Pain Management Strategies and Health Care Use in Community-Dwelling Individuals Living with Chronic Pain.
OBJECTIVE
To describe factors associated with high clinic and emergency room (ER) use among individuals with chronic pain.


METHODS
This study is part of a larger cross-sectional survey on the epidemiology of chronic pain in Canada. The current analysis was guided by the Andersen-Newman Service Utilization Model.


METHODS
Respondents (N = 702) were grouped into high (top 10%) and low (bottom 90%) users based on the number of visits made to clinics and ERs over the past year. The two groups were compared on predisposing (e.g., pain self-efficacy and sociodemographic characteristics), enabling (e.g., income and education), and need (e.g., pain characteristics and number of comorbidities) factors as well as personal health behaviors (e.g., use of medications). Binary logistic regression analysis was used to identify characteristics associated with high use in each setting.


RESULTS
High users were defined as 30 or more clinic visits or one or more ER visits. The factors associated with high clinic use in the adjusted analysis were low pain self-efficacy (odds ratio [OR] = 2.60, 95% confidence interval [CI] = 1.50-4.51), two or more comorbidities (OR = 2.13, 95% CI = 1.23-3.69), five or more pain sites (OR = 2.30, 95% CI = 1.28-4.14), and having an "other" pain diagnosis (OR = 1.78, 95% CI = 1.01-3.20). Factors that increased ER use were low pain self-efficacy (OR = 2.01, 95% CI = 1.28-3.15) and two or more comorbidities (OR = 2.31, 95% CI = 1.48-3.59), while use of alternative pain management strategies reduced ER use (OR = 0.42, 95% CI = 0.21-0.84).


CONCLUSIONS
Longitudinal studies are needed to confirm if modifiable factors such as pain self-efficacy and use of alternative therapies reduce health care use.
School of Nursing.
Elizabeth G
EG
Mann
Departments of Public Health Sciences.
Ana
A
Johnson
Anesthesiology and Perioperative Medicine and Biomedical and Molecular Sciences.
Ian
I
Gilron
School of Nursing and Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.
Elizabeth G
EG
VanDenKerkhof
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D059350:Chronic Pain / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
Canada; Chronic Pain; Health Care Use; Pain Management; Self-Efficacy