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/.

Permalink -

https://repository.canterbury.ac.uk/item/88w9y/the-pain-divide-a-cross-sectional-analysis-of-chronic-pain-prevalence-pain-intensity-and-opioid-utilisation-in-england

Download files

Accepted author manuscript
17611_Pain paper.pdf

  • 51
    total views
  • 56
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

The effects of social protection policies on health inequalities:evidence from systematic reviews
Hillier-Brown, F., Thomson, K., McGowan, V., Cairns, J., Eikemo, T., Gonzalez, D. and Bambra, C. 2019. The effects of social protection policies on health inequalities:evidence from systematic reviews. Scandinavian Journal of Public Health. https://doi.org/10.1177/1403494819848276
Defying the odds? Identifying and understanding the relationship between health and resilience
Cairns, J. 2013. Defying the odds? Identifying and understanding the relationship between health and resilience. PhD Thesis Durham University Geography department
Health Inequalities
Cairns, J. and Curtis, S. 2017. Health Inequalities. in: Richardson, D., Castree, N., Goodchild, M., Kobayashi, A., Liu, W. and Marston, R. (ed.) International Encyclopedia of Geography Wiley.
The impact of place on suicidal behaviour
Bambra, C. and Cairns, J. 2017. The impact of place on suicidal behaviour. Samaritans.
Interim evaluation of an integrated approach to improving health and wellbeing in County Durham, UK
Visram, S., Thirlway, F., Cairns, J., Akhter, N. and Lewis, S. 2016. Interim evaluation of an integrated approach to improving health and wellbeing in County Durham, UK. Oxford University Press. https://doi.org/10.1093/eurpub/ckw169.002
Public involvement in alcohol research
Cairns, J. and Nicholls, J. 2017. Public involvement in alcohol research. UK Alcohol Research UK.
How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? two systematic reviews
Bambra, C., Hillier-Brown, F., Cairns, J., Kasim, A., Moore, H. and Summerbell, C. 2015. How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? two systematic reviews. Public Health Research. 3 (1). https://doi.org/10.3310/phr03010
A systematic review of the effectiveness of individual, community and societal-level interventions at reducing socio-economic inequalities in obesity among adults
Hillier-Brown, F., Bambra, C., Cairns, J., Kasim, A., Moore, H. and Summerbell, C. 2014. A systematic review of the effectiveness of individual, community and societal-level interventions at reducing socio-economic inequalities in obesity among adults. International Journal of Obesity. 38 (12), pp. 1483-1490. https://doi.org/10.1038/ijo.2014.75
Defying the odds: a mixed-methods study of health resilience in deprived areas of England
Cairns, J. and Bambra, C. 2013. Defying the odds: a mixed-methods study of health resilience in deprived areas of England. Social Science and Medicine. 91, pp. 229-237. https://doi.org/10.1016/j.socscimed.2013.03.014
Defying deprivation: a cross-sectional analysis of area level health resilience in England
Cairns, J., Curtis, S. and Bambra, C. 2012. Defying deprivation: a cross-sectional analysis of area level health resilience in England. Health & Place. 18 (4), pp. 928-933. https://doi.org/10.1016/j.healthplace.2012.02.011
Healthy land? an examination of the area-level association between brownfield land and morbidity and mortality in England
Bambra, C., Robertson, S., Kasim, A., Smith, J., Cairns, J., Copeland, A., Finlay, N. and Johnson, K. 2014. Healthy land? an examination of the area-level association between brownfield land and morbidity and mortality in England. Environment and Planning A: Economy and Space. 46 (2), pp. 433-454. https://doi.org/10.1068/a46105
A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children
Hillier-Brown, F., Bambra, C., Cairns, J., Kasim, A., Moore, H. and Summerbell, C. 2014. A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children. BMC Public Health. 14 (1,). https://doi.org/10.1186/1471-2458-14-834
This divided land: an examination of regional inequalities in exposure to brownfield land and the association with morbidity and mortality in England
Bambra, C., Cairns, J., Kasim, A., Smith, J., Robertson, S., Copeland, A. and Johnson, K. 2015. This divided land: an examination of regional inequalities in exposure to brownfield land and the association with morbidity and mortality in England. Health & Place. 34, pp. 257-269. https://doi.org/10.1016/j.healthplace.2015.05.010
Inside and out: a critical analysis of social capital
Cairns, J. 2017. Inside and out: a critical analysis of social capital. Journal of Poverty and Social Justice. 25 (3), pp. 233-248. https://doi.org/10.1332/175982717X14903615014478
Area-level socioeconomic disadvantage and suicidal behaviour in Europe: a systematic review
Cairns, J., Graham, E. and Bambra, C. 2017. Area-level socioeconomic disadvantage and suicidal behaviour in Europe: a systematic review. Social Science and Medicine. 192, pp. 102-111. https://doi.org/10.1016/j.socscimed.2017.09.034
Making the case for qualitative comparative analysis in geographical research: a case study of health resilience
Cairns, J., Wistow, J. and Bambra, C. 2017. Making the case for qualitative comparative analysis in geographical research: a case study of health resilience. Area. 49 (3,), pp. 369-376. https://doi.org/10.1111/area.12327
How can primary care help to reduce weight stigma?
Henderson, E., Norrenberg, A., Cairns, J. and Gadsby, E. 2018. How can primary care help to reduce weight stigma? British Journal of General Practice (BJGP). 68 (1). https://doi.org/10.3399/bjgp18X696665
Co-production in substance use research
Cairns, J. and Nicholls, J. 2018. Co-production in substance use research. Drugs and Alcohol Today. 18 (1), pp. 6-16. https://doi.org/10.1108/DAT-02-2018-0002
Weighing up the evidence: a systematic review of the effectiveness of workplace interventions to tackle socio-economic inequalities in obesity
Cairns, J., Bambra, C., Hillier-Brown, F., Moore, H. and Summerbell, C. 2014. Weighing up the evidence: a systematic review of the effectiveness of workplace interventions to tackle socio-economic inequalities in obesity. Journal of Public Health. 37 (4,), pp. 659-670. https://doi.org/10.1093/pubmed/fdu077
Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities
Cairns, J., Warren, J., Garthwaite, K., Greig, G. and Bambra, C. 2014. Go slow: an umbrella review of the effects of 20 mph zones and limits on health and health inequalities. Journal of Public Health. 37 (3), pp. 515-520. https://doi.org/10.1093/pubmed/fdu067
Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults
Bambra, C., Hillier-Brown, F., Moore, H., Cairns, J. and Summerbell, C. 2013. Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults. Systematic Reviews. 2 (1,). https://doi.org/10.1186/2046-4053-2-27