title: The societal burden of pain in Germany: health-related quality-of-life, health status and direct medical costs.
abstract: OBJECTIVE
  The purpose of this paper is to estimate the impact of the severity and frequency of pain on health-related quality-of-life (HRQoL), self-reported health status, and direct medical costs in Germany.
  
  
  METHODS
  Data are from the internet-based 2010 National Health and Wellness Survey (NHWS). Estimates of the impact of pain experience are generated by a series of regression models. In the case of HRQoL the physical and mental summary scores from the SF-12, together with SF-6D utilities, are evaluated within an ordinary least squares framework. Health status is assessed through an ordered logit model. Direct medical costs are estimated through a semi-logarithmic healthcare cost function. Socioeconomic characteristics, health risk behaviors, and the Charlson Comorbidity Index (CCI) are introduced as control variables in all regressions.
  
  
  RESULTS
  An estimated 23.96% of the adult German population (16.39 million) reported experiencing pain in the last 30 days. Of these 13.16% reported severe pain. The experience of frequent severe and moderate pain has a significant deficit impact on HRQoL. For those experiencing severe daily pain, the deficit in the SF-12 physical component score (PCS) is -17.930 (95% CI: -18.720 to -17.140), the SF-12 mental component score (MCS) is -8.787 (05% CI: -9.857 to -7.716), and SF-6D absolute utilities -0.201 (95% CI: -0.214 to -0.188); with self-reported health status the deficit impact of severe daily pain is also substantial (OR=29.000; 95% CI: 23.000-36.580). In the case of direct medical costs severe daily pain increases healthcare provider costs by 101.6% and total direct costs by 123.9%.
  
  
  CONCLUSIONS
  The NHWS is an internet survey. The principal limitation is that as a self-report there is no separate validation of pain severity or chronicity.
  
  
  CONCLUSIONS
  The experience of pain has a substantial negative impact on HRQoL, health status, and resource utilization in Germany. If pain is considered as a disease in its own right, the experience of chronic pain presents policy-makers with a major challenge.
authors: College of Pharmacy, University of Minnesota, Minneapolis, MN 55455-0343, USA. Langley@maimonresearch.com
authors: Paul C
authors: PC
authors: Langley
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010146:Pain / Q000191:economics* / Q000523:psychology*; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult