ABSTRACT

OBJECTIVE

To examine and map the consequences of chronic pain in adulthood.

METHOD

Documents addressing the impact of chronic pain on the psychological and social spheres of people suffering from chronic pain, published in Spanish and English between 2013 and 2018, were included. Those who addressed pharmacological treatments, chronic pain resulting from surgical interventions or who did not have access to the full text were excluded. Finally, 28 documents from the 485 reviewed were included

RESULTS

Studies show that pain is related to high rates of limitation in daily activities, sleep disorders and anxiety-depression spectrum disorders. People in pain have more problems to get the workday done and to maintain social relationships. Chronic pain is also associated with worse family functioning.

CONCLUSIONS

This review shows that limitations in the ability to perform activities of daily living, sleep, psychological health, social and work resources and family functioning are lines of interest in published articles. However, knowledge gaps are detected in areas such as the influence of having suffered pain in childhood or adolescence, the consequences of non-fulfillment of working hours and gender inequalities.

Adult; Adulthood; Chronic Pain; Cost of disease; Daily Activities; Quality of life; Review

INTRODUCTION

Pain is an unpleasant sensory and emotional experience that acts as a sign of biological alertness in the face of real or potential tissue damage¹1. International Association for the Study of Pain (IASP). Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. 2. ed. Seattle (USA): IASP Press; 1986. . It can be classified according to etiology, anatomical location or duration²2. Blyth FM, Windt DA, Croft PR. Chronic disabling pain. Am J Prev Med. 2017;49(1):98-101. https://doi.org/10.1016/j.amepre.2015.01.008
https://doi.org/10.1016/j.amepre.2015.01... . According to the latter, chronic non-cancer pain (CNCP) persists continuously or intermittently for a period of more than three months and is not associated with cancer processes³3. Campbell G, Darke S, Bruno R, Degenhardt L. The prevalence and correlates of chronic pain and suicidality in a nationally representative sample. Aust N Z J Psychiatry. 2015;49(9):803-11. https://doi.org/10.1177/0004867415569795
https://doi.org/10.1177/0004867415569795... .

CNCP is considered a public health problem that affects 20% to 35% of the world’s population⁴4. Castro A, Gili M, Aguilar JL, Pélaez R, Roca M. Sueño y depresión en una muestra de pacientes con dolor crónico. Rev Soc Esp Dolor. 2014;21(6):299-306. https://doi.org/10.4321/S1134-80462014000600002
https://doi.org/10.4321/S1134-8046201400... , 19% of the European population⁵5. Sola H, Salazar A, Dueñas M, Ojeda B, Failde I. A nationwide cross-sectional study of the impact of chronic pain on an individual´s employment: relationship with the family and the social support. BMJ Open. 2016;6(12):e012246. https://doi.org/10.1136/bmjopen-2016-012246
https://doi.org/10.1136/bmjopen-2016-012... and 17% of the Spanish population⁶6. Cabrera-León A, Rueda M, Cantero-Braojos M. Calibrated prevalence of disabling chronic pain according to different approaches: a face-to-face cross-sectional population-based study in Southern Spain. BMJ Open. 2017;7:e014033. https://doi.org/10.1136/bmjopen-2016-014033
https://doi.org/10.1136/bmjopen-2016-014... . When pain persists for long periods of time, it loses its protective purpose⁷7. Jonsdottir T, Aspelund T, Jonsdottir H, Gunnarsdottir S. The relationship between chronic pain pattern, interference with life and health-related quality of life in a nationwide community sample. Pain Manag Nurs. 2014;15(3):641-51. https://doi.org/10.1016/j.pmn.2013.07.005
https://doi.org/10.1016/j.pmn.2013.07.00... and becomes the result of a complex process in which biological, psychological and sociocultural⁸8. Von Korff M, Dunn KM. Chronic pain reconsidered. Pain. 2008;138(2):267-76. https://doi.org/10.1016/j.pain.2007.12.010
https://doi.org/10.1016/j.pain.2007.12.0... factors interact with each other⁹9. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883-91. https://doi.org/10.1016/j.jpain.2008.05.005
https://doi.org/10.1016/j.jpain.2008.05.... . Several international organizations, such as the European Pain Federation or the International Association for the Study of Pain, consider that a change of perspective in the assessment and treatment of pain is necessary, being addressed as an entity in itself¹⁰10. Torralba A, Miquel A, Darba J. Situación actual del dolor crónico en España: iniciativa “Pain Proposal”. Rev Soc Esp Dolor. 2014;21(1):16-22. https://doi.org/10.4321/S1134-80462014000100003
https://doi.org/10.4321/S1134-8046201400... , in which the family, social and cultural context that the person lives is considered¹¹11. Amaya-Ropero MC, Carrillo-González GM. Apoyo social percibido y afrontamiento en personas con dolor crónico no maligno. Aquichan. 2015;15(4):461-74. https://doi.org/10.5294/aqui.2015.15.4.2
https://doi.org/10.5294/aqui.2015.15.4.2... .

