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Unwanted company

A study of children, adults and the elderly reveals a high rate of chronic pain

Research among Brazilians, not involved in clinical treatment, revealed a high index of chronic pain, similar to that of highly industrialized countries. “The results demonstrate the magnitude of chronic pain among us and confirms that we are speaking of a public health problem”, says professor Cibele de Mattos Pimenta, the coordinator of the survey.

Among adults, a headache is the most frequent with women, a pelvic pain in the youngest and a back pain in people of the lower social economic classes.According to the standard of international studies, the researcher defined as chronic pain as the one that persists for more than six months in one or more locations of the body and can be continuous or recurring (comes and goes). It is different from a sharp pain that comes from a traumatic wound or an acute pathological process and persists until its cure. “Children, adults and the elderly, sufferers from chronic pain,” affirms Cibele, “have their activities and professional lives jeopardized and generally suffer significant loses in the quality of life, well being and personal happiness.”

Evil of the times
What are the causes of the high levels of chronic pain? Although the study didn’t go as far as to ask this question, Cibele suggests: “There are hypothesis that this is related to our present modern life style, with physical inactiveness, stress and a higher intolerance to pain. Nevertheless, it is a problem which could and should be prevented through measures that improve the quality of the work environment, with an efficient health plan destined towards prevention and therapeutic attention, and the definition of basic policies of public health.”

In the United States, the Nuprin Pain Report, published in 1986 in the Clinical Journal of Pain, estimated the loss of US$ 500 million in working days due to chronic pain, amounting to an annual loss of US$ 40 billion. In Europe, it is the most frequent cause of absence of workers aged less than 45 years, and the second reason for medical consultations. According to another study, released in 1992 by the British Journal of General Practice, between 25% and 30% of the population of the industrialized countries have chronic pain, presently classified as the largest public health problem.

A professor at the Nursing School of the São Paulo University (EE-USP), Cibele worked with researchers from the State University of Londrina (UEL) and with post-graduate students from the EE-USP. In order to avoid distortions, only people who had at that time not submitted themselves to treatment of the pain, nor were they linked to the services of the public health network, were included in the study.

The survey covered 1,871 inhabitants of Londrina (PR), a town considered suitable for obtaining representative samples. Chronic pain was found in 28.75% of the 915 children from 7 to 14 years, of those almost 55.51% said that it effected their presence at school and 63.12% their concentration. Among the 505 adults interviewed, whose ages varied from 18 to 60 years, 61.38% had a problem and the majority didn’t miss their work for this reason, but their performance was jeopardized . In the group of the elderly, (451 were interviewed whose ages ranged between 60 and 85 years), 51.4% had chronic pain and 11.5% in more than one location.

A learned pain
The research verified that it is rare for a child to receive preventative treatment for headaches, the most frequent pain. Children of families where someone already had a chronic pain were the most common, even with coincidences in the location of the pain. According to Cibele, this confirmation leads to the hypothesis that they “learn to have pain” and copy adult behavior. It even hints at the influence in the manner of treatment of the complaining child, with medication, greater attention and permission to miss school. Also it might mean the existence of genetic factors.

The examined children went to both public and private schools in Londrina, where there is a high rate of attendance, 95%. They associated headaches to nervousness and agitation, stomach pain to diet, and pains in the legs to physical activities. They also believed that leg pains are triggered off by sleep and consequently could be the so called growing pains that normally occur during the night.

Working day loses
The adults were chosen from employees at the UEL who had permanent work contracts. The majority continued to work even when in pain, a fact that, according to Cibele, accentuates the importance of preventative measures which would improve the quality of life of the worker. Sick Leaves could also occur, burdening the employer and the public health services. In this group, the feelings mostly associated with the problem were irritation, depression and a wish to be alone. On a day to day basis, the pain affected more their mood and sleep.

Clear thinking elderly
Also in the eldest group, selected by way of a pre-study that evaluated their mental condition, chronic pain appeared more among women. Cibele formed a hypothesis. Women suffer more disrespect for their complaints about pain and tend to emphasize them more. Also, the hormone system could be an influence.The research indicated that family and health workers normally play down the pain of the elderly, considering it to be “normal of advanced age”, which, for professor Cibele, appears to be a cultural fact. In general, the elderly person feels to be a “burden” and has less access to the health services than other people.

Within the three groups, there were almost no relationships between recurring pain and sex, age group, social class and the education level of the head of the family. Nevertheless, abdominal pain had itslowest incidence in the age group of 13 to 14 years and recurring pain in the selected population occurred least in the social economic groups D and E where the heads of the family had little or no schooling.

Children, adults and the elderly create their own ideas about the cause of pain. For example, one in four of the elderly associated a back pain to the movement of bending, of getting up or of twisting their trunk. However, there is still not a complete picture to be drawn about this understanding and on the impact of this problem that makes people cancel trips and live successive days in agony.

Incessant suffering

– Chronic pain came up in 28.75% of the 915 interviewed, more in girls (31.5%) than in boys (25.9%).
– The most frequent being headache (15.96%) followed by stomach (6.78%), genitals (6.99%), back (1.97%) and throat (0.76%).
– It is just as common in the age group 10 to 12 years (30.67%) as in the age group 7 to 9 years (30.42%) and less frequent in the age group 13 to 14 years (24.44%).
– It appeared every week in 70% of the children and in 60% of those cases could last for more than an hour.
– It heavily jeopardized the practice of sport (74.9%), play (63%) and outings (58%) and only slightly sleep and videogames.

– The majority (61.38%) of the 505 interviewed told of living with chronic pain, the most frequent being those who work in basic services (76.08%) and the least those holding a position as an executive or a manager (37%).
– In this group it shows itself in the face and mouth (26.73%), the back region, sacrum and coccyx (19.40%), genitals (13.26%), arms and shoulders (8.11%), stomach (7.52%), pelvic region (3.76%), cervical region (3.56%), thoracic region (2.17%) and general (0.79%).
– To control the pain, 60.74% of those surveyed took medication on their own and only 11.8% consulted a doctor.

The elderly
– A little more than half (51.44%) have chronic pain in at least one location. The frequency is greater in women (57.23%) than in men (48.28%).
– A pain in the legs is daily in 42.7% of the elderly and 31.63% also complain of daily pain in the region of the back.
– Those interviewed associate chronic pain to feelings of sadness and depression (28.33%) or anxiety and nervousness (28.87%).
– The aspects of their lives most affected are: sleep (40%), mood (39.07%), leisure (36.74%), appetite (20.93%), sexual activity (18.14%), family life (16.28%) and professional life (10.23%).

The Project
Chronic Pain in Children, Adults and the Elderly: Prevalence, Characterization and the Impact on Daily Life (nº 99/07984-7); Modality Regular line of research assistance; Coordinator Professor Cibele Andrucioli de MattosPimenta – Nursing School of USP; Investment R$ 55,100.00