The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization

Figures & data

Table 1.  Reported pain level and frequency of pain.

Pain dimension	Respondents five EU countries*	Distribution (%)
Pain level
Mild	8,970,445	18.0
Moderate	29,439,982	59.2
Severe	11,318,103	22.8
Pain frequency
Daily	21,703,485	43.6
2–6 times a week	14,510,928	29.2
Weekly or less	13,514,117	27.2
Pain level and frequency
Severe and daily experience	8,506,068	17.1
Severe and 4–6 times per week	969,348	2.0
Severe and 2–3 times per week	734,408	1.5
Severe and weekly or less	1,108,279	2.2
Moderate and daily experience	11,746,535	23.6
Moderate and 4–6 times a week	4,145,306	8.3
Moderate and 2–3 times per week	6,047,471	12.2
Moderate and weekly or less	7,500,670	15.1
Mild and daily experience	1,450,882	2.9
Mild and 2–6 times per week	2,614,395	5.3
Mild and weekly or less	4,905,168	9.9

*UK, France, Spain, Germany, Italy.

Table 2.  Distribution of SF-12 physical and mental component scores for persons reporting pain and no pain.

Class interval	Physical component score distribution (%)		Mental component score distribution (%)
	No pain	Pain	No pain	Pain
90–100	0.0	0.0	0.0	0.0
80–89	0.0	0.0	0.0	0.0
70–79	0.0	0.0	0.0	0.3
60–69	5.7	2.0	8.9	7.0
50–59	50.2	25.2	35.8	27.7
40–49	25.6	29.2	30.2	29.0
30–39	12.0	23.6	18.3	23.8
20–29	5.0	15.1	5.4	9.8
10–19	1.3	4.7	1.1	2.1
Under 10	0.1	0.3	0.1	0.2
Average score	50.6	41.1	46.5	44.3

Table 3.  Distribution of SF-6D utility scores for persons reporting pain and no pain.

Utility score	Persons reporting no pain (%)	Persons reporting pain (%)
0.90–1.0	15.9	4.4
0.80–0.89	14.3	7.9
0.70–0.79	23.3	16.8
0.60–0.69	33.8	33.4
0.50–0.59	11.1	26.5
0.40–0.49	1.4	8.5
0.30–0.39	0.2	2.6
0.20–0.29	0.0	0.0
0.10–0.19	0.0	0.0
Under 0.10	0.0	0.0
Average	0.73	0.64

Table 4.  Healthcare resource utilization distribution for persons reporting pain and no pain.

Resource utilization events	Traditional healthcare provider visits (%)		Emergency room visits (%)		Hospitalizations (%)
	No pain	Pain	No pain	Pain	No pain	Pain
0	18.1	7.4	89.7	81.9	92.7	85.0
1	14.9	7.4	7.4	11.4	5.5	10.7
2	14.6	9.4	1.7	3.8	1.0	2.5
3	11.4	9.2	0.5	1.4	0.3	0.8
4	8.7	9.2	0.2	0.4	0.1	0.3
5	6.5	7.7	0.2	0.5	0.1	0.3
6	5.6	6.6	0.1	0.2	0.05	0.1
7	3.7	5.6	0.02	0.1	0.03	0.02
8	3.2	4.8	0.03	0.1	0.03	0.05
9	2.2	4.2	0.02	0.01	0.01	0.01
10 or more	11.1	28.6	0.2	0.3	0.2	0.3
Average	4.39	8.32	0.18	0.34	0.14	0.29

Table 5.  Distribution of independent variables.

