome in several pain clinics. Mental health status, workplace quality and personal satisfaction is also measured at these clinics. Comparison of these results to those founded in Intensive Care Units (ICU) in the same hospitals, will give us a more adequate view of the type of stress suffered by pain workers.

Methods: Stress, Anxiety, and Hostility measures, as well as mental health status and psychophysiological measures were taken among pain clinic workers in three different hospital settings in Santa Fe de Bogota, Colombia. These variables were correlated with age, years working at the unit, number of patients seen, distribution and duration of calls, organizational structure of the unit, and decision autonomy.

Results: Descriptive analysis of the measured variables show a moderate to intense stress levels among pain clinic staff. These variables compared to similar data among ICU staff, render differential incidence ofstressors related mainly with the unit design.

Conclusions: Organizational factors seem to be some of the most influential ones in the stress levels perceived by the pain workers. Some ideas that would help to modify this fact are suggested


Cruz D.A.L.M.: Pimenta, C.A.M.; Teixeira, M.J. Nursing School of Univ ofSao Paulo, League Against Pain. Hospital das Clinicas of Univ ofSao Paulo. Av. Eneas de C. Aguiar, 419, Sao Paulo, 05403-000, Brazil.

Aim of Investigation: To compare the profile of health related problems (HRP) between cancer and non cancer pain patients in order to verify if there is a stable cluster of health problems related to pain.

Methods: Were studied 114 patients: 68 (59,6%) with oncologic pain, and 46 (40,4%) with non-oncologic chronic pain. The mean age was 53,1 years, 54,4% were female. The records of the first nursing consultation were the source of data. The North American Nursing Diagnosis Classification was the framework to assess the HRP. Were applied non-parametric tests to compare the variables between the groups. Were accepted, as a component of a 'chronic pain syndrome', the HRP positioned above the Percentile 75 which frequencies weren't different between the groups.

Results: There were 36 categories of HRP for the 114 patients. Six of them had higher frequency for the oncologic pain patients: 'constipation ', 'altered nutrition: less than the body requirements ', 'riskfor aspiration ', 'impaired swallowing ', 'sensory-perceptual alteration (gustatory) ', altered thought processes'. The diagnoses 'risk for constipation', and 'altered sexuality patterns''had statistically higher frequencies for the non-oncologic pain patients. For the oncologic pain patients were identified 353 HRP (mean - 5,2; range - 1-12), and for the non-oncologic pain patients, 191 (mean -4,1; range- 1-9) (p<0.05).

Conclusion: The suggested health related problems to compound the 'chronic pain syndrome' were: 'sleep pattern disturbed', 'knowledge deficit', 'anxiety' and 'fear', 'activity intolerance', and 'impaired physical mobility'.

9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.96 - 103


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