Open Access Research article

Untying chronic pain: prevalence and societal burden of chronic pain stages in the general population - a cross-sectional survey

Winfried Häuser12, Frederik Wolfe3, Peter Henningsen1, Gabriele Schmutzer4, Elmar Brähler45 and Andreas Hinz4*

Author Affiliations

1 Department of Internal Medicine I, Klinikum Saarbrücken, D-66119 Saarbrücken, Germany

2 Department of Psychosomatic Medicine, Technische Universität München, D- 81675 München, Germany

3 National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, KS, USA

4 Department of Medical Psychology and Medical Sociology, Universität Leipzig, Ph.-Rosenthal-Str. 55, D-04103 Leipzig, Germany

5 Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, D-55131 Mainz, Germany

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BMC Public Health 2014, 14:352  doi:10.1186/1471-2458-14-352

Published: 13 April 2014



Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys.


A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses.


2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]).


Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.

Chronic pain; Disease load; Social inequality; General population; Cross-sectional survey