Epidemiology of Chronic Pain in Denmark and Sweden
Table 1
Summary of all papers included in the Denmark () and Sweden () literature reviews. Risk of bias and study representativeness, study characteristics, and results of relevant outcomes extracted.
Paper and reference number, country
Number of participants, demographic data (age and gender if reported), and target population
Type of study/study quality/risk of bias and representativeness
Chronic pain condition and main study outcomes reported
Breivik et al. 2006 [2]/Fricker Pain in Europe (PIE) 2003 [3]* Multicountry study—data taken for Denmark and Sweden
Denmark for prevalence outcome, for all other outcomes (interviewees from Denmark); mean age 50.3 years; 43% men Sweden for prevalence outcome for all other outcomes (interviewees from Sweden) Mean age 51.5 yrs, 46% women Target population Adult general population ≥18 years
Observational survey High risk of bias Representativeness unclear
Chronic pain condition Moderate to severe chronic noncancer pain lasting ≥6 months (1% reported cancer-related pain) Outcomes reported (Denmark/Sweden) Prevalence: 16%/18% Mean duration of pain in years: 8.3/9.0 Economic impact: Work days lost in the past 6 months: mean 9.4 days/mean: 7 days Number of people in the sample reported as employed: 135/303 (45%) /113/300 (37.6%) Proportion who felt that pain impacted upon employment. Due to pain: 29%/24%, lost their job, 11%/25% changed job, and 21%/28% changed job responsibilities Presentation and treatment of chronic pain: (1) Proportion who took prescription medication: 47%/65% (2) Proportion with inadequate pain control from medication: 74%/30% (3) Proportion with inadequate pain control overall: 61%/45% (4) Proportion of people reported seeing a “pain management specialist”: 14%/12% Frequency of prescribed treatments Drug treatment: NSAID 38%/27%, weak opioid 8%/36%. Strong opioid 11%/3%, paracetamol 0%/26%, COX-2 inhibitor 8%/7% Most common nondrug treatments massage: 21%/36%, Physical therapy: 23%/55%, acupuncture 21/41%
(4115 had no chronic pain); 46.3% men Target population General population
Observational survey Low risk of bias Representative
Chronic pain condition General noncancer chronic pain (≥6 months) Outcomes reported Frequency of treatments Drug treatment: opioid usage rate: 11.2% Nondrug treatment: approx. 16% of opioid users and 18% of nonopioid users had tried massage, osteopathy or another manipulative therapy
(pain group: , control group (general population sample without pain): ); 48% men Target population Adult general population ≥16 years
Observational survey Low risk of bias Representativeness unclear
Chronic pain condition General chronic pain lasting six months or more Outcomes reported Work loss days lost in past 6 months: mean: 9.6 days (versus 4.8 in control group) Odds ratio of quitting job (pain group versus control): OR = 7.3 (95% CI: 6.2, 8.6) Odds ratio of absence due to illness (pain group versus control): (95% CI: 1.6, 2.4)
(1906 with pain); 48% men, control group (no pain) N not reported. Target population Adult general population ≥16 years
Observational survey Medium risk of bias Representativeness unclear
Chronic pain condition 1994 survey: VRS 4, 5, or 6 (moderate, severe, or very severe pain), 2000 survey: pain lasting 6 months or more’ Cancer patients were excluded. Outcomes reported Presentation and treatment of chronic pain Proportion of patients who had at least 1 consultation to a medical doctor within the past three months (in 2000): 59–78% Proportion who had contact with specialists: 19%; most commonly surgeons (4.1%) and rheumatologists (4.3%)
(in 2000, 357 with chronic pain); 47% men Target population Adult general population ≥18 years
Retrospective analysis Medium risk of bias Representativeness unclear
Chronic pain condition Moderate to very severe general noncancer chronic pain (>6 months) Outcomes reported Prevalence: in adults ≥18 yrs: 12-month prevalence in 2000:15.7%