Independent variable*	No pain (%)	Pain (%)
Socio-demographic variables
Age: 18–39 years	38.0	28.9
Age: 40–59 years	35.2	41.7
Age: 60 years and older	26.8	29.4
Gender: male	50.9	39.4
Gender: female	49.1	60.7
Education: university or higher	32.1	25.1
Education: high school completed	50.7	49.2
Education: not completed high school	17.2	27.2
Income: under €20,000	25.6	33.1
Income: €20,000–39,999	35.0	34.0
Income: €40,000 and above	23.3	18.5
Income reporting declined	16.1	14.5
Country of residence
Country: France	20.5	18.3
Country: Germany	26.0	33.8
Country: Italy	21.8	10.8
Country: Spain	14.0	11.8
Country: UK	17.7	25.3
Health risk behaviors
BMI: underweight	2.6	2.3
BMI: normal weight	39.9	31.3
BMI: overweight	37.3	35.8
BMI: obese	16.3	24.1
BMI: morbidly obese	1.6	4.5
BMI: reporting declined	2.2	2.0
Current smoker	28.5	32.8
Alcohol user	60.4	54.8
Morbidity/comorbidity status
Charlson Comorbidity Index = 0	80.6	65.5
Charlson Comorbidity Index = 1	13.6	20.5
Charlson Comorbidity Index = 2	3.9	8.7
Charlson Comorbidity Index > 2	1.9	5.3

*Distribution of pain variables given in Table 1.

Table 6.  Regression results: health related quality of life.

Independent variables	SF-12 physical component score		SF-12 mental component score		SF-6D health utility score
	Model 1 Coefficient	Model 2 Coefficient	Model 1 Coefficient	Model 2 Coefficient	Model 1 Coefficient	Model 2 Coefficient
Pain level reported in last month*
Mild	−2.180		−1.161		−0.028
Moderate	−6.690		−2.491		−0.072
Severe	−15.398		−5.087		−0.164
Pain level and frequency*
Severe pain and daily experience		−17.857		−5.496		−0.186
Severe pain and 4–6 times a week		−12.168		−5.403		−0.136
Severe pain and 2–3 times a week		−9.525		−4.779		−0.108
Severe pain and weekly or less		−4.744		−2.125		−0.066
Moderate pain and daily experience		−10.270		−2.612		−0.100
Moderate pain and 4–6 times a week		−6.718		−2.724		−0.073
Moderate pain and 2–3 times week		−5.526		−3.151		−0.067
Moderate pain and weekly or less		−2.296		−1.685		−0.037
Mild pain and daily experience		−4.107		−1.201*		−0.032
Mild pain and 2–6 times a week		−3.334		−2.482		−0.046
Mild pain and weekly or less		−0.997		−0.444*		−0.018
Socio-demographic variables
Age: 40–59 years^1	−2.793	−2.572	1.976	2.006	0.006	0.008
Age: 60 years and older^1	−6.526	−6.169	6.003	6.048	0.018	0.021
Gender: male^2	0.795	0.759	2.025	2.015	0.025	0.025
Education: university or higher^3	1.035	1.018	0.534	0.523	0.008	0.008
Education: High school completed^3	1.338	1.357	0.489	0.481	0.007	0.007
Income: €20,000–39,999^4	1.111	1.041	1.304	1.296	0.019	0.018
Income: €40,000 and above^4	1.424	1.308	2.074	2.063	0.029	0.029
Income: not stated^4	1.246	1.174	1.555	1.544	0.025	0.024
Country: UK^5	−0.735	−0.580	−2.007	−1.988	−0.008	−0.007
Country: France^5	0.634	0.672	−4.143	−4.136*	−0.033	−0.033
Country: Spain^5	−0.798	−0.723	0.210*	0.208	0.002*	0.002*
Country: Italy^5	−0.670	−0.646	−5.812	−5.802	−0.073	−0.073
Health risk behaviors
BMI: underweight^6	−0.992	−1.017	−2.063	−2.049	−0.021	−0.021
BMI: overweight^6	−0.996	−0.963	0.383	0.387	−0.001*	−0.001*
BMI: obese^6	−3.232	−3.126	−0.303	−0.289*	−0.020	−0.019
BMI: morbidly obese^6	−6.631	−6.307	−1.762	−1.714	−0.050	−0.048
BMI: not stated^6	−2.335	−2.297	−0.638*	−0.627*	−0.013	−0.012
Current smoker^7	−0.367	−0.402	−0.847	−0.848	−0.007	−0.008
Alcohol user^8	1.021	0.971	−0.154*	−0.163*	0.002*	0.001*
Morbidity/comorbidity status
Charlson Comorbidity Index	−1.738	−1.678	−0.987	−0.976	−0.018	−0.018
Constant	52.387	52.233	45.179	45.168	0.732	0.731
R2	0.360	0.381	0.130	0.131	0.120	0.199

All variables significant at 5% level except (*).