In the last ten years, scientific production on the repercussions of pain has increased. Numerous studies state that the perception and appreciation of CNCP affect sleep¹²12. Reid MC, Williams CS, Gill TM. The relationship between psychological factors and disabling musculoskeletal pain in community-dwelling older persons. J Am Geriatr Soc. 2003;51(8):1092-8. https://doi.org/10.1046/j.1532-5415.2003.51357.x
https://doi.org/10.1046/j.1532-5415.2003... or limitations of daily activity¹³13. Olivares-Crespo ME, Cruzado-Rodríguez JA. Evaluación psicológica del dolor. Clin Salud. 2008 [citado 09 feb 2019];19(3):321-41. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742008000300004
http://scielo.isciii.es/scielo.php?scrip... , but also psychological and social factors such as anxiety, depression¹⁴14. Catalano D, Chan F, Wilson L, Chiu CY, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56(3):200-11. https://doi.org/10.1037/a0024571
https://doi.org/10.1037/a0024571... , self-esteem¹⁵15. Orhurhu VJ, Pittelkow TP, Hooten WM. Prevalence of smoking in adults with chronic pain. Tob Induc Dis. 2015;13(1):15-20. https://doi.org/10.1186/s12971-015-0042-y
https://doi.org/10.1186/s12971-015-0042-... , coping¹⁶16. Manchado-Garabito R, Tamames-Gómez S, López-González M, Mohedano-Macías L, D´Agostino M, Veiga-de Cabo J. Revisiones sistemáticas exploratorias. Med Segur Trab. 2009 [citado 27 ene 2019];55(216):12-19. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0465-546X2009000300002&lng=es
http://scielo.isciii.es/scielo.php?scrip... , resilience¹³13. Olivares-Crespo ME, Cruzado-Rodríguez JA. Evaluación psicológica del dolor. Clin Salud. 2008 [citado 09 feb 2019];19(3):321-41. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742008000300004
http://scielo.isciii.es/scielo.php?scrip... , social and family support⁷7. Jonsdottir T, Aspelund T, Jonsdottir H, Gunnarsdottir S. The relationship between chronic pain pattern, interference with life and health-related quality of life in a nationwide community sample. Pain Manag Nurs. 2014;15(3):641-51. https://doi.org/10.1016/j.pmn.2013.07.005
https://doi.org/10.1016/j.pmn.2013.07.00... and/or use of toxic substances¹⁴14. Catalano D, Chan F, Wilson L, Chiu CY, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56(3):200-11. https://doi.org/10.1037/a0024571
https://doi.org/10.1037/a0024571... .

Therefore, we consider it necessary to know the individual and social consequences that CNCP has on the adult population. For this, we conducted a Scoping Review of the scientific literature. Our goal is to examine and map the consequences of chronic pain in adulthood.

METHODS

The Scoping Review methodology is used to map the scientific literature and detect areas of study that are not sufficiently researched¹⁶16. Manchado-Garabito R, Tamames-Gómez S, López-González M, Mohedano-Macías L, D´Agostino M, Veiga-de Cabo J. Revisiones sistemáticas exploratorias. Med Segur Trab. 2009 [citado 27 ene 2019];55(216):12-19. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0465-546X2009000300002&lng=es
http://scielo.isciii.es/scielo.php?scrip... . To accomplish this, we used the methodological framework proposed by Arksey and O’Malley¹⁷17. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. https://doi.org/10.1080/1364557032000119616
https://doi.org/10.1080/1364557032000119... and the Joanna Briggs Institute Reviewer’s Manual¹⁸18. The Joanna Briggs Institute. Joanna Briggs Institute reviewer’s manual 2015: methodology for JBI scoping reviews. Adelaide (AUS); 2015 [citado 18 dic 2018]. Disponible en: https://joannabriggs.org/assets/docs/sumari/ReviewersManualMethodology-for-JBI-Scoping-Reviews 2015v2.pdf
https://joannabriggs.org/assets/docs/sum... . Although the Scoping Review methodology does not require quality assessment, several authors consider it a strength¹⁹19. Bellomo R, Bagshaw SM. Evidence-based medicine: classifying the evidence from clinical trials: the need to consider other dimensions. Crit Care. 2006;10(5):232. https://doi.org/10.1186/cc5045
https://doi.org/10.1186/cc5045... , as it allows to make recommendations for clinical practice²⁰20. Armstrong R, Hall BJ, Doyle J, Waters E. ‘Scoping the scope’ of a Cochrane review. J Public Health. 2011;33(1):147-50. https://doi.org/10.1093/pubmed/fdr015
https://doi.org/10.1093/pubmed/fdr015... .

In view of these considerations, we assessed the level of evidence (LE) and the degree of recommendation (DR) of the studies included in accordance with the Scottish Intercollegiate Guidelines Network²¹21. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323(7308):334-6. https://doi.org/10.1136/bmj.323.7308.334
https://doi.org/10.1136/bmj.323.7308.334... . In this case, LE and DR scores are related. Thus, for an investigation with NE 1++; 1+ or 1- is considered extremely recommended (DR A); for NE 2++, 2+ or 2- the recommendation rating would be favorable (DR B), and for LE 3 and 4 the degrees of recommendation would be favorable, but not conclusive (DR C), and it is not recommended or disapproved (DR D), respectively.

Databases and research strategy

The search in the literature was performed in four scientific databases (CINAHL, PubMed, Scopus and Web of Science) and in gray literature deposits (Research Repository of the University of Seville IDUS, TESEO, Openthesis, Opengrey, Grey Literature Report, American Pain Society, European Pain Federation, and International Association for the Study of Pain).

They were held between November and December 2018 with the following search strategy: (“chronic pain” OR “persistent pain” OR “long term pain”) and (adult*) AND (impact* OR influenc* OR cause* OR outcome* OR result* OR consequence* OR effect* OR repercussion*).

As inclusion criteria, documents addressing the biopsychosocial consequences of chronic non-cancer pain were considered: 1) documents addressing the biopsychosocial consequences of chronic non-cancer pain; (2) in adults between 18 and 65 years old, not hospitalized; 3) published between 2013 and December 2018 and 4) written in Spanish or English.

