title: Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey.
abstract: BACKGROUND
  Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys.
  
  
  METHODS
  A cross-sectional survey with 4360 people aged  ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses.
  
  
  RESULTS
  2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]).
  
  
  CONCLUSIONS
  Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
authors.forename: Frederik
authors.initials: F
authors.lastname: Wolfe
authors.forename: Peter
authors.initials: P
authors.lastname: Henningsen
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schmutzer
authors.forename: Elmar
authors.initials: E
authors.lastname: Brähler
authors.affiliation: Department of Medical Psychology and Medical Sociology, Universität Leipzig, Ph,-Rosenthal-Str, 55, D-04103 Leipzig, Germany. andreas.hinz@medizin.uni-leipzig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hinz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000453:epidemiology*; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology; D010147:Pain Measurement; D015995:Prevalence; D057566:Self Report; D018582:Sick Leave / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014478:Unemployment; D055815:Young Adult
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