(1906 with pain); 42% men. Control group (patients not reporting chronic pain) ,106, 50% men Target population Adult general population ≥16 years
Observational survey Medium risk of bias Representativeness unclear
Chronic pain condition Chronic noncancer pain lasting ≥6 months Outcomes reported Impact of chronic pain General health. Self-rated health status (5 point scale): 45% of those with chronic noncancer pain rated their health as really good/good and 55% rated their health as fair/bad/very bad. In contrast, 88% of the control group who reported no pain rated their health as really good/good. Age adjusted mean scores for SF-36 subscales (general health, physical function, role emotional, role physical, social function, vitality, mental health). Those with chronic noncancer pain scored lower on all relevant SF-36 subscales compared to those without pain. No statistical analyses were reported. Chronic pain sufferers who took opioids were significantly less active than those that did not take opioids (adjusted OR 1.55, 95% CI 1.11, 2.15) Economic impact Odds ratio of opioid use (versus nonopioid use) and not being engaged in employment: (95% CI: 0.31, 0.65) Odds ratio of opioid use (versus nonopioid use) and having disability pension: (95% CI: 1.38, 2.99) Presentation and treatment Proportion who had contact with a medical doctor within the last 3 months: 69.8% Proportion inadequate pain control: opioid users 90%, nonopioid users 46% Proportion satisfaction with medical treatment: opioid users 52%, nonopioid users 56% Prescribed treatments; analgesics by type Analgesics of any type: 30%, opioids 12% (9% weak and 3% strong), anxiolytics 3%, antidepressants 4%
; median age 51 years, 33% men Target population Patients of Danish origin with chronic nonmalignant pain and applying for a disability pension due to chronic pain
Retrospective cohort study Medium risk of bias Representativeness unclear
Chronic pain condition Nonmalignant “chronic pain” (not further defined) Outcomes reported Economic impact Proportion of chronic noncancer pain patients that were finally denied a disability pension: 44.45% Proportion of chronic noncancer pain patients that were finally awarded a disability pension: 55.55% Mean total costs of healthcare in patients applying for disability pension: 33 139 DKK per year, (=Euro €4449) Presentation and treatment Mean number of visits to GP in a group of individuals with chronic noncancer pain who claimed compensation for disability: 8 in the year before claim and 7.7 in the year following the final decision Mean number of visits to outpatient clinics: 1.7 and 1.2, respectively
( high pain group (HPG); low pain group (LPG); control group (CG) i.e., no pain); 52.2% men Target population Adult general population
Observational survey Low risk of bias Representative
Chronic pain condition Moderate to severe general noncancer chronic pain. Chronic was not defined Outcomes reported Impact of chronic pain General health. Self-rated health status (5 point scale): fewer (48.7%, 95% CI 44.6, 52.8) moderate to severe chronic noncancer pain sufferers reported their health as good compared to those with mild pain (80.7%, 95% CI 78.8, 82.5) or no pain (92.5%, 95% CI 91.1, 93.6) Adjusted mean scores for SF-36 subscales (general health, physical function, role emotional, role physical, social function, vitality, mental health). Those with moderate to severe noncancer pain scored lower on all relevant SF-36 subscales compared to those with mild pain and those without pain. No statistical analyses were reported. Health-related disability (long-lasting activity restriction [>6 months] due to ill health). More sufferers of moderate to severe chronic noncancer pain stated their activities were restricted for more than six months compared to those without pain (adjusted OR 21.9, 95% CI 13.86, 34.6)
; mean age 48.1 (SD 13.74) years; 39% men Target population All patients referred to the Multidisciplinary Pain Clinic in Funen County at Odense University Hospital, Denmark and on the waiting list as at 1st December 2005.
