Chronic pain - prevalence, demographic inequalities and healthcare utilisation: a primary care database analysis

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 Condition (LTCs). Consultation cost estimates were based on health care professional type and consultation mode.

Results 358 889 adult patients were registered in sample practices, with continuous (12-month) health care 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/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): 9.32; 95% Confidence Interval: 8.83 to 9.84; compared to 18–39-year-olds). Much smaller AORs were found for ethnicity, social deprivation, gender 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.