A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors

Zachary Zimmer; Kathryn Fraser; Hanna Grol-Prokopczyk; Anna Zajacova

doi:10.1097/j.pain.0000000000002557

journal article Dec 15, 2021

A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors

Zachary Zimmer

Kathryn Fraser

Hanna Grol-Prokopczyk

Anna Zajacova

Pain Vol. 163 No. 9 pp. 1740-1750 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1097/j.pain.0000000000002557

Abstract

Abstract
There is wide variation in population-level pain prevalence estimates in studies of survey data around the world. The role of country-level social, economic, and political contextual factors in explaining this variation has not been adequately examined. We estimated the prevalence of unspecified pain in adults aged 25+ years across 52 countries using data from the World Health Survey 2002 to 2004. Combining data sources and estimating multilevel regressions, we compared country-level pain prevalence and explored which country-level contextual factors explain cross-country variations in prevalence, accounting for individual-level demographic factors. The overall weighted age- and sex-standardized prevalence of pain across countries was estimated to be 27.5%, with significant variation across countries (ranging from 9.9% to 50.3%). Women, older persons, and rural residents were significantly more likely to report pain. Five country-level variables had robust and significant associations with pain prevalence: the Gini Index, population density, the Gender Inequality Index, life expectancy, and global region. The model including Gender Inequality Index explained the most cross-country variance. However, even when accounting for country-level variables, some variation in pain prevalence remains, suggesting a complex interaction between personal, local, economic, and political impacts, as well as inherent differences in language, interpretations of health, and other difficult to assess cultural idiosyncrasies. The results give new insight into the high prevalence of pain around the world and its demonstrated association with macrofactors, particularly income and gender inequalities, providing justification for regarding pain as a global health priority.

Topics

No keywords indexed for this article. Browse by subject →

References

62

[1]

Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women.

Nancy E. Adler, Elissa S. Epel, Grace Castellazzo et al.

Health Psychology 2000 10.1037/0278-6133.19.6.586

[2]

Amate-Fortes "World analysis of the determinants of the inequality in health. Is the measurement of inequality important?" Rev Za Soc Polit (2020)

[3]

Andrews "Pain as a risk factor for disability or death" J Am Geriatr Soc (2013) 10.1111/jgs.12172

[4]

Andrews "Chronic widespread pain prevalence in the general population: a systematic review" Eur J Pain (2018) 10.1002/ejp.1090

[5]

Angel "The effects of social structure and culture on reported health" Soc Sci Q (1984)

[6]

Bambra "Scaling up: the politics of health and place" Soc Sci Med (2019) 10.1016/j.socscimed.2019.04.036

[7]

Sex differences in pain: a brief review of clinical and experimental findings

E.J. Bartley, R.B. Fillingim

British Journal of Anaesthesia 2013 10.1093/bja/aet127

[8]

Bergman "Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study" J Rheumatol (2001)

[9]

Blyth "Chronic pain in Australia: a prevalence study" PAIN (2001) 10.1016/s0304-3959(00)00355-9

[10]

Blyth "Global burden of pain and global pain policy—creating a purposeful body of evidence" PAIN (2018) 10.1097/j.pain.0000000000001311

[11]

Bohlin "Perceived gender inequality in the couple relationship and musculoskeletal pain in middle-aged women and men" Scand J Public Health (2013) 10.1177/1403494813498157

[12]

Bonathan "Socioeconomic status and the course and consequences of chronic pain" Pain Manag (2013) 10.2217/pmt.13.18

[13]

Brattberg "The prevalence of pain in a general population. The results of a postal survey in a county of Sweden" PAIN (1989) 10.1016/0304-3959(89)90133-4

[14]

Brinda "Association between gender inequality index and child mortality rates: a cross-national study of 138 countries" BMC Public Health (2015) 10.1186/s12889-015-1449-3

[15]

Brønnum-Hansen "Ranking health between countries in international comparisons" Scand J Public Health (2014) 10.1177/1403494814522555

[16]

Coggon "Drivers of international variation in prevalence of disabling low back pain: findings from the cultural and psychosocial influences on disability study" Eur J Pain (2019) 10.1002/ejp.1255

[17]

Coggon "Disabling musculoskeletal pain in working populations: is it the job, the person, or the culture?" Pain (2013) 10.1016/j.pain.2013.02.008

[18]

Covinsky "Pain, functional limitations, and aging" J Am Geriatr Soc (2009) 10.1111/j.1532-5415.2009.02388.x

[19]

Croft "The prevalence of chronic widespread pain in the general population" J Rheumatol (1993)

[20]

Crook "The prevalence of pain complaints in a general population" PAIN (1984) 10.1016/0304-3959(84)90824-8

[21]

Diffenbaugh "Global warming has increased global economic inequality" Proc Natl Acad Sci (2019) 10.1073/pnas.1816020116

[22]

Elzahaf "The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis" Curr Med Res Opin (2012) 10.1185/03007995.2012.703132

[23]

Farioli "Musculoskeletal pain in Europe: role of personal, occupational and social risk factors" Scand J Work Environ Health (2014) 10.5271/sjweh.3381

[24]

Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings

Roger B. Fillingim, Christopher D. King, Margarete C. Ribeiro-Dasilva et al.

The Journal of Pain 2009 10.1016/j.jpain.2008.12.001

[25]

Gaye "Measuring key disparities in human development: the gender inequality index" Hum Dev Res Pap (2010)

[26]

Gibson "Age-related differences in pain perception and report" Clin Geriatr Med (2001) 10.1016/s0749-0690(05)70079-3

[27]

Pain as a global public health priority

Daniel S Goldberg, Summer J McGee

BMC Public Health 2011 10.1186/1471-2458-11-770

[28]

Grol-Prokopczyk "Sociodemographic disparities in chronic pain, based on 12-year longitudinal data" PAIN (2017) 10.1097/j.pain.0000000000000762

[29]

Persistent Pain and Well-being

Oye Gureje, Michael Von Korff, Gregory E. Simon et al.