Exclusion criteria were: 1) documents dealing with pharmacological treatments; 2) documents that address people with chronic non-cancer pain resulting from neurodegenerative diseases, chronic infectious diseases or cognitive impairment and 3) documents that did not have access to the full text.

Screening

After the removal of duplicate articles in the research, the selection process was performed, evaluating the relevance of the studies identified. This process was performed by two reviewers independently.

In the first phase, reviewers assessed the titles and abstracts found to exclude articles that did not meet the inclusion and exclusion criteria. Later, they reviewed their contents in full text and decided which ones were included in the data extraction phase. In case of disagreement about the inclusion of an article between the two reviewers, it was discussed with the rest of the research team until consensus was reached.

Data extraction and analysis

Team members produced a document that served as a model for the extraction of information from the article to be standardized. In addition, they developed a protocol to systematize the work procedure. Two of the team members independently collected information about each of the articles (authors’ names, year and country of publication, study objective and methodology, sample size and characteristics, intervention, main results obtained and key points). All team members discussed the information in cases of disagreement until consensus was reached.

RESULTS

After the review, 485 articles whose titles met the inclusion criteria were obtained. The search for gray literature produced 60 documents. Once duplicates were removed, 285 titles and abstracts were reviewed using the inclusion and exclusion criteria. Exactly 170 full texts were recovered for screening. After reviewing the full texts, 142 were excluded, because they did not report the theme of the study, remaining 28 documents for analysis ( Figure ). The studies included were classified into four areas based on the effects of chronic pain: activities of daily living (ADL); sleep (S); psychological health (PH) and socio-labor and family consequences (SLFC) ( Table ).

Consequences on everyday activities

Chronic Non-Cancer Pain increases in disability and limitation in daily activities²²22. Akbari F, Dehghani M, Khatibi A, Vervoort T. Incorporating family function into chronic pain disability: the role of catastrophizing. Pain Res Manag. 2016;2016:6838596. https://doi.org/10.1155/2016/6838596
https://doi.org/10.1155/2016/6838596...

23. Inoue S, Kobayashi F, Nishihara M, Arai YC, Ikemoto T, Kawai T, et al. Chronic pain in the Japanese community: prevalence, characteristics and impact on quality of life. PLoS One. 2015;10(6):e0129262. https://doi.org/10.1371/journal.pone.0129262
https://doi.org/10.1371/journal.pone.012...

24. Cabrera-Perona V, Buunk AP, Terol-Cantero MC, Quiles-Marcos Y, Martín-Aragón M. Social comparison processes and catastrophising in fibromyalgia: a path analysis. Psychol Health. 2017;32(6):745-64. https://doi.org/10.1080/08870446.2017.1307370
https://doi.org/10.1080/08870446.2017.13...

25. Kawai K, Kawai AT, Wollan P, Yawn BP. Adverse impacts of chronic pain on health-related quality of life, work productivity, depression and anxiety in a community-based study. Fam Pract. 2017;34(6):656-61. https://doi.org/10.1093/fampra/cmx034
https://doi.org/10.1093/fampra/cmx034... - ²⁶26. Jensen HI, Plesner K, Kvorning N, Krogh BL, Kimper-Karl A. Associations between demographics and health-related quality of life for chronic non-malignant pain patients treated at a multidisciplinary pain centre: a cohort study. Int J Qual Health Care. 2016;28(1):86-91. https://doi.org/10.1093/intqhc/mzv108
https://doi.org/10.1093/intqhc/mzv108... . People tend to avoid activities that cause or increase the severity of pain, leading to a decrease in activity levels compared with healthy people²²22. Akbari F, Dehghani M, Khatibi A, Vervoort T. Incorporating family function into chronic pain disability: the role of catastrophizing. Pain Res Manag. 2016;2016:6838596. https://doi.org/10.1155/2016/6838596
https://doi.org/10.1155/2016/6838596...

23. Inoue S, Kobayashi F, Nishihara M, Arai YC, Ikemoto T, Kawai T, et al. Chronic pain in the Japanese community: prevalence, characteristics and impact on quality of life. PLoS One. 2015;10(6):e0129262. https://doi.org/10.1371/journal.pone.0129262
https://doi.org/10.1371/journal.pone.012... - ²⁴24. Cabrera-Perona V, Buunk AP, Terol-Cantero MC, Quiles-Marcos Y, Martín-Aragón M. Social comparison processes and catastrophising in fibromyalgia: a path analysis. Psychol Health. 2017;32(6):745-64. https://doi.org/10.1080/08870446.2017.1307370
https://doi.org/10.1080/08870446.2017.13... , ²⁷27. Jones JD, Vogelman JS, Luba R, Mumtaz M, Comer SD. Chronic pain and opioid abuse: factors associated with health-related quality of life. Am J Addict. 2017;26(8):815-21. https://doi.org/10.1111/ajad.12637
https://doi.org/10.1111/ajad.12637... . In this sense, when pain interferes with the ability to perform daily activities, people tend to show a negative perception of themselves due to lower physical capacity and misunderstanding of people in their environment²⁸28. Bailly F, Foltz V, Rozenberg S, Fautrel B, Gossec L. The impact of chronic low back pain is partly related to loss of social role: a qualitative study. Joint Bone Spine. 2015;82(6):437-41. https://doi.org/10.1016/j.jbspin.2015.02.019
https://doi.org/10.1016/j.jbspin.2015.02... , a fact that translates into greater catastrophizing in the face of pain²⁹29. Mun CJ, Thummala K, Davis MC, Karoly P, Tennen H, Zautra AJ. Predictors and social consequences of daily pain expectancy among adults with chronic pain. Pain. 2017;158(7):1224-33. https://doi.org/10.1097/j.pain.0000000000000903
https://doi.org/10.1097/j.pain.000000000... . In turn, studies indicate that people with CNCP spend more time sitting and less time standing, and that an increase in physical activity during the afternoon is related to the decrease in activities of daily living in the evening³⁰30. Raijmakers BG, Nieuwenhuizen MG, Beckerman H, Groot S. Differences in the course of daily activity level between persons with and without chronic pain. Am J Phys Med Rehabil. 2015;94(2):101-13. https://doi.org/10.1097/PHM.0000000000000206
https://doi.org/10.1097/PHM.000000000000... .