Observational survey Medium risk of bias Representativeness unclear
Chronic pain condition General noncancer chronic pain Outcomes reported Economic impact Percentage of work hours lost due to chronic noncancer pain: 41.0% (SD = 23.00) Healthcare costs (by regression analysis): costs increase with age—about DKK 560–806 (€4,200–€6,500) per person per year Costs are higher in year prior to pain onset—about DKK 8,699 (€1,159) per person compared to the previous years Mean costs in Danish Krone (DKK) for council: (1) Personal care services, (2) housekeeping, gardening, and so forth: (1) DKK 12,468 (€1662), (2) DKK 2,592 (€346) Total costs in DKK: DKK 15,060 per patient per year (=Euro (€) 2008) Mean costs for patients: (3) Privately provided services, (4) alternative treatment: (3) DKK 12,408 (€1654), (4) DKK 2,978 (€397) Total costs in DKK: DKK 15,386 per patient per year(=€2051) Frequency of treatments Nondrug treatments (drug treatments not reported): 79% alternative treatments: 43% acupuncture, 42% massage/manipulation, 31% reflexology
(all with chronic pain); 47.7% men Target population Adult general population ≥16 years
Observational survey Low risk of bias Representative
Chronic pain condition General noncancer pain ≥6 months Outcomes reported Prevalence. In adults ≥18 yrs: 12-month prevalence in 2005: 20.2% Impact of chronic pain General health. Self-rated health status (5 point scale): 79.4% of those who rated their present health as very bad reported chronic pain, whereas 7.2% who rated their health as very good reported chronic pain Age adjusted mean scores for SF-36 subscales. Those with chronic noncancer pain scored lower on all relevant SF-36 subscales compared to those without pain. No statistical analyses were reported Presentation and treatment Proportion of chronic pain patients not satisfied with the chronic pain treatment they received: 44.5% in 2000, 45.9% in 2005
; mean age 49 (SD 13) yrs; 34% men Target population Patients (age above 18 years) who were consecutively referred to the Multidisciplinary Pain Center at the National Hospital, Copenhagen (1995–1997)
Observational survey High risk of bias Representativeness unclear
Chronic pain condition General nonmalignant chronic pain lasting 6 months or more; low back pain: 32% Outcomes reported Economic impact Proportion of chronic noncancer pain patients that were applying for a disability pension (1) At referral to pain clinic 20%, (2) during treatment 9%, (3) at followup 4% Total health care costs (period of 29 months including multidisciplinary pain treatment) 7707 Euro (€), (DKK 57,802), (2) total medication costs, €1476 (DKK 11,070), and (3) total social transfers (costs of welfare benefit, sickness benefit and pensions): €9514 (DKK 71,355) Total social transfers per period (per patient per month): (1) prior to referral €459 (DKK 3,442), (2) waiting list €398 (DKK 2,985), (3) treatment period €354 (DKK 2,655), (4) followup period: €172 (DKK 1,290)
Sampled ; responded ; had any chronic pain: median age 49.5 years; 49.4% men Target population Adult general population aged 25–74
Observational survey Medium risk of bias Representative
Chronic pain condition Any general moderate to severe chronic pain Outcomes reported Prevalence of general chronic pain: 54.7% Prevalence of chronic back pain: 15.4% % of high intensity pain patients with reduced capacity for Activities of Daily Living (ADL). Total reduced ADL capacity: 13%, study compared visitors and nonvisitors to Primary Health Care (PHC): Visitors to PHC: 13.8%, Nonvisitors to PHC: 12.1% (difference between groups not significant) Percentage consulting physician or physiotherapist in last three months: 45.7% consulted a physician (versus 29.8%, of nonchronic pain persons) and 7.2% consulted a physiotherapist (versus 1.2%, in nonchronic pain individuals) Percentages of visits to Primary Health Care (PHC), Hospital Care, and Alternative Care, compared to people without chronic pain: PHC doctor—39.5% of people with chronic pain consulted (c/w 25.5%, ), people with pain of 3–6 months duration: 59% PHC contacts compared with those with pain of >6 months duration: 34%, Hospital Care—12.3% of people with chronic pain made at least one visit to hospital clinics in the last three months (c/w 7.3% without pain—NS). 