A survey on pain complaints and health care utilization in a German population sample

A postal survey was carried out on every 71st person aged between 18 and 80 in the population registers in County Regierungsbezirk Karlsruhe in the State of Baden-Würtemberg. It asked 2127 persons whether they had, in the previous 6 months, experienced any form of unduly prolonged pain (as distinct from brief intercurrent self-limiting episodes related to injury inflammation etc.) and, if so, to specify its location, duration, severity and persistence. It also sought information on the resulting calls on healthcare professionals and the degree of satisfaction with treatments received. The age and gender distributions of the sample selected for survey matched those in the population from which it was drawn. Of the 1420 respondents, only 1304 declared their age and gender--a condition for inclusion in the analysis. Of these, 610 reported some form of unduly prolonged pain, which had lasted more than a year in 530. For all pain lasting longer than a year, the estimated prevalence of mild pain was 11%, severe 25% and intolerable 3.5%: the corresponding estimates for persistent as opposed to episodic pain were 2% for mild, 10% for sever and 1% for intolerable. Pain was present in more than one anatomical location in most of those who reported it. Musculoskeletal pain was overwhelmingly the most common. Increasing age, obesity and being female pre-disposed to the reporting of pain, with women being more liable to report headache and pain in the neck and shoulder. One hundred and thirty-six pain reporters either gave no information on consultation or sought no help from healthcare professionals: a third of the remainder consulted more than one professional, with general practitioners and specialists in physical medicine (niedergelassener Orthopäde) being the most common. A wide variety of treatments were used, with oral medications, massage, exercises, mud pack and heat treatment being the most popular; two-thirds of sufferers used more than one type of treatment. The most popular types of treatment tended also to be the most successful, except for oral medication (which was also the most heterogeneous). Multiple logistic regression analyses identified consistent associations between duration and severity of pain, the number of sites where it was reported, the numbers of healthcare professionals consulted and the number of treatments tried, and the same groupings of features were associated with decreased likelihood of overall satisfaction with treatment received.