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Pain lasting for several months,1 or persisting after an injury has healed,2 is considered chronic. Chronic pain affects not only individuals, but also their families, the health care system, and society as a whole.3 It may lead to other health concerns such as eating problems, sleep disturbances and fatigue.4-6 Absences from school, work and social activities have been linked to chronic pain.3,7,8 People may lose or change jobs, and in more extreme cases, cannot work at all.3,5,9,10 Mental health may be compromised; chronic pain has been associated with anxiety, depression, loneliness, and suicide ideation and attempts.11
Although chronic pain is usually associated with aging, it is relatively common at younger ages. However, few large, population-based studies have examined chronic pain among non-elderly people.4,12-14 Instead, research on pain at younger ages has focused on specific chronic conditions and pain sites,15-17 small sectors of the population such as occupational or ethnic groups,18-20 or convenience samples such as children attending certain schools or living in certain areas.4,21 Results from such studies provide only a partial picture of chronic pain in younger people.
This population-based analysis uses data from the 2007/2008 Canadian Community Health Survey (CCHS). It provides estimates of the prevalence of chronic pain by socio-demographic characteristics for a sample of 57,660 respondents aged 12 to 44, representing the 14.6 million Canadians in that age range (Appendix Table A). Chronic pain is examined in relation to chronic conditions, impact on functioning, work characteristics, health care use, and general well-being and mental health. (See The data)
One in ten
In 2007/2008, more than 1.5 million Canadians aged 12 to 44—9% of males and 12% of females—reported chronic pain (Table 1). The prevalence of chronic pain rose with advancing age: among 12- to 17-year-olds, 2% of males and 6% of females reported chronic pain; at ages 35 to 44, the corresponding figures were 14% and 17%.
Consistent with previous research,9,10,20,24,25 data from the 2007/2008 CCHS show that females aged 12 to 44 had higher odds of chronic pain than did males in that age range. However, the relationship was no longer significant when the presence of chronic conditions was considered, suggesting that they largely account for the association between gender and pain (data not shown).
Household educational attainment was associated with pain. People in households where no one had graduated from secondary school were almost twice as likely to report chronic pain as were those in households with at least one postsecondary graduate.
Compared with people whose racial/cultural background was White, Aboriginal people were more likely to report pain. This may, in part, be explained by the higher prevalence of pain-related chronic conditions (back problems, migraine, arthritis, stomach/intestinal ulcers, anxiety disorders and mood disorders) among the Aboriginal population (data not shown).
And for males, chronic pain was more common among those in rural than urban areas.
Back problems were reported by more than 2 million people aged 12 to 44 (14% of males and 17% of females), about a third of whom also reported chronic pain (Table 2). Migraine headaches, too, were common at these ages, especially among females (17%), and almost a quarter of these females reported chronic pain. Arthritis, relatively uncommon at ages 12 to 44 (fewer than 5%), was highly associated with pain; about half of males and females with arthritis also reported chronic pain. Not surprisingly, the more chronic conditions people had, the more likely they were to report chronic pain.
More than 60% of 12- to 44-year-olds with chronic pain reported experiencing activity limitations "sometimes" or "often," compared with 15% of those who did not have chronic pain (Table 3). These limitations touched all domains of life—home, school, work, transportation and leisure—and persisted in multivariate analysis that accounted for age, socio-demographic characteristics and chronic conditions (data not shown).
The majority of males (64%) and females (74%) with chronic pain reported that it not only limited but prevented at least a few activities. The prevalence of activity-preventing pain rose with age and was consistently higher among females than males. The difference between the sexes was particularly pronounced at ages 12 to 17: 66% of females with chronic pain reported that it prevented activities, compared with 42% of males.
Activities of daily living (ADL) (activities vital to retaining independence) include personal care such as bathing, dressing, eating and taking medication, as well as moving about inside the house. Instrumental activities of daily living (IADL) further assess functional independence and include preparing meals, doing everyday housework, getting to appointments, running errands such as grocery shopping, and banking and paying bills. People who needed help with ADL or IADL tasks because of health problems were identified. Because most 12- to 17-year-olds, regardless of their health status, require help with many IADL, this variable was examined only for people aged 18 to 44.
Very few pain-free 18- to 44-year-olds needed help with ADL, but among those with chronic pain, 3% of men and 5% of women required assistance (Table 3). Similarly, while 2% of people without chronic pain needed help with IADL, the figures were 13% for men and 23% for women with chronic pain. Among people with chronic pain, women were more likely than men to need help moving about inside the house, doing housework, running errands, and preparing meals. The percentages of men and women with chronic pain who needed help with personal care or managing finances did not differ significantly (data not shown).
In the week before they were interviewed, the majority of 25- to 44-year-olds had worked at a job. However, while 87% of men and 72% of women who were pain-free had done so, the figures were 78% for men and 65% for women who reported chronic pain (Table 3). As these differences suggest, people with chronic pain were more likely than the no-pain group to be without a job in the week before their interview or to be permanently unable to work.
Workers with chronic pain were no more likely than those without chronic pain to be absent from their jobs. But possibly as a consequence of trying to cope with pain-related work limitations, those with chronic pain were more likely to report work stress.
Not surprisingly, people aged 12 to 44 with chronic pain were more likely than those without chronic pain to use a variety of health care services, including many not covered by public health insurance (Table 4). For example, 19% of males and 18% of females with chronic pain had consulted a physiotherapist in the previous 12 months, compared with 7% of males and females who were generally pain-free.
As might be expected, people with chronic pain were less likely than those who were generally pain-free to assess their well-being positively (Table 5). While almost all (more than 95%) of 12- to 44-year-olds who were free of chronic pain described their health as good, very good or excellent, the percentages were considerably lower for those with chronic pain: 80% of males and 76% of females. As well, 23% of people with chronic pain reported that their health was worse than it had been a year earlier; this was the case for 7% of those who were pain-free.
People with chronic pain were less likely than those without it to be satisfied with their lives or to have a positive sense of community belonging. They were more likely to perceive life as stressful and were less likely to report good, very good or excellent mental health.
Mood disorders such as depression and dysthymia, and anxiety disorders such as a phobia and panic disorder are relatively common at ages 12 to 44, especially among females (Table 2). The prevalence of mood and anxiety orders was particularly high among people with chronic pain (Table 5). For example, 21% of females with chronic pain had a mood disorder and 18% had an anxiety disorder; among women who were pain-free, 6% reported a mood disorder, and 6%, an anxiety disorder.
The relationships between chronic pain and measures of well-being persisted when potentially confounding socio-demographic characteristics and painful chronic conditions were taken into account (Table 5). In most cases, the associations between pain and well-being were present regardless of pain intensity (data not shown).
Chronic pain is common in younger Canadians. It affects daily activities, employment, health care use, and general and psycho-social well-being. The association between chronic pain and mood and anxiety disorders revealed in this study highlights the importance of monitoring younger people with chronic pain for these mental disorders.
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