The Pain Divide: a cross-sectional analysis of chronic pain prevalence, pain intensity and opioid utilisation in England.
OBJECTIVES
Our central research question was, in England, are geographical inequalities in opioid use driven by health need (pain)? To answer this question, our study examined: (1) if there are regional inequalities in rates of chronic pain prevalence, pain intensity and opioid utilisation in England; (2) if opioid use and chronic pain are associated after adjusting for individual-level and area-level confounders.


DESIGN
Cross-sectional study design using data from the Health Survey for England 2011.


SETTING
England.


PRIMARY AND SECONDARY OUTCOME MEASURES
Chronic pain prevalence, pain intensity and opioid utilisation.


PARTICIPANTS
Participant data relating to chronic pain prevalence, pain intensity and opioid usage data were obtained at local authority level from the Health Survey for England 2011; in total, 5711 respondents were included in our analysis.


METHODS
Regional and local authority data were mapped, and a generalised linear model was then used to explore the relationships between the data. The model was adjusted to account for area-level and individual-level variables.


RESULTS
There were geographical variations in chronic pain prevalence, pain intensity and opioid utilisation across the English regions-with evidence of a 'pain divide' between the North and the South, whereby people in the North of England more likely to have 'severely limiting' or 'moderately limiting' chronic pain. The intensity of chronic pain was significantly and positively associated with the use of opioid analgesics.


CONCLUSIONS
There are geographical differences in chronic pain prevalence, pain intensity and opioid utilisation across England-with evidence of a 'pain divide'. Given the public health concerns associated with the long-term use of opioid analgesics-and their questionable activity in the management of chronic pain-more guidance is needed to support prescribers in the management of chronic pain, so the initiation of opioids can be avoided.
['Todd|Adam|A|0000-0003-1496-9341', 'Akhter|Nasima|N|', 'Cairns|Joanne-Marie|JM|', 'Kasim|Adetayo|A|', 'Walton|Nick|N|', 'Ellison|Amanda|A|', 'Chazot|Paul|P|', 'Eldabe|Sam|S|', 'Bambra|Clare|C|']
D000328:Adult D000701:Analgesics, Opioid D059350:Chronic Pain D003430:Cross-Sectional Studies D004739:England D005260:Female D054624:Health Status Disparities D054625:Healthcare Disparities D006801:Humans D016014:Linear Models D008297:Male D008875:Middle Aged D010147:Pain Measurement D015995:Prevalence D012720:Severity of Illness Index D012923:Social Class
public health health policy pain management