A less active lifestyle is also associated with persistence and more severe pain levels³¹31. Pitcher MH, Von Korff M, Bushnell MC, Porter L. Prevalence and profile of high-impact chronic pain in the United States. J Pain. 2019;20(2):146-60. https://doi.org/10.1016/j.jpain.2018.07.006
https://doi.org/10.1016/j.jpain.2018.07.... , comorbidity of chronic diseases such as obesity or diabetes³⁰30. Raijmakers BG, Nieuwenhuizen MG, Beckerman H, Groot S. Differences in the course of daily activity level between persons with and without chronic pain. Am J Phys Med Rehabil. 2015;94(2):101-13. https://doi.org/10.1097/PHM.0000000000000206
https://doi.org/10.1097/PHM.000000000000... , ³²32. Ojala T, Häkkinen A, Karppinen J, Sipilä K, Suutama T, Piirainen A. Chronic pain affects the whole person: a phenomenological study. Disabil Rehabil. 2015;37(4):363-71. https://doi.org/10.3109/09638288.2014.923522
https://doi.org/10.3109/09638288.2014.92... , more difficulty in self-care and increased use of health services³³33. McCracken LM, Barker E, Chilcot J. Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. J Behav Med. 2014;37(6):1215-25. https://doi.org/10.1007/s10865-014-9570-9
https://doi.org/10.1007/s10865-014-9570-... .

Consequences of sleep

Sleep problems are a common consequence in people with CNCP²⁹29. Mun CJ, Thummala K, Davis MC, Karoly P, Tennen H, Zautra AJ. Predictors and social consequences of daily pain expectancy among adults with chronic pain. Pain. 2017;158(7):1224-33. https://doi.org/10.1097/j.pain.0000000000000903
https://doi.org/10.1097/j.pain.000000000... . Studies suggest pain management improve sleep quality by up to 14%. The results indicate there is a circular and dynamic interrelation in which pain causes sleep disorders, which, in turn, increase pain intensity³⁴34. Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut YE, et al. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci. 2014;18(17):2475-81.

35. Campbell P, Tang N, McBeth J, Lewis M, Main CJ, Croft PR, et al. The role of sleep problems in the development of depression in those with persistent pain: a prospective cohort study. Sleep. 2013;36(11):1693-8. https://doi.org/10.5665/sleep.3130
https://doi.org/10.5665/sleep.3130... - ³⁶36. Andrews NE, Strong J, Meredith PJ, D´Arrigo RG. Association between physical activity and sleep in adults with chronic pain: a momentary, within-person perspective. Phys Ther. 2014;94(4):499-510. https://doi.org/10.2522/ptj.20130302
https://doi.org/10.2522/ptj.20130302... .

Other studies state that between 50 and 88% of people meet the diagnostic criteria for sleep disorders³⁶36. Andrews NE, Strong J, Meredith PJ, D´Arrigo RG. Association between physical activity and sleep in adults with chronic pain: a momentary, within-person perspective. Phys Ther. 2014;94(4):499-510. https://doi.org/10.2522/ptj.20130302
https://doi.org/10.2522/ptj.20130302... , ³⁷37. Crandford JA, Arnedt TO, Conroy DA, Bohnert KM, Bourque C, Blow FC, et al. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend. 2017;180:227-33.https://doi.org/10.1016/j.drugalcdep.2017.08.017
https://doi.org/10.1016/j.drugalcdep.201... and have abnormal brain activity during sleep³⁸38. Robertson JA, Purple RJ, Cole P, Zaiwalla Z, Wulff K, Pattinson KTS. Sleep disturbance in patients taking opioid medication for chronic back pain. Anaesthesia. 2016;71(11):1296-307. https://doi.org/10.1111/anae.13601
https://doi.org/10.1111/anae.13601... . In a study conducted by Cranford et al.³⁷37. Crandford JA, Arnedt TO, Conroy DA, Bohnert KM, Bourque C, Blow FC, et al. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend. 2017;180:227-33.https://doi.org/10.1016/j.drugalcdep.2017.08.017
https://doi.org/10.1016/j.drugalcdep.201... , it was reported that 30% of the participants had sleep problems every night and/or several times a night. The most common changes are difficulty in starting or maintaining sleep, waking up earlier, having fragmented or no-restorative sleep³⁴34. Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut YE, et al. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci. 2014;18(17):2475-81. , and higher levels of fatigue during the day; more evident symptoms in women than in men³⁸38. Robertson JA, Purple RJ, Cole P, Zaiwalla Z, Wulff K, Pattinson KTS. Sleep disturbance in patients taking opioid medication for chronic back pain. Anaesthesia. 2016;71(11):1296-307. https://doi.org/10.1111/anae.13601
https://doi.org/10.1111/anae.13601... .

