It is well known by now that pain is a common health problem that everyone will experience at least once in their life. After much research, education and advocacy, pain is nowadays considered as a health issue on its own rather than a consequence of another disease or medical condition. For some people, a recent and acute low back pain (LBP) episode will persist over time and become chronic. This happens for about 5 to 10% of individuals. For others, osteoarthritis (OA), another common and painful joint disease will limit their daily activities. Women and the elderly are most likely to develop OA although it can affect 14% of the Canadian adult population.
Goal
Osteoarthritis and low back pain have an important and similar economic burden on our society. This means that people impacted by these conditions might not be able to work, will require several types of pain management interventions, prescriptions and consultations with a variety of healthcare professionals. As an example, osteoarthritis-related costs reach $7.6 billion annually in Canada. In this study, researchers wanted to better understand the impact of these diseases on people and on the society. Therefore, they assessed the associations between these two conditions and healthcare resource utilization and disability status to understand the gaps in accessing adequate pain management.
Methodology
A unique database such as the Quebec Pain Registry offers a number of possibilities to study people living with different types of pain, due to its self-reported questionnaires and medical data that were collected using standardized tools. Self-reported questionnaires were administered on the first visit at a pain clinic and collected data regarding pain characteristics, alcohol and drug consumption, psychological distress symptoms such as anxiety, depression and stress. The questionnaires also surveyed participants’ well-being, health and comfort with daily life. In other words, physical and mental health-related quality of life were assessed. Nurses also collected medical information regarding the pain duration, frequency, neuropathic pain, circumstances surrounding pain onset, other health-related issues and current and past medical history. To better understand how patients used the healthcare system, researchers looked at the number of emergency visits, hospitalizations, medications and procedures used to alleviate pain.
Main findings
In this study, 2 663 people with chronic LBP and 139 people with OA were selected from the Quebec Pain Registry and had their data analyzed by the research team. Participants were included in the study if their pain was moderate to severe. Most of the participants were women and about 50% had a college or university diploma. When looking at the employment status, about 40% of people with chronic LBP and 27,6% of those with OA were working. Persons that had LBP had consulted with nearly 6 different types of health-care professionals and those with OA had consulted with about 5 health-care professionals. Most of these people living with LBP used physical therapies, psychological interventions and engaged by themselves in different strategies to manage their pain. Results also show that people with LBP and OA used most commonly acetaminophen, nonsteroidal anti-inflammatory drugs (common over the counter include aspirin and ibuprofen) and opioids. Other healthcare conditions that were present in both groups were depressive disorders, hypertension, headaches, anxiety and high cholesterol. Surprisingly, hospitalizations and emergency visits were relatively infrequent and most of participants were not receiving disability benefits.
Take home message
Among people living with moderate-to-severe chronic LBP that were seeking specialized care, health-care utilization and disability status were negatively associated with pain severity, pain interference and quality of life, which is consistent with the literature. These results were not found for people living with OA, which can be due to a much smaller sample size.