Reference categories: *no pain reported in last month.

¹Age 18–39 years; ²females; ³not completed high school; ⁴income under €20,000; ⁵country: Germany; ⁶BMI normal weight; ⁷non-smoker; ⁸non-drinker.

Table 7.  Regression results: healthcare resource utilization.

Independent variables	Traditional provider visits		Emergency room visits		Hospitalizations
	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2
	Percentage change	Percentage change	Percentage change	Percentage change	Percentage change	Percentage change
Pain level reported in last month*
Mild	27.9		4.3*		17.0
Moderate	63.5		66.4		44.4
Severe	132.3		172.7		229.0
Pain level and frequency*
Severe pain and daily experience		145.4		194.1		263.1
Severe pain and 4–6 times a week		115.0		106.4		163.0
Severe pain and 2–3 times a week		81.3		103.6		88.9
Severe pain and weekly or less		90.6		133.2		145.1
Moderate pain and daily experience		84.6		86.2		66.5
Moderate pain and 4–6 times a week		73.6		85.4		96.1
Moderate pain and 2–3 times week		61.3		83.0		30.3*
Moderate pain and weekly or less		28.1		14.6*		−7.0*
Mild pain and daily experience		41.0		−7.6*		52.7
Mild pain and 2–6 times a week		52.2		21.7		41.5
Mild pain and weekly or less		10.9		−1.2*		−6.6*
Socio-demographic variables
Age: 40–59 years^1	11.4	10.4	−33.3	−33.8	−15.6	−16.8
Age: 60 years and older^1	27.1	25.3	−32.6	−33.6	9.7*	7.8*
Gender: male^2	−25.7	−25.5	−5.6*	−4.9*	−3.1*	−2.4*
Education: university or higher^3	2.3*	2.3*	39.3	39.7	11.5*	12.5*
Education: high school completed^3	4.6	4.5	37.8	37.8	11.0*	11.4*
Income: €20,000–39,999^4	−1.4*	−1.3*	−24.1	−23.8	−20.5*	−19.8*
Income: €40,000 and above^4	−0.9	−0.6*	−18.9	−18.5	−9.1*	−8.2*
Income: not stated^4	−5.6	−5.3	−27.2	−26.9	−32.4	−31.6
Country: UK^5	−30.0	−30.5	20.0	19.3	−57.9	−58.0
Country: France^5	1.6*	1.4*	−16.9	−17.1	−27.9	−27.9
Country: Spain^5	2.4*	2.1*	185.8	185.7	−22.7*	−22.5*
Country: Italy^5	9.6	9.8	26.6	26.8	−53.4	−52.9
Health risk behaviors
BMI: underweight^6	15.4	15.2	38.8	39.1	101.3	101.0
BMI: overweight^6	7.1	6.9	−4.7*	−5.0*	23.0	22.8
BMI: obese^6	22.7	22.4	6.2*	5.8*	−3.8*	−4.5*
BMI: morbidly obese^6	35.0	33.8	5.0*	3.6*	26.3*	24.2*
BMI: not stated^6	−13.1	−13.5	27.6*	27.5*	19.0*	17.3*
Current smoker^7	3.2	3.3	22.1	22.0	10.6	11.4
Alcohol user^8	−6.0	−5.9	−11.4	−11.2	−20.3	−20.4
Morbidity/comorbidity status
Charlson Comorbidity Index	24.5	24.2	48.1	47.8	61.7	61.2
Log pseudo likelihood	−159,852.2	−159,746.5	−29,036.7	−29,018.3	−23,371.4	−23,348.6
Alpha	0.011	0.011	0.326	0.326	0.789	0.792

All variables significant at 5% level except (*).

Reference categories: *no pain reported in last month.

¹Age 18–39 years; ²females; ³not completed high school; ⁴income under €20,000; ⁵country: Germany; ⁶BMI normal weight; ⁷non-smoker; ⁸non-drinker.

McDermott AM, Toelle TR, Rowbotham DJ, et al. The burden of neuropathic pain: results of a cross-sectional survey. Eur J Pain 2006;10:127-135

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