Sleep disorders due to CNCP are also related to limitation in performing daily activities and disability³⁴34. Karaman S, Karaman T, Dogru S, Onder Y, Citil R, Bulut YE, et al. Prevalence of sleep disturbance in chronic pain. Eur Rev Med Pharmacol Sci. 2014;18(17):2475-81. . Andrews et al.⁴4. Castro A, Gili M, Aguilar JL, Pélaez R, Roca M. Sueño y depresión en una muestra de pacientes con dolor crónico. Rev Soc Esp Dolor. 2014;21(6):299-306. https://doi.org/10.4321/S1134-80462014000600002
https://doi.org/10.4321/S1134-8046201400... noted that people performing more intense activities during the day suffer more pain and stay awake longer periods at night.

On the other hand, some people resort to using cannabis to improve the quality of their sleep. Cranford et al.³⁷37. Crandford JA, Arnedt TO, Conroy DA, Bohnert KM, Bourque C, Blow FC, et al. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend. 2017;180:227-33.https://doi.org/10.1016/j.drugalcdep.2017.08.017
https://doi.org/10.1016/j.drugalcdep.201... found that 80% of study participants responded to having used cannabis in the last six months to improve the quality of their sleep, showing a positive opinion about them. However, in 65% of cases people have developed cannabis dependence.

Consequences on psychological health

CNCP is associated with suffering from mental illness⁴4. Castro A, Gili M, Aguilar JL, Pélaez R, Roca M. Sueño y depresión en una muestra de pacientes con dolor crónico. Rev Soc Esp Dolor. 2014;21(6):299-306. https://doi.org/10.4321/S1134-80462014000600002
https://doi.org/10.4321/S1134-8046201400... . Different studies have investigated this relationship, finding that mental illnesses are present in 75.3% of cases of pain⁴4. Castro A, Gili M, Aguilar JL, Pélaez R, Roca M. Sueño y depresión en una muestra de pacientes con dolor crónico. Rev Soc Esp Dolor. 2014;21(6):299-306. https://doi.org/10.4321/S1134-80462014000600002
https://doi.org/10.4321/S1134-8046201400... , ¹⁴14. Catalano D, Chan F, Wilson L, Chiu CY, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56(3):200-11. https://doi.org/10.1037/a0024571
https://doi.org/10.1037/a0024571... , and anxiety and depression rates reach 30-40%, being more pronounced in women¹³13. Olivares-Crespo ME, Cruzado-Rodríguez JA. Evaluación psicológica del dolor. Clin Salud. 2008 [citado 09 feb 2019];19(3):321-41. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742008000300004
http://scielo.isciii.es/scielo.php?scrip... . Anxiety and depression cause fear of pain-enhancing activities, generating a spiral of pain, fear and avoidance²⁴24. Cabrera-Perona V, Buunk AP, Terol-Cantero MC, Quiles-Marcos Y, Martín-Aragón M. Social comparison processes and catastrophising in fibromyalgia: a path analysis. Psychol Health. 2017;32(6):745-64. https://doi.org/10.1080/08870446.2017.1307370
https://doi.org/10.1080/08870446.2017.13... , ³⁹39. Wong WS, Chen PP, Yap J, Mak KH, Tam BK, Fielding R. Chronic pain and psychiatric morbidity: a comparison between patients attending specialist orthopedics clinic and multidisciplinary pain clinic. Pain Med. 2011;12(2):246-59. https://doi.org/10.1111/j.1526-4637.2010.01044.x
https://doi.org/10.1111/j.1526-4637.2010...

40. Craner JR, Gilliam WP, Sperry JA. Rumination, magnification, and helplessness: how do different aspects of pain catastrophizing relate to pain severity and functioning? Clin J Pain. 2016;32(12):1028-35. https://doi.org/10.1097/AJP.0000000000000355
https://doi.org/10.1097/AJP.000000000000...

41. Boggero IA, Carlson CR. Somatosensory and affective contributions to emotional, social, and daily functioning in chronic pain patients. Pain Med. 2015;16(2):341-7. https://doi.org/10.1111/pme.12598
https://doi.org/10.1111/pme.12598... - ⁴²42. Altug F, Kavlak E, Kurtca MP, Ünal A, Cavlak U. Comparison of pain intensity, emotional status and disability level in patients with chronic neck and low back pain. J Back Musculoskelet Rehabil. 2015;28(3):505-8. https://doi.org/10.3233/BMR-140548
https://doi.org/10.3233/BMR-140548... .

Several authors highlight the relationship between adaptability and CNCP experiences. Thus, people with higher self-esteem have much less unpleasant pain stimuli, improving the use of coping strategies⁴³43. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison. Clin J Pain. 2014;30(8):713-23. https://doi.org/10.1097/AJP.0000000000000027
https://doi.org/10.1097/AJP.000000000000... , ⁴⁴44. Walker S, Esterhuyse K. Pain severity, coping and satisfaction with life in patients with chronic pain. South African J Anaesth Analg. 2013;19(5):252-6. https://doi.org/10.1080/22201173.2013.10872935
https://doi.org/10.1080/22201173.2013.10... . The findings of El-Shormilisy et al.⁴⁵45. El-Shormilisy N, Strong J, Meredith PJ. Associations among gender, coping patterns and functioning for individuals with chronic pain: a systematic review. Pain Res Manag. 2015;20(1):48-55. https://doi.org/10.1155/2015/490610
https://doi.org/10.1155/2015/490610... suggest that coping is also mediated by sex. Women with CNCP develop fewer adaptation strategies than men, resulting in worse functional outcomes.