2.8% of chronic pain individuals had an emergency contact during this period Alternative Care—5.9% of people with chronic pain used alternative care. Chiropractor—3.7% () Acupuncture—1.7% () Homeopathy, zone therapy, and other naturopathy—% NR. 58.2% took steps to relieve the pain themselves Proportion of people taking steps to reduce pain themselves. Visitor to PHC: ; median age 51.0 yrs; 55.1% female. Nonvisitor to PHC: ; median age 49.5 yrs; female 50.6% Number of “high intensity” visitors/nonvisitors to Primary Health Care (PHC). Type of care received: self-care: 58.2%, conventional medicine: 47.1%, alternative care: 5.9%, combined conventional and alternative care: 3.1% Drug treatments. Visitors/nonvisitors to healthcare: Prescriptions: 59.6%/35.6%, nonprescriptions: 62.2%, 48.3% Alternative treatments. Visitors/Nonvisitors to Health Care: 8.9%/10.3% Analgesic use in the past 2 weeks: 62.4%, alternative treatments in the last 3 months, any: 5.9%, chiropractor: 3.7%, acupuncture: 1.7%
Total sampled , chronic pain , mean age not reported, 49.6% men Target population Adults in Bromölla health district aged 25–74 years
Observational survey (and continued diagnosis registration) Medium risk of bias Representative
Chronic pain condition any chronic widespread pain; any chronic neck-shoulder pain (cancer not excluded) Outcomes reported Diagnoses related to chronic musculoskeletal pain in 1996 (per 1000) Back pain 36.7, fibrositis-myalgia 33.0, local tendinitis-bursitis 28.6, other musculoskeletal disease or symptom 25.7, arthralgia 15.1, osteoarthritis 9.0, neck syndrome 8.8, shoulder syndrome 8.0, inflammatory joint and collagen disease 7.8, total diagnoses related to musculoskeletal pain 192.6
responders; mean age 50.3 yrs, 39% men Target population Adult general population of Sweden ≥18 years
Longitudinal study Low risk of bias Representative
Chronic pain condition Any chronic musculoskeletal pain Outcomes reported Mean of SF-36 subscales (scale 0–100, higher is better health): physical functioning 75, role-physical 60, bodily pain 50, general health 60, vitality 55, social functioning 80, role-emotional 73, mental health 73
, mean age 55.1 yrs, 44% men Target population Patients with chronic pain in Sweden ≥18 years, and their spouses
Observational survey High risk of bias Representativeness unclear
Costs to society—proportion of patients employed or on pensions and benefits. Fully employed or in school: 22%, employed but in partial sick-leave: 14%, temporary disability pension: 8%, housewife: 4%, early retirement or disability: 26%, retirement pension: 26%, unemployed: 0%
responders, analysed, mean age 46.5 yrs, 47% men Target population Adult population of South-West Sweden aged 20–74 yrs
Observational survey Low risk of bias Representative
Chronic pain condition Any chronic regional or widespread musculoskeletal (MSK) pain (cancer not excluded) Outcomes reported Prevalence of any musculo-skeletal chronic pain: 34.5% Prevalence of chronic low back pain: women/men: 26.4%/19% Prevalence of chronic neck pain: women/men: 22.9%/14.5% Prevalence for chronic widespread Pain: 11.4% % of people reporting pain at 8, 9 or 10 on the 10-point NRS scale: 35%/24% Mean of SF-36 subscales for CRP, CWP, and fibromyalgia, respectively (Scale 0–100, higher is better health): physical funct. 80, 63, 50, role-physical 64, 45, 20, bodily pain 54, 40, 28, general health 65, 49, 33′ vitality 59, 44, 33, social functioning 84, 71, 58, role-emotional 78, 60, 45, mental health 78, 65, 58
Responders . Proportion of males/females not reported–response rates were 57.5%/66% respectively Mean age not reported Target population Adult population of south-west Sweden aged 20–74 yrs; responders , CRP , CRP , FM , assumed to be same population as Bergman 2001
Observational survey Medium risk of bias Representative
Chronic pain condition Any chronic widespread pain (CWP), chronic regional pain (CRP) or chronic fibromyalgia (FM) Outcomes Reported Quality of life: Mean Scores on SF-36 subscale (Score of 100 represents the highest level of functioning): Fibromyalgia/Wides read Pain/Regional Pain: Mental Health 58/65/78;Role-emotional 45/60/78Social Functioning 58/71/84Vitality 33/44/59General health 33/49/65Bodily pain 28/40/54Role-physical 20/45/64Physical functioning 50/63/80