JAMA 1998 10.1001/jama.280.2.147

[30]

Hauck "Priorities for action on the social determinants of health: empirical evidence on the strongest associations with life expectancy in 54 low-income countries, 1990–2012" Soc Sci Med (2016) 10.1016/j.socscimed.2016.08.035

[31]

Henschke "The epidemiology and economic consequences of pain" Mayo Clin Proc (2015) 10.1016/j.mayocp.2014.09.010

[32]

Hickel "Is global inequality getting better or worse? A critique of the World Bank's convergence narrative" Third World Q (2017) 10.1080/01436597.2017.1333414

[33]

Hosseinpoor "Socioeconomic inequality in smoking in low-income and middle-income countries: results from the World Health Survey" PLoS One (2012) 10.1371/journal.pone.0042843

[34]

Hosseinpoor "Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey" Am J Public Health (2013) 10.2105/ajph.2012.301115

[35]

Hoy "The epidemiology of low back pain" Best Pract Res Clin Rheumatol (2010) 10.1016/j.berh.2010.10.002

[36]

Jaba "The relationship between life expectancy at birth and health expenditures estimated by a cross-country and time-series analysis" Proced Econ Finance (2014) 10.1016/s2212-5671(14)00454-7

[37]

A Systematic Review and Meta-Analysis of the Global Burden of Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: Trends in Heterogeneous Data and a Proposal for New Assessment Methods

Tracy Jackson, Sarah Thomas, Victoria Stabile et al.

Anesthesia & Analgesia 2016 10.1213/ane.0000000000001389

[38]

Johnson "The prevalence of chronic pain in developing countries" Pain Manag (2013) 10.2217/pmt.12.83

[39]

Kaufmann "The worldwide governance indicators: methodology and analytical issues" Hague J Rule L (2011) 10.1017/s1876404511200046

[40]

Kim "Relationship between the remaining years of healthy life expectancy in older age and national income level, educational attainment, and improved water quality" Int J Aging Hum Dev (2016) 10.1177/0091415016657560

[41]

Kim "Does quality of government matter in public health?: comparing the role of quality and quantity of government at the National Level" Sustainability (2019) 10.3390/su11113229

[42]

King "Associations between gender equality and health: a systematic review" Health Promot Int (2020)

[43]

Landivar "Early signs indicate that COVID-19 is exacerbating gender inequality in the labor force" Socius (2020) 10.1177/2378023120947997

[44]

Leung "Toward sustainable environmental quality: priority research questions for Asia" Environ Toxicol Chem (2020) 10.1002/etc.4788

[45]

Lynch "Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions" BMJ (2000) 10.1136/bmj.320.7243.1200

[46]

Mackenbach "Life expectancy and national income in Europe, 1900-2008: an update of Preston's analysis" Int J Epidemiol (2013) 10.1093/ije/dyt122

[47]

Mansfield "A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population" PAIN (2016) 10.1097/j.pain.0000000000000314

[48]

Status Syndrome

Michael Marmot

Significance 2004 10.1111/j.1740-9713.2004.00058.x

[49]

Messias "Income inequality and depression prevalence across the United States: an ecological study" Psychiatr Serv (2011) 10.1176/ps.62.7.pss6207_0710

[50]

Milanovic "Global income inequality in numbers: in history and now" Glob Pol (2013) 10.1111/1758-5899.12032

Showing 50 of 62 references

Cited By

296

Heals on Wheels: Development and Implementation of Community Outreach and Group Medical Visits for People Experiencing Chronic Pain

Catherine Justice, Susan Haddow · 2025

Global Advances in Integrative Medi...

Diagnosis, Prognosis, and Drug Target Discovery for Chronic Widespread Pain: A Large Proteogenomic Study

Li Chen, Eoin Kelleher · 2025

Advanced Science

Nimesulide: Critical Appraisal of Safety and Efficacy in Acute Pain

Mangesh Tiwaskar, Sushant Charde · 2025

Journal of the Association of Physi...

Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain

Frank J. P. M. Huygen, Konstantinos Soulanis · 2024

JAMA Network Open

Development of a Novel Co-Amorphous Curcumin and L-Arginine (1:2): Structural Characterization, Biological Activity and Pharmacokinetics

Jose Antonio Mancillas-Quiroz, Miriam del Carmen Carrasco-Portugal · 2024

Pharmaceutics

Moving towards the use of artificial intelligence in pain management

Ryan Antel, Sera Whitelaw · 2024

European Journal of Pain

Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases

Zack Biskupiak, Victor Vinh Ha · 2024

Journal of Clinical Medicine

Metrics

296

Citations

62

References

Details

Published: Dec 15, 2021
Vol/Issue: 163(9)
Pages: 1740-1750

Authors

Z

Zachary Zimmer

Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada; Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada

K

Kathryn Fraser

Global Aging and Community Initiative, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada

H

Hanna Grol-Prokopczyk

Department of Sociology, University of Buffalo, Buffalo, NY, United States

A

Anna Zajacova

Department of Sociology, University of Western Ontario, London, ON, Canada

Cite This Article

Zachary Zimmer, Kathryn Fraser, Hanna Grol-Prokopczyk, et al. (2021). A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors. Pain, 163(9), 1740-1750. https://doi.org/10.1097/j.pain.0000000000002557

A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors

You May Also Like