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

Journal article

Todd, A., Akhter, N., Cairns, J., Kasim, A., Walton, N., Ellison, A., Chazot, P., Eldabe, S. and Bambra, C. 2018. The pain divide: a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England. BMJ Open. 8 (7). https://doi.org/10.1136/bmjopen-2018-023391
AuthorsTodd, A., Akhter, N., Cairns, J., Kasim, A., Walton, N., Ellison, A., Chazot, P., Eldabe, S. and Bambra, C.
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.

Year2018
JournalBMJ Open
Journal citation8 (7)
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2018-023391
Publication dates
Print11 Sep 2018
Publication process dates
Deposited14 Sep 2018
Accepted07 Jun 2018
Accepted author manuscript
Output statusPublished
Additional information

Open Access http://creativecommons.org/licenses/by-nc/4.0/.

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