Fricker-Pain in Europe 2003 [33], (PowerPoint presentation—additional data for Breivik 2006 available for Sweden only)
Same cohort as Breivik 2006 for prevalence outcome for all other outcomes (interviewees from Sweden) Mean age 51.5 yrs, 46% women Target Population Adult general population ≥18 years
Observational survey High risk of bias Representativeness unclear
Chronic pain condition Moderate to severe chronic noncancer pain lasting ≥6 months (1% reported cancer-related pain) Outcomes reported Impact of pain on functioning—pain prevents 64% of respondents from thinking or concentrating clearly; 55% feel tired all the time; 47% felt their pain impacted on their employment; 42% cannot function normally; 26% are in too much pain to take care of themselves and other people Impact of pain on depression: 24% had a diagnosis of depression by a clinician. Presence of symptoms: depression: 40.6%, insomnia: 34.8%, nervousness: 17.8% Impact of pain on isolation and helplessness. Feeling helpless: 55%, feeling alone: 34% Proportion who had tried prescription medication and then stopped: 36% Participants’ reporting of duration and severity of pain: 36% had pain so severe that no more could be tolerated, 33% had chronic pain all the time, 21% had chronic pain several times a week, 18% could tolerate somewhat more pain, 2% could tolerate a lot more pain Most common causes of chronic pain: arthritis/OA: 27%, traumatic injury: 19%, nerve damage: 17%, cancer: 13%, herniated/deteriorating discs: 12%, tumours: 6%, fracture/deterioration of spine: 6%, carpal tunnel syndrome: 5%, RA: 5%, whiplash: 4%
Sampled , responders , with chronic pain . Mean age with chronic pain: 56, 78% women Target population General population aged 18–74 yrs in the county of Östergötland, Sweden
Observational study Low risk of bias Representative
Chronic pain condition Any chronic widespread fibromyalgia pain (FM) Any general chronic widespread non-fibromyalgia pain (non-FM). Cancer pain not excluded Outcomes reported Physical functioning using Arthritis Self-Efficacy subscale functioning (0–100 high score indicates better functioning); Fibromyalgia Impact subscale physical function (0–100 higher score indicates worse functioning); SF-36 subscale physical function (0–100 higher score indicates better functioning: SF-36 subscale physical function; 52.9 (17.7) versus 65.0 (22.5) mean (SD) for FM compared with non-FM: Arthritis Self-Efficacy subscale functioning—65.7 (19.2) versus 74.8 (19.6), Fibromyalgia Impact subscale physical function 37.5 (20.3) versus 31.3 (22.6) Self-rated depressive symptoms (Beck’s depression inventory*); self-rated anxiety symptoms (Beck’s anxiety inventory: range 0–63, higher score more anxiety): chronic fibromyalgia pain—mean (SD) depression: 12.3 (8.0), mean (SD) anxiety: 13.2 (9.7) Chronic non-fibromyalgia pain—mean (SD) depression: 8.9 (5.9), mean (SD) anxiety: 9.3 (7.0) Multidimensional pain inventory (MPI)—support (perceived support from significant others: from 0 never to 6 very often): chronic fibromyalgia pain—mean (SD) support: 3.5 (1.7), chronic non-fibromyalgia pain—support: 3.5 (1.7) Percentage of participants on sickness benefits: with FM pain: 37.1%, with non-FM pain: 12.7%
, mean age not reported, 41.8% men Target population Adults aged 20–50 yrs taken from the general Swedish population
Observational study Low risk of bias Representative
