Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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6. The Epidemiology of Chronic Pain and Work Disability
6. The Epidemiology of Chronic Pain and Work Disability
Pages 101-120
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From page 101... ...
Keeping in mind that among the claimants who are most troublesome for the disability insurers are those who have pain and associated impairment that cannot fully be accounted for by clinical findings, there are several pieces of epidemiological data that would be useful. What are the numbers and characteristics of people with: ~ chronic pain (and what kinds of pain do they have)
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From page 102... ...
Whereas current pain may be measurable with some validity, the threshold of recall of previous pain probably varies with the recentness of the episode, the severity of the symptom when it was present, associated events such as surgery, and the persistence of the probing questions in the interviewing process (Bierring-Sorensen, 1982~. There is no agreed-upon operational definition of chronic pain in the studies reviewed.
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From page 103... ...
The frequency of work disability due to pain may be estimated from the Nuprin study from the reported number of days during the previous 12 months respondents had such severe pains that they "could not work or engage in routine activities." Different aspects of pain and disability were measured in the various surveys. The two national health surveys (Drury, 1984; Enquete Sante Canada, 1981)
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The common types of pain are headache, backache, muscle pain, joint pain, stomach pain, premenstrual or menstrual pain, and dental pain. The Nuprin study classified only 2 percent of people as having other types of pains.
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An estimated 1~15 percent of adults have some work disability due to back pain in any given year. The leading causes of disability in people in their working years are musculoskeletal conditions such as low back pain, joint pain, arthritis, and rheumatism (Kelsey et al., 1979; U.S.
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From page 111... ...
Work disability attests to a certain degree of pain severity. Furthermore, because absence from work is an objectively verifiable behavior rather than a subjectively remembered sensation, it is a reasonably reliable proxy for other outcomes of interest and complements them.
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From page 112... ...
did not consult a doctor for their pain, 41 percent saw one or two doctors, and 29 percent saw three or more doctors (Louis Harris, 1985~. Descriptive Epidemiology of Chronic Pain and Disability Trends in Time There appears to be an increase on the relative frequency of back pain-caused work disability over time.
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From page 113... ...
In the two studies in Ohio, age-specific prevalence rates of back pain were 3~70 percent higher in people aged 3~64 years than in those aged 18-34 years (Nagi et al., 1973; Reisbord and Greenland, 19851. Back pain and chronic joint pain for more than 30 days per year was highest in the 50- to 64-year-old respondents in the Nuprin Pain Survey.
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From page 114... ...
also used multivariate methods in their study of work disability in 180 people after diagnosis of rheumatoid arthritis. No one physical characteristic of a job correlated significantly with whether these people remained employed.
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From page 115... ...
Although not entirely consistent, the data indicate that back pain may be more likely to become a chronic problem in people of lower socioeconomic status. People with less than a high school education had more chronic back pain in three American surveys (Louis Harris, 198~; Nagi et al., 1973; Reisbord and Greenland, 19851.
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From page 116... ...
of work disability after the diagnosis of rheumatoid arthritis, the social characteristics of the workplace predicted cessation of employment twice as well as personal or medical factors. Two important workplace factors were control over the pace of work and self-employment.
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From page 117... ...
Much work remains to be done before rational policies based on scientific studies can be proposed to ameliorate the problem of chronic pain and related work disability. Epidemiological Studies Most of the descriptive epidemiological work and the surveys reported to date are cross-sectional studies.
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From page 118... ...
Methodological Research The development and standardization of concepts of chronic pain measurement are critical. The assessment of phenomena such as pain that have few or no directly observable components, the standardization of measurement of relevant clinical phenomena, the validation of indexes and scales of attributes such as quality of life, and even the establishment of minimum standards for recording relevant clinical and social information are neglected in much of the epidemiological and clinical literature.
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From page 119... ...
Nuprin Pain Report.
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From page 120... ...
Spitzer, W.O., and Task Force. Rapport du Groupe de Travail Quebecois sur les Aspects Cliniques des Affections Vertebrales Chez les Travailleurs.
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