Chronic pain: prevalence, demographic inequalities, and healthcare utilisation. A primary care database analysis

Abstract

Background: Chronic pain (CP) is an ill-defined condition, often under-recorded in primary care records. Aim: To determine prevalence, evidence of health inequalities, primary care consultation rates, and healthcare utilisation costs of CP. Design & setting: Cross-sectional, retrospective study using anonymised primary care data from all GP practices in one inner-city London area. Method: CP was defined on the basis of analgesic medication codes and novel inclusion of diagnostic codes for conditions known to be strongly associated with CP. CP prevalence and consultation rates were determined; comparisons were made with 31 other long-term conditions (LTCs). Consultation cost estimates were based on healthcare professional type and consultation mode. Results: In total, 358 889 adult patients were registered in sample practices, with continuous (12-month) healthcare records available for 327 800 (91.3%). CP prevalence was 18.6%; the second most prevalent LTC after anxiety at 21.4%. CP mean annual consultation rates were 15.3 per patient, the highest LTC consultation rate. CP incurred the highest primary care consultation costs of any of the included LTCs. Age was the strongest predictor of CP, particularly in those aged ≥60 years (adjusted odds ratio [AOR] for 60-69 years: 9.32; 95% confidence interval [CI] = 8.83 to 9.84; compared with those aged 18–29 years). Much smaller AORs were found for ethnicity, social deprivation, sex, and non-UK country of birth. Conclusion: CP represents the most demanding LTC, in terms of consultation rates and costs, managed in primary care. Yet there is considerable uncertainty about optimal management and alternatives to long-term, high-volume primary care consultation rates.