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The Pain Divide : a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England.

Todd, Adam and Akhter, Nasima and Cairns, Joanne-Marie and Kasim, Adetayo and Walton, Nick and Ellison, Amanda and Chazot, Paul and Eldabe, Sam and Bambra, Clare (2018) 'The Pain Divide : a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England.', BMJ open., 8 (7). e023391.

Abstract

Objectives: Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders. Design: Cross-sectional study design using data from the Health Survey for England 2011. Setting England. Primary and secondary outcome measures: Chronic pain prevalence, pain intensity and opioid utilisation. Participants: Participant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis. Methods: Regional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables. Results: There were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions—with evidence of a ‘pain divide’ between the North and the South, whereby people in the North of England more likely to have ‘severely limiting’ or ‘moderately limiting’ chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics. Conclusions: There are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England—with evidence of a ‘pain divide’. Given the public health concerns associated with the long-term use of opioid analgesics—and their questionable activity in the management of chronic pain—more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.

Item Type:Article
Full text:(VoR) Version of Record
First Live Deposit - 18 September 2018
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Status:Peer-reviewed
Publisher Web site:https://doi.org/10.1136/bmjopen-2018-023391
Publisher statement:This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Record Created:18 Sep 2018 13:43
Last Modified:18 Sep 2018 14:44

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