title: The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization.
abstract: OBJECTIVE
  This paper reports on the results of a series of quantitative assessments of the association of severe and frequent pain with health-related quality of life and healthcare resource utilization in five European countries.
  
  
  METHODS
  The analysis contrasts the contribution of the increasing severity and frequency of pain reported against respondents reporting no pain in the previous month. The data are taken from the 2008 National Health and Wellness Survey. Single-equation generalized linear regression models are used to evaluate the association of pain with the physical and mental component scores of the SF-12 questionnaire as well as health utilities generated from the SF-6D. In addition, the role of pain is assessed in its association with healthcare provider visits, emergency room visits and hospitalizations.
  
  
  RESULTS
  The results indicate that the experience of pain, notably severe and frequent pain, is substantial and is significantly associated with the SF-12 physical component scores, health utilities and all aspects of healthcare resource utilization, which far outweighs the role of demographic and socioeconomic variables, health risk factors (in particular body mass index) and the presence of comorbidities. In the case of severe daily pain, the marginal contribution of the SF-12 physical component score is a deficit of -17.86 compared to those reporting no pain (population average score 46.49), while persons who are morbidly obese report a deficit of only -6.63 compared to those who are normal weight. The corresponding association with health utilities is equally dramatic with a severe daily pain deficit of -0.19 compared to those reporting no pain (average population utility 0.71).
  
  
  CONCLUSIONS
  For the five largest EU countries, the societal burden of pain is considerable. The experience of pain far outweighs the contribution of more traditional explanations of HRQoL deficits as well as being the primary factor associated with increased provider visits, emergency room visits and hospitalizations.
authors.affiliation: College of Pharmacy, University of Minnesota, Minnesota, MN 55455-0343, USA. P8366@MSN.com
authors.forename: Paul
authors.initials: P
authors.lastname: Langley
authors.forename: Gerhard
authors.initials: G
authors.lastname: Müller-Schwefe
authors.forename: Andrew
authors.initials: A
authors.lastname: Nicolaou
authors.forename: Hiltrud
authors.initials: H
authors.lastname: Liedgens
authors.forename: Joseph
authors.initials: J
authors.lastname: Pergolizzi
authors.forename: Giustino
authors.initials: G
authors.lastname: Varrassi
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D005062:European Union; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000191:economics / Q000523:psychology*; D059408:Pain Management; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D055815:Young Adult