Chronic pain condition Any chronic nonspecific spinal pain, including mild pain. Cancer pain not excluded Outcomes reported Multidimensional pain inventory—social support: punishing responses (range 0–6), solicitous responses (range 0–6), and distracting responses (range 0–6): any chronic nonspecific spinal pain (3–12 mo)—mean (SD) for social support: punishing resp. 0.8 (1.1), solicitous resp. 3.0 (1.6), distracting resp. 3.2 (1.9) Pain duration: any chronic non-specific spinal pain (>12 mo)—Mean (SD) 24% of people reported being in pain for between 3 and 12 months and 76% had pain for over 12 months pain intensity. On a 1–100 score (100 being most pain), the mean pain score was 44.8 (SD18.6) for the <12 month group, and 47.3 (SD 17.7) for the >12 month group Mean pain intensity (SD) on a 1–100 scale: punishing resp. 0.8 (1.1), solicitous resp. 2.5 (1.5), distracting resp. 2.7 (1.8) Pain duration and intensity 3–12 months (depression comorbidity). Pain 3–12 months: mean score 44.8 (SD 18.6), pain >12 months: 47.3 (SD 17.7) HADS-D score (hospital anxiety and depression rating scale of 0–14): mean score 47.3 (SD 17.7) Pain 3–12 months: mean score 44.8 (SD 18.6), pain >12 months Mean score 47.3 (SD 17.7) pain duration >12 months (depression comorbidity). depression: HADS-D mean 5.2 (SE 0.27); Depression: HADS-D mean 5.3 (SE 0.15), those with chronic nonspecific spinal pain had a significantly higher HADS-D mean score then those with recurrent nonspecific pain lasting <3 months (; 4.2 [SE 0.24]; ). Mean BMI score pain duration 3–12 months: BMI mean 25.1 (SD 4.0) Mean BMI score pain duration >12 months: BMI mean 24.5 (SD 3.6)
, mean age 48 yrs, 47% men Target population Adult general population of Sweden ≥18 years
Observational survey and economic study High risk of bias Not representative
Chronic pain condition Any chronic noncancer low back pain (LBP) Outcomes reported Costs to society: direct costs per patient Total average annual direct cost per patient: €3089 (15% of total costs), total healthcare costs when home help was excluded: €3017 (14.7% of total costs) Indirect costs. Largest indirect cost: sickness absence from work—average yearly cost per patient: €9563 Largest indirect cost item and total indirect costs: total indirect costs per patient: €17,576 (85% of total LBP costs); total annual costs per patient (estimated): €20,666 Satisfaction with treatment, that is, pain relief, tolerance, and overall treatment: median of responses on a scale from 1 (very dissatisfied) to 6 (very satisfied), Patients scored a median of 3 (somewhat dissatisfied) for all 3 questions—pain relief, tolerance, and overall treatment. Drug treatments reported: step 1: NSAIDs 51%; COX-2 inhibitors 5%, analgesics: 59%, muscle relaxants/anxiolytics: 11%, antidepressants: 8%, other: 1%
, median age 46 yrs, 47% men Adults aged 18–74 yrs in the county of Östergötland in southern Sweden
Observational survey High risk of bias Representativeness unclear
Chronic pain condition General chronic pain Outcomes reported Proportion of patients seeking health care for their pain: 64.8%, of those in constant pain: 86.3%, of those with severe pain: 79.5%
Responders , with chronic pain , mean age 51 yrs, 39% men Target population Adults aged 25–64 yrs resident in Northern Sweden
Observational survey Medium risk of bias Representative
Chronic pain condition Any chronic neck pain (cancer not excluded) Outcomes reported % on sick leave due to neck pain: 29% Prevalence of chronic neck pain: 18.5%
Responders , mean age 50 yrs, 46% men Adults aged 25–74 yrs from Southern Sweden
Observational survey Medium risk of bias Representative
Chronic pain condition Any chronic upper extremity pain; any chronic upper extremity pain associated with physical impairment (cancer not excluded) Outcomes reported Prevalence of chronic upper extremity pain with physical impairment: 20.8% (95% CI 19.2, 22.5) Cooccurrence with chronic upper extremity numbness or tingling: 32% (164/513) of those with chronic pain with physical impairment or 6.7% (95% CI 5.7, 7.7) of total sample (164/2466)
Analysed responders , mean age 66 (SD 14.1), 74% women Target population Adults in Malmö area of Sweden with rheumatoid arthritis.
Observational survey Medium risk of bias Representative