On the other hand, the prevalence of suicidal ideation and suicide attempts in the population with CNCP is 20% and 5 to 14%, respectively, twice the general population³3. Campbell G, Darke S, Bruno R, Degenhardt L. The prevalence and correlates of chronic pain and suicidality in a nationally representative sample. Aust N Z J Psychiatry. 2015;49(9):803-11. https://doi.org/10.1177/0004867415569795
https://doi.org/10.1177/0004867415569795... , ⁴⁵45. El-Shormilisy N, Strong J, Meredith PJ. Associations among gender, coping patterns and functioning for individuals with chronic pain: a systematic review. Pain Res Manag. 2015;20(1):48-55. https://doi.org/10.1155/2015/490610
https://doi.org/10.1155/2015/490610... . According to Campbell et al.³3. Campbell G, Darke S, Bruno R, Degenhardt L. The prevalence and correlates of chronic pain and suicidality in a nationally representative sample. Aust N Z J Psychiatry. 2015;49(9):803-11. https://doi.org/10.1177/0004867415569795
https://doi.org/10.1177/0004867415569795... , this relationship may be due to many people who do not reduce the intensity of their pain, despite undergoing lifelong treatment.

The relationship between CNCP and tobacco use is also complex. According to Orhurhu et al.¹⁴14. Catalano D, Chan F, Wilson L, Chiu CY, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56(3):200-11. https://doi.org/10.1037/a0024571
https://doi.org/10.1037/a0024571... , 25.3% of people with CNCP use tobacco, twice the general population. A study by Dirtre et al.⁴⁸48. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013;21(6):443-9. https://doi.org/10.1037/a0034174
https://doi.org/10.1037/a0034174... found that 43% of participants who used tobacco also had CNCP. These people reported tobacco use as an agent who calmed anxiety caused by pain. In this sense, the relationship between CNCP and tobacco use is dynamic. Smokers have higher pain rates, increased number of painful sites and higher levels of anxiety and depression, which would encourage tobacco use¹⁴14. Catalano D, Chan F, Wilson L, Chiu CY, Muller VR. The buffering effect of resilience on depression among individuals with spinal cord injury: a structural equation model. Rehabil Psychol. 2011;56(3):200-11. https://doi.org/10.1037/a0024571
https://doi.org/10.1037/a0024571... , ⁴⁸48. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013;21(6):443-9. https://doi.org/10.1037/a0034174
https://doi.org/10.1037/a0034174... . Thus, pain would strengthen tobacco dependence that results in greater pain⁴⁸48. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013;21(6):443-9. https://doi.org/10.1037/a0034174
https://doi.org/10.1037/a0034174... .

Socio-employment and family consequences

Several studies have shown CNCP causes social isolation, decreased leisure activities and work difficulties²⁰20. Armstrong R, Hall BJ, Doyle J, Waters E. ‘Scoping the scope’ of a Cochrane review. J Public Health. 2011;33(1):147-50. https://doi.org/10.1093/pubmed/fdr015
https://doi.org/10.1093/pubmed/fdr015... , ²³23. Inoue S, Kobayashi F, Nishihara M, Arai YC, Ikemoto T, Kawai T, et al. Chronic pain in the Japanese community: prevalence, characteristics and impact on quality of life. PLoS One. 2015;10(6):e0129262. https://doi.org/10.1371/journal.pone.0129262
https://doi.org/10.1371/journal.pone.012... , ⁴⁷47. Triñanes Y, González-Villar A, Gómez-Perretta C, Carrillo-de la Peña MT. Suicidality in chronic pain: predictors of suicidal ideation in fibromyalgia. Pain Pract. 2015;15(4):323-32. https://doi.org/10.1111/papr.12186
https://doi.org/10.1111/papr.12186... . However, people who have greater social participation may have better health, reduced anxiety, depression and reduced perceived stress²³23. Inoue S, Kobayashi F, Nishihara M, Arai YC, Ikemoto T, Kawai T, et al. Chronic pain in the Japanese community: prevalence, characteristics and impact on quality of life. PLoS One. 2015;10(6):e0129262. https://doi.org/10.1371/journal.pone.0129262
https://doi.org/10.1371/journal.pone.012... , ²⁴24. Cabrera-Perona V, Buunk AP, Terol-Cantero MC, Quiles-Marcos Y, Martín-Aragón M. Social comparison processes and catastrophising in fibromyalgia: a path analysis. Psychol Health. 2017;32(6):745-64. https://doi.org/10.1080/08870446.2017.1307370
https://doi.org/10.1080/08870446.2017.13... . In this sense, El-Shormilisy et al.¹¹11. Amaya-Ropero MC, Carrillo-González GM. Apoyo social percibido y afrontamiento en personas con dolor crónico no maligno. Aquichan. 2015;15(4):461-74. https://doi.org/10.5294/aqui.2015.15.4.2
https://doi.org/10.5294/aqui.2015.15.4.2... , claim that women and men with CNCP are differently related to their social environment. According to this author, women are socialized from an early age to express their emotions and seek social support, and men would be more likely not to do so. This could translate into greater resources to deal with the CNCP in them.

In the field of research, the existence of CNCP poses a great economic burden for the individual and the system. According to Dany et al.⁴⁸48. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013;21(6):443-9. https://doi.org/10.1037/a0034174
https://doi.org/10.1037/a0034174... , most people need to keep working despite the pain, especially in these groups with fewer resources, and they may have less productivity at work.

