United States National Pain Strategy for Population Research: Concepts, Definitions and Pilot Data

Abstract National Pain Strategy (NPS) population research objectives include: estimating chronic pain prevalence; studying pain treatment with electronic health care data; and, developing metrics to assess progress in reducing chronic pain impact. In this paper, the NPS Population Research Workgroup reviews concepts relevant to achieving these aims. High impact chronic pain was defined as persistent pain with substantial restriction of life activities lasting six months or more. In pilot work, we tested a brief assessment of high impact chronic pain, and employed electronic health records data to describe pain-related health care. A mail survey of adult health plan enrollees (N=770) found that 14% had high impact chronic pain. Relative to persons with lower impact chronic pain, those with high impact chronic pain were more often frequent users of health care for pain, reported lower quality of life, greater pain-related interference with activities, and more often reported pain at multiple anatomic locations. Analyses of health care data (N=289,464) found that pain patients had higher health care costs compared to others and that pain services were typically delivered in primary care. These results support the feasibility of developing data on chronic pain through national health interview surveys and large electronic health care databases. Perspective Pilot analyses supported the feasibility of brief chronic pain assessments suitable for national health surveys and use of electronic health care databases to develop data regarding trends in the delivery of pain treatments, costs, and effectiveness. These methods are relevant to achieving the aims of the U.S. National Pain Strategy.