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      Pain as a global public health priority

      , 1 , 2

      BMC Public Health

      BioMed Central

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          Abstract

          Background

          Pain is an enormous problem globally. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year. Nevertheless, the problem of pain has primarily been regarded as a medical problem, and has been little addressed by the field of public health.

          Discussion

          Despite the ubiquity of pain, whether acute, chronic or intermittent, public health scholars and practitioners have not addressed this issue as a public health problem. The importance of viewing pain through a public health lens allows one to understand pain as a multifaceted, interdisciplinary problem for which many of the causes are the social determinants of health. Addressing pain as a global public health issue will also aid in priority setting and formulating public health policy to address this problem, which, like most other chronic non-communicable diseases, is growing both in absolute numbers and in its inequitable distribution across the globe.

          Summary

          The prevalence, incidence, and vast social and health consequences of global pain requires that the public health community give due attention to this issue. Doing so will mean that health care providers and public health professionals will have a more comprehensive understanding of pain and the appropriate public health and social policy responses to this problem.

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          Most cited references 24

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          Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact.

          Estimates on the epidemiology of chronic non-cancer pain vary widely throughout Europe. It is unclear whether this variation reflects true population differences or methodological factors. Such epidemiological information supports European decision makers in allocating healthcare resources. Pan-Europe epidemiological data about chronic non-cancer pain was obtained using systematic review principles in searching and summarising results. Multiple databases (MEDLINE, EMBASE, Cochrane Library, CRD Databases, and GIN) were systematically searched for primary studies containing epidemiological data on chronic non-cancer pain in Europe excluding studies that solely concerned migraines, headaches and pain associated with specific disease conditions. The studies were prioritised according to quality, recency and validity. Eighteen research questions concerning aspects of chronic pain included: prevalence; incidence; pain treatments, control and compliance; treatment satisfaction; and quality of life and economic impacts. The search yielded 16 619 references and 45 were relevant to Europe. Studies for each question were selected that provided the most recent, representative and valid data. There was a clear lack of studies concerning chronic non-cancer pain in Europe as a whole. The 1-month prevalence of moderate-to-severe non-cancer chronic pain was 19%. Chronic pain significantly impacted on patient-perceived health status, affected everyday activities including economic pursuits and personal relationships, and was significantly associated with depressive symptoms. The majority relied on drugs for pain control and NSAIDs were the most frequent drug choice. Despite pain medications, a large proportion had inadequate pain control. To the authors' knowledge this is the most comprehensive literature review on epidemiological data in this field. It is clear that chronic pain has a dramatic impact on European society. Since chronic non-cancer pain is treated differently from cancer-related pain, the lack of data in this area clearly underlines the need for decision makers in healthcare to gather further epidemiological data.
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            Comorbid depression, chronic pain, and disability in primary care.

            The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together. A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate). Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than those without MDD (66% versus 43%, respectively). Disabling chronic pain was present in 41% of those with MDD versus 10% of those without MDD. Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL, greater somatic symptom severity, and higher prevalence of panic disorder than other respondents. The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level. Compared with participants without MDD, the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level. Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone.
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              The precious and the precocious: understanding cumulative disadvantage and cumulative advantage over the life course.

               M O'Rand (1996)
              The explanation of increasing heterogeneity and inequality within aging cohorts is a central concern of the life-course perspective and common ground for demographers, economists, historians, sociologists, and psychologists alike. Income and wealth inequality among the aged is one area of shared interest where cross-disciplinary fertilization is occurring. While indices of aged economic inequality applied across different data sets replicate the level of inequality among the elderly, theoretical and methodological concerns are focused more and more on identifying and specifying the long-term interactions between institutional and life-course processes producing this outcome. Institutional mechanisms incorporated in opportunity structures such as labor markets and pensions stratify the availability of resources and rewards, and they interact with life-course processes related to labor force history and job mobility to produce complex patterns of cumulative advantage and cumulative disadvantage. However, the examination of long-term mechanisms of stratification requires finer-grained observations of work, employer, and pension histories than current data-collection strategies afford. Two biases--the steady worker bias and the one pension bias--are inherent in most longitudinal data bases and hamper progress in our understanding of the production of aged inequality.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2011
                6 October 2011
                : 11
                : 770
                Affiliations
                [1 ]Department of Bioethics & Interdisciplinary Studies, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Mailstop 641, Greenville, N.C. 27834, USA
                [2 ]Department of Health Policy & Management, University of Kansas School of Medicine/KU Medical Center, Center for Practical Bioethics, The Harzfeld Building, 1111 Main St. Ste. 500 Kansas City, MO 64105, USA
                Article
                1471-2458-11-770
                10.1186/1471-2458-11-770
                3201926
                21978149
                Copyright ©2011 Goldberg and McGee; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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