Chronic pain condition Chronic noncancer pain (rheumatoid arthritis pain) Outcomes reported Percentage of patients with RA on sick leave or sickness pension Women: 22%, men: 16%, short-term sick-leave: 6.5%, long-term sick-leave: 8.5%, On early retirement due to RA: 18.4%, total retired: 47%; total on sick pension or sick leave: 21% Mean annual total costs per patient: mean annual total costs per patient: 108,370 SEK (€12,286) Annual direct costs. Annual direct costs: 44,485 SEK (€5,043) (41% of the total costs), direct healthcare costs. 33,092 SEK (€3,751) (30.5% of the total costs) Costs to patients. Costs to patients: 4302 SEK (€488) (4% of total costs)—this included costs of informal care (2.5% of total) and costs of private investments (1.5% of total costs) Duration of RA. All: mean 16.7 yrs (SD12.9), women: mean 16.8 yrs (SD 12.9); men: mean 16.3 yrs (SD 12.7) Patients’ perception of pain on a 100-point VAS scale (over the last week). All: mean score 40 (SD 24), women: mean score 42 (SD 24); men: mean score 35 (SD24)
Age stratified sample , selected population , age range 76–100 yrs, 34.4% men Target population Elderly population ≥75yrs in Southern Sweden
Observational survey High risk of bias Not representative
Chronic pain condition Any chronic general pain, including mild pain in the elderly (≥75 yrs). Cancer pain was not excluded Outcomes reported Level of social support in the elderly with chronic pain Multidimensional pain inventory—subscale social support (range 0–6, 6 indicates high degree of support): support (mean (SD)—living at home: 3.83 (2.10), living in special accommodation: 3.64 (1.92), living alone: 3.29 (2.05), living with someone: 4.69 (1.79) Percentage that did not use any pain-relieving method: 3.8% Percentage using prescription and nonprescription medication in various environments and helpfulness of treatment: helpfulness calculated by median score [75th–25th percentile]: living at home—39% used prescription medication, helpfulness: median 3.0 [4.0–2.0] generally helpful, 23% used nonprescription medication Helpfulness: median 3.0 [4.0–2.0] generally helpful living in special accommodation—31% used prescription medication Helpfulness: median 2.5 [3.0–2.0] somewhat-generally helpful, 9% used nonprescription medication, helpfulness: median 2.0 [3.3–1.0] somewhat helpful Living alone—51% used prescription medication, helpfulness: median 3.0 [4.0–2.0] generally helpful, 28% used nonprescription medication Helpfulness: median 2.5 [4.0–2.0] somewhat-generally helpful Living with someone—44% used prescription medication; helpfulness: median 3.0 [4.0–3.0] generally helpful’ 21% used nonprescription medication, helpfulness: median 2.5 [3.3-2.0] somewhat-generally helpful Cause of pain in elderly with any chronic general pain: 37% did not know cause of pain Of those that received a diagnosis or knew cause of pain: osteoarthritis 34%, musculoskeletal diseases/problems 27%, nonmusculoskeletal diseases/problems 16%, other rheumatic diseases 14%, rheumatoid arthritis 6%, osteoporosis 2%, unspecified musculoskeletal pain 1%
Sampled ,897, mean age 59.8 yrs (SD 11.1), 46.5% men Target population All twins born in Sweden between 1886 and 1959 (registry based)
Observational case-control study Low risk of bias Representative
Chronic pain condition Any chronic widespread pain (CWP) Outcomes reported Prevalence of chronic widespread pain: 4.1% CWP in those aged => 42 yrs: poor general health was found in 83.1% of participants with CWP and 26.7% of participants without CWP Quality of life: health which prevents activities was reported in 81.9% of people with CWP and 26.4% of participants without CWP Depression: current depressive symptoms: 40.2%, lifetime major depression: 36.2%, lifetime generalized anxiety disorder: 9.9%, lifetime eating disorders, aged <65 yrs: 38.3% Comorbidity with CWP. Cotwin MZ analysis: (OR (95% CIs) adjusted for age and sex): chronic impairing fatigue, age ≤64 yrs: 3.71 (2.06–6.70), CFS-like illness, age ≤64 yrs: 9.75 (3.48–27.28), Joint pain (i.e., ≥1 of RA, prolonged joint pain, or OA): 4.60 (2.63–8.04), possible RA: 3.89 (1.87–8.09), prolonged joint pain: 5.56 (2.73–11.30), OA, knee or hip: 2.43 (1.30–4.53), migraine, age ≤64 yrs: 3.27 (1.67–6.43), tension-type headache, age ≤64 yrs: 3.00 (1.47–6.14), Current depressive symptoms: 2.00 (1.27–3.15), lifetime major depression: 1.13 (0.74–1.72), lifetime generalized anxiety disorder: 1.60 (0.73–3.53) lifetime eating disorders, age ≤64 yrs: 0.93 (0.59–1.45), irritable bowel syndrome: 3.50 (1.84–6.65), GERD: 2.17 (1.33–3.56), urinary tract problems: 1.77 (1.05–2.99), prolonged cough, >3 mo: 1.41 (0.76–2.63) Possible asthma: 1.25 (0.65–2.41), allergy, any: 1.70 (1.08–2.67) obesity, BMI ≥30: 2.09 (1.02–4.29), overweight, BMI ≥25: 1.28 (0.76–2.16) sleep problems, age ≥55 yrs: 3.00 (1.09–8.25), poor general health: 6.20 (3.59–10.70), health prevents activities: 5.22 (3.15–8.65), poorer health status than 5 yrs ago: 3.27 (2.11–5.07), frequent infections, >2 per year: 3.08 (1.61–5.91)
