The Level of Expressed Need--a measure of help-seeking behaviour for chronic pain in the community

Chronic pain is a common and disabling condition, with a high impact on health and the health services in the community. The extent of help-seeking behaviour and factors that influence this are complex, but poorly understood. A simple, valid measure of help-seeking behaviour would be useful for community-based research, with a view to developing and evaluating interventions. The aims of the study were to test a hierarchical scale designed to measure help-seeking behaviour in chronic pain in postal surveys of the community, and to explore factors associated with responses. As part of a community survey of chronic pain, we developed the Level of Expressed Need (LEN) scale, based on questions about the use of treatment and professional advice for chronic pain. We compared this scale with two measures of chronic pain severity--the Chronic Pain Grade (CPG), and the Glasgow Pain Questionnaire (GPQ)--and analyzed associations with the SF36 general health questionnaire and demographic variables. Of 3605 respondents (corrected response rate 82%), 1817 reported chronic pain. Of these, 17% were at the mildest and 28% at the severest LEN. There were strong correlations with both the CPG (r=0.48) and the GPQ (r=0.55). There were, however, many important disparities in responses to these measures. Several other factors were independently associated with a high LEN in chronic pain: female gender, lower educational level, and physical, mental, pain and general health dimensions of the SF36 questionnaire. The LEN is a useful tool for measuring the help-seeking response to chronic pain in the general population. The findings confirm that this response is influenced by clinical and demographic factors in addition to the severity of the pain. Further development work will strengthen the instrument to explore these.