The family environment of people with CNCP may also be affected²⁴24. Cabrera-Perona V, Buunk AP, Terol-Cantero MC, Quiles-Marcos Y, Martín-Aragón M. Social comparison processes and catastrophising in fibromyalgia: a path analysis. Psychol Health. 2017;32(6):745-64. https://doi.org/10.1080/08870446.2017.1307370
https://doi.org/10.1080/08870446.2017.13... , ⁴⁹49. Wilson AC, Fales JL. Parenting in the context of chronic pain: a controlled study of parents with chronic pain. Clin J Pain. 2015;31(8):689-98. https://doi.org/10.1097/AJP.0000000000000157
https://doi.org/10.1097/AJP.000000000000... , as it impacts the family scope, its functioning, and how its members communicate or resolve conflicts. Reactions from other members can trigger different types of invalid responses, rejection, and/or support²²22. Akbari F, Dehghani M, Khatibi A, Vervoort T. Incorporating family function into chronic pain disability: the role of catastrophizing. Pain Res Manag. 2016;2016:6838596. https://doi.org/10.1155/2016/6838596
https://doi.org/10.1155/2016/6838596... . In this sense, difficulties with the partner contribute to increased depression and anxiety⁵⁰50. Henne E, Morrissey S, Conlon E. An investigation into the relationship between persistent pain, psychological distress and emotional connectedness. Psychol Health Med. 2015;20(6):710-9. https://doi.org/10.1080/13548506.2014.986142
https://doi.org/10.1080/13548506.2014.98... .

Regarding parental relationships, parents model the perceptions and attitudes of their sons and daughters in the face of pain through their own experience, taking as an example the actions and discourses they observe. In turn, pain may affect parents’ ability to complete physical tasks related to creation⁴⁹49. Wilson AC, Fales JL. Parenting in the context of chronic pain: a controlled study of parents with chronic pain. Clin J Pain. 2015;31(8):689-98. https://doi.org/10.1097/AJP.0000000000000157
https://doi.org/10.1097/AJP.000000000000... .

DISCUSSION

The increase in scientific production on chronic pain in adulthood allowed us to characterize aspects of interest and detect new lines of research, despite having this Scoping Review as the main limitation of linguistic bias, since there were no studies published in languages other than Spanish or English.

This review shows the ability to perform activities of daily living, sleep, psychological health, labor socio-economic consequences and family functioning are lines of interest in articles published. However, knowledge gaps are detected in areas such as consequences of work, toxic consumption and gender inequalities.

There is an extensive literature on the impact of CNCP on functional capacity, but comorbidity with other chronic diseases is less known. Butchart et al.⁵¹51. Butchart A, Kerr EA, Heisler M, Piette JD, Krein SL. Experience and management of chronic pain among patients with other complex chronic conditions. Clin J Pain. 2009;25(4):293-8. https://doi.org/10.1097/AJP.0b013e31818bf574
https://doi.org/10.1097/AJP.0b013e31818b... , found that about 30% of people with coronary heart disease and chronic obstructive pulmonary disease (COPD) also suffer pain. Torrance et al.⁵²52. Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality: a cohort record linkage study. Eur J Pain. 2010;14(4):380-6. https://doi.org/10.1016/j.ejpain.2009.07.006
https://doi.org/10.1016/j.ejpain.2009.07... state that comorbidity between chronic pain and one of these two diseases increases by up to three times the probability of dying compared with the population who do not suffer from pain. These authors explain this relationship as a result of the decrease in the daily functioning capacity of people with CNCP. These higher rates of comorbidity, mortality and dependence result in greater use of health services and, therefore, economic expenses, as found by Pitcher et al.³¹31. Pitcher MH, Von Korff M, Bushnell MC, Porter L. Prevalence and profile of high-impact chronic pain in the United States. J Pain. 2019;20(2):146-60. https://doi.org/10.1016/j.jpain.2018.07.006
https://doi.org/10.1016/j.jpain.2018.07.... , in our results. However, few studies produce actual figures on the real economic impact of CNCP. Direct and indirect costs in Europe are estimated at 200 million euros and in the US between US$560 million and US$635 million⁵⁴54. Gaskin DJ, Richard P. The economic costs of pain in the United States. En: Institute of Medicine (US), Committee on Advancing Pain Research, Care, and Education. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2011. p.55-112 .

As to psychological health, numerous authors have found that the condition of mental illness, such as anxiety or depression in people with CNCP, is common. Knowing this relationship is important, because authors such as Rayner et al.⁵⁵55. Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCraken LM. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain. 2016;157(7):1472-9. https://doi.org/10.1097/j.pain.0000000000000542
https://doi.org/10.1097/j.pain.000000000... report that an effective approach and treatment of depression and anxiety in people with CNCP can improve their health by up to 14%, reducing thus functional limitation and impact on health systems. On the other hand, other authors consider this relationship inverse, that is, chronic pain would be one of the first consequences of mental illness⁵⁶56. Boersma K, Linton S. Expectancy, fear and pain in the prediction of chronic pain and disability: a prospective analysis. Eur J Pain. 2006;10(6):551-7. https://doi.org/10.1016/j.ejpain.2005.08.004
https://doi.org/10.1016/j.ejpain.2005.08...

57. Windt D, Croft P, Penninx B. Neck and upper limb pain: more pain is associated with psychological distress and consultation rate in primary care. J Rheumatol. 2002;29(3):564-9

58. Windt D, Kuijpers T, Jellema P, Heijden GJ, Bouter LM. Do psychological factors predict outcome in both low-back pain and shoulder pain? Ann Rheum Dis. 2007;66(3):313-9. https://doi.org/10.1136/ard.2006.053553
https://doi.org/10.1136/ard.2006.053553... - ⁵⁹59. Nijrolder I, Windt D, Horst H. Prediction of outcome in patients presenting with fatigue in primary care. Br J Gen Pract. 2009;59(561):e101-9. https://doi.org/10.3399/bjgp09X420329
https://doi.org/10.3399/bjgp09X420329... . However, for authors such as Von Korff et al.⁶⁰60. Von Korff M, Le Resche L, Dworkin SF. First onset of common pain symptoms: a prospective study of depression as a risk factor. Pain. 1993;55(2):251-8. https://doi.org/10.1016/0304-3959(93)90154-H
https://doi.org/10.1016/0304-3959(93)901... , the temporal relationship between mental illness and CNCP is unclear, it seems to be bidirectional and both act as a positive reinforcement for the other.

