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A World Health Organization Study in Primary Care

Oye Gureje, MBBS, PhD, FWACP; Michael Von Korff, ScD; Gregory E. Simon, MD, MPH; Richard Gater, MRCPsych

JAMA. 1998;280:147-151.

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 is inadequate.

Objective.— To assess the prevalence and impact of persistent pain among primary care patients.

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 interviewed (n=5438).

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.

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.

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