Mullersdorf and Soderback 2000 Int J Rehab [43], Sweden
Invited ,000, responders . Mean age not reported, 48% men Target population Swedish population aged 18–58 yrs
Observational survey High risk of bias Representativeness unclear
Chronic pain condition Any general long-term pain (defined as at least 3 months). Cancer was not excluded Outcomes reported % with self-perceived activity limitation and/or participation restriction due to pain: In participants with long-term pain: 16.6%, men 7.4%; women 9.3%; In participants with long-term and recurrent pain. 13.0%; men 5.6%; women 7.3%
Müllersdorf and Söderback 2000 Dis & Rehab [44], Sweden
Invited ,000, study sample (pain sufferers) , control group . Mean age not reported, 48% men Target population Swedish population aged 18–58 yrs
Observational survey Low quality High risk of bias Representativeness unclear
Chronic pain condition Any general chronic pain—long-term pain and recurrent pain Outcomes reported % of people on/not on sick leave over last year. Not on sick leave over the past year: 44.3%, on sick leave for <3 months: 40.6%, on sick leave for >3 months: 15.1%, mean sick leave: 43 days Frequencies (N) of health care staff that respondents consulted and received treatment from and % differences between genders: physicians (966) M 74% F 74%, physiotherapist (722) M 49.3%, F 59.0%, chiropractor (397) M 30.8%, F 30.2%, nurse (257) M 22.7%, F 17.8%, occupational therapist (139) M 6.0%, F 13.5%, psychologist (97) M 5.2%, F 8.8%, welfare officer (79) M 3.0%, F 7.9%, vocational guidance officer (46) M 3.4%, F 3.6%, clergymen, lay worker, priest (22) M 2.0%, F 1.5%, other (60) M 3.4%, F 5.3%
, at followup 3 years later, , responders . Mean age 55.3 yrs, 49% men Target population Adults with spinal cord injuries at a hospital in Stockholm, Sweden
Longitudinal study Medium risk of bias Not representative
Chronic pain condition Any chronic pain due to spinal cord injury (SCI) Outcomes reported Percentage using drug and using or tried nondrug treatments: 70.5% Percentage not using drugs at time of study: 51% Percentage of above pts who tried one or more analgesics: 41.2% Participants with the following characteristics more likely to try nondrug therapy for pain relief: those with moderate pain (VAS 40–69 mm) versus mild pain (VAS 0–39 mm): adjusted OR 4.94 (95% CI 1.5, 16.7). Those with severe pain (VAS ≥70 mm) versus mild pain (VAS 0–39 mm): adjusted OR 10.45 (95% CI 2.0, 54.7). Those with aching pain (adjusted OR 4.04 [95% CI 1.3, 12.8]) and cutting/stabbing pain (adjusted OR 3.55 [95% CI 1.1, 11.1]) were also more likely to try nondrug treatment. Percentage using drug treatments: 48.9% Percentage types of drugs used. Step I—NSAIDs: 15.6%, step III (opiates): 34.4% anti-convulsants: 12.2% anti-depressants: 11.1% % tried or using nondrug treatments: acupuncture: 35.6%, massage: 34.4%, TENS: 32.2%, heat: 24.4%, cold: 10.0%, other (mental training): 5.6%, other (physical training): 4.4%
, with fibromyalgia ; mean age 46 yrs, 100% female Target population Adult women aged 30–68 yrs in the area of Linköping, Sweden
Observational study Low quality High risk of bias Representativeness unclear
Chronic pain condition Any chronic fibromyalgia (FM) Outcomes reported Costs to society: working part time/full time/retired: 21%, partly sick listed: 24%, Employment status of patients with FM: sick listed/sickness pension: 55%
, mean age 38.1 yrs (SD9.4), 34% men Target population Adult population of Upsala, Sweden, aged 18–64 yrs
Observational survey Medium risk of bias Representativeness unclear
Chronic pain condition Any long-term noncancer pain Outcomes reported Satisfaction with social contacts: 32% satisfied, 68% dissatisfied Proportion of participants on sickness benefits. on sickness benefit: 69%, on sickness pension: 4%, on social allowance: 1%