People with CNCP have higher rates of tobacco use. In our results, authors such as Catalano et al.¹³13. Olivares-Crespo ME, Cruzado-Rodríguez JA. Evaluación psicológica del dolor. Clin Salud. 2008 [citado 09 feb 2019];19(3):321-41. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-52742008000300004
http://scielo.isciii.es/scielo.php?scrip... and Ditre et al.⁴⁸48. Ditre JW, Zale EL, Kosiba JD, Zvolensky MJ. A pilot study of pain-related anxiety and smoking dependence motives among persons with chronic pain. Exp Clin Psychopharmacol. 2013;21(6):443-9. https://doi.org/10.1037/a0034174
https://doi.org/10.1037/a0034174... affirm that tobacco habit increases the level of pain. However, Shi et al.⁶¹61. Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO. Smoking and pain: pathophysiology and clinical implications. Anesthesiology. 2010;113(4):977-92. https://doi.org/10.1097/ALN.0b013e3181ebdaf9
https://doi.org/10.1097/ALN.0b013e3181eb... observe that this relationship has not been shown, but they insist that depressive symptoms associated with tobacco use can increase pain levels.

No studies on the relationship between chronic pain and alcohol consumption were found. We consider it necessary to conduct research on this subject considering the results obtained by Riley & King⁶²62. Riley JL 3rd, King C. Self-report of alcohol use for pain in a multi-ethnic community sample. J Pain. 2009;10(9):944-52. https://doi.org/10.1016/j.jpain.2009.03.005
https://doi.org/10.1016/j.jpain.2009.03.... in 2009, in which they show that alcohol may be used to relieve pain by its transient analgesic effect. Some results contradict the Danish cohort study by Ekholm et al.⁶³63. Ekholm O, Grønbaek M, Peuckmann V, Sjøgren P. Alcohol and smoking behavior in chronic pain patients: the role of opioids. Eur J Pain. 2009;13(6):606-12. https://doi.org/10.1016/j.ejpain.2008.07.006
https://doi.org/10.1016/j.ejpain.2008.07... , concluding that patients with CNCP are less likely to consume alcohol, but it is risky when mixed with the drug⁶⁴64. Brennan PL, Schutte KK, Moos RH. Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers. Addiction. 2005;100(6):777-86. https://doi.org/10.1111/j.1360-0443.2005.01074.x
https://doi.org/10.1111/j.1360-0443.2005... .

Regarding labor consequences, the loss of work and the economic cost that generates pain are little studied. Yamada et al.⁶⁵65. Yamada K, Matsudaira K, Imano H, Kitamura A, Iso H. Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain. BMJ Open. 2016;25:6(4):e010356. https://doi.org/10.1136/bmjopen-2015-010356
https://doi.org/10.1136/bmjopen-2015-010... claim that people with CNCP may have lower productivity rates, which would be a heavy economic burden. In this sense, Pain Proposal’s results support this statement, adding that 21% of the population with CNCP felt unable to finish their working day, which translates into an impact on the labor market of 2.5 million euros and 52 million of lost working days per year¹⁰10. Torralba A, Miquel A, Darba J. Situación actual del dolor crónico en España: iniciativa “Pain Proposal”. Rev Soc Esp Dolor. 2014;21(1):16-22. https://doi.org/10.4321/S1134-80462014000100003
https://doi.org/10.4321/S1134-8046201400... . They also indicate that in Spain, the average number of days lost due to pain is 16.8 days a year⁶⁶66. Caramés-Álvarez MA, Navarro-Rivera M. Costes del tratamiento del dolor versus su no tratamiento. Aproximación a la realidad de Portugal y España. Dor. 2016,24. [13 mar 2019]. Disponible en: https://www.sedolor.es/download/costes-del-tratamiento-del-dolor-versus-no-tratamiento-aproximacion-la-realidad-portugal-espana/
https://www.sedolor.es/download/costes-d... .

Regarding gender inequalities, research shows that, as in other clinical pathologies, women receive more precarious health care than men⁶⁷67. Hampton SB, Cavalier J, Langford R. The influence of race and gender on pain management: a systematic literature review. P Manag Nurs. 2015;16(6):968-77. https://doi.org/10.1016/j.pmn.2015.06.009
https://doi.org/10.1016/j.pmn.2015.06.00... . Several studies have found great differences in subjective perception of pain or general well-being in women, despite having scores similar to those of men in analytical and radiological data, which may lead us to think that it is devaluing itself with the use of clinical indices that do not reflect the women’s reality. In addition, the authors emphasize the importance of gender analysis in the study of CNCP⁶⁸68. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942-68. https://doi.org/10.1002/jclp.20816
https://doi.org/10.1002/jclp.20816... . In this review, the studies found prevalence data disaggregated by sex, and some, in a transversal way, identify differences in male and female experiences, but do not analyze them from a gender perspective⁶⁹69. Wranker L, Rennemark M, Berglund J, Elmstâhl S. Relationship between pain and Quality of Life Findings from the Swedish National Study on Aging and Care-Blekinge study. Scan J Pain. 2014;5(4):270-275. https://doi.org/10.1016/j.sjpain.2014.05.029
https://doi.org/10.1016/j.sjpain.2014.05... .

REFERENCIAS

Publication Dates

History