Customize your JAMA Network experience by selecting one or more topics from the list below.
Gureje O, Von Korff M, Simon GE, Gater R. Persistent Pain and Well-being: A World Health Organization Study in Primary Care. JAMA. 1998;280(2):147–151. doi:10.1001/jama.280.2.147
From the Department of Psychiatry, University College Hospital, Ibadan, Nigeria (Dr Gureje); Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Wash (Drs Von Korff and Simon); and Department of Psychiatry, Withington Hospital, West Didsbury, Manchester, England (Dr Gater). Dr Gureje is now with the Department of Psychiatry, Royal Melbourne Hospital, Parkville, Australia.
Context.— There is little information on the extent of persistent pain across
cultures. Even though pain is a common reason for seeking health care, information
on the frequency and impacts of persistent pain among primary care patients
Objective.— To assess the prevalence and impact of persistent pain among primary
Design and Setting.— Survey data were collected from representative samples of primary care
patients as part of the World Health Organization Collaborative Study of Psychological
Problems in General Health Care, conducted in 15 centers in Asia, Africa,
Europe, and the Americas.
Participants.— Consecutive primary care attendees between the age of majority (typically
18 years) and 65 years were screened (n=25916) and stratified random samples
Main Outcome Measures.— Persistent pain, defined as pain present most of the time for a period
of 6 months or more during the prior year, and psychological illness were
assessed by the Composite International Diagnostic Interview. Disability was
assessed by the Groningen Social Disability Schedule and by activity-limitation
days in the prior month.
Results.— Across all 15 centers, 22% of primary care patients reported persistent
pain, but there was wide variation in prevalence rates across centers (range,
5.5%-33.0%). Relative to patients without persistent pain, pain sufferers
were more likely to have an anxiety or depressive disorder (adjusted odds
ratio [OR], 4.14; 95% confidence interval [CI], 3.52-4.86), to experience
significant activity limitations (adjusted OR, 1.63; 95% CI, 1.41-1.89), and
to have unfavorable health perceptions (adjusted OR, 1.26; 95% CI, 1.07-1.49).
The relationship between psychological disorder and persistent pain was observed
in every center, while the relationship between disability and persistent
pain was inconsistent across centers.
Conclusions.— Persistent pain was a commonly reported health problem among primary
care patients and was consistently associated with psychological illness across
centers. Large variation in frequency and the inconsistent relationship between
persistent pain and disability across centers suggests caution in drawing
conclusions about the role of culture in shaping responses to persistent pain
when comparisons are based on patient samples drawn from a limited number
of health care settings in each culture.
Create a personal account or sign in to: