Background & Aims

Chronic pain is highly prevalent worldwide, however its environmental risk factors are either ignored or poorly understood in the prevention and management of pain. Environmental health addresses all the physical, chemical and biological factors external to a person, and the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics (WHO, Environmental Health. 2015). Identification of environmental risk factors may largely contribute to the reduction of chronic pain duration, severity and subsequently lead to its prevention. Our study aimed to identify and study environmental risk factors, their prevalence and implications for the management of chronic pain.

Methods

Cross-sectional survey was conducted among outpatients in primary health care institutions. Study enrollment criteria were age >18 and pain history over 3 months duration. Risk factors included smoking, alcohol consumption, obesity (as defined by Cancer Treatment Center of America), lifestyle and social behavior. Semi-structured pain questionnaire was developed and disseminated. Pain severity was assessed by numerical pain scale. Multivariate analysis was conducted. Statistical significance was set up at p<0.05.

Results

Age of the enrolled study subjects ranged from 19 to 80 (95% CI – 42.66+4.9). The vast majority of patients were females. Pain prevalence was 54.2% and vast majority of participants (75%) suffered of chronic pain over 4 years. Environmental factors such as smoking and alcohol consumption appeared to be common in respondents; 35.6% were current smokers, 2.1% – ex-smokers. 66.7% consumed alcohol 3-5 times per week; almost 40% were overweight and 46.8% – followed sedentary style of life. 31% suffered of insomnia and 21.0% experienced stress in everyday life. Prevalence of some environmental factors was significantly higher in subjects with pain than in those without pain; smoking was two times higher (64.0%) in patients with pain than in non-pain subjects (31.6%) (OR=3.9 (CI=1.09 to 13.66), p=0.0368), however alcohol consumption significantly prevailed in subjects without pain (36.8%) than in those with pain (20.8%). Nearly a half of the study subjects were not active physically.

Conclusions

The study showed that prevalence of environmental factors was high among the chronic pain patients. Understanding modifiable environmental risk factors of chronic pain, will contribute to effective pain relief and allow to develop evidence based management and preventive strategy. Given that healthier environments could prevent almost one quarter of the global burden of disease (WHO, Environmental Health. 2015), and that the most recent estimations of global burden of disease have underestimated the contribution of chronic pain (Croft P 2010), based on our study results we consider that the role of environmental modifiable risk factors is inadequately addressed in chronic pain morbidity and management.

References

1.Andrew M. McIntosh, Lynsey S. Hall et al. Genetic and Environmental Risk for Chronic pain and the Contribution of Risk Variants for major depressive disorders: a A Family-Based analysis. PLoS Med:e1002090. – PMC – PubMed, 2016;16.
2.Brennan, P.L., K.K. Schutte, and R.H. and Moos. ” Pain and use of alcohol to manage pain: Prevalence and 3-year outcomes among older problem and non-problem drinkers. Addiction. 2005: 100:777–786.
3.Castillo, R. C., Wegener, S. T. , Heins, S. E., Haythornwaite, J. C., MacKenzie, E. J., & Bosse, M. J. Longitudinal relationships between anxiety, depression, and pain: Results from a two-year cohort of lower extremity trauma patients. Pain, 2013: 08.025.
4.Chadi G Abdallah, Paul Geha. Chronic Pain and Chronic Stress: Two Sides of the Same Coin? Chronic Stress, V.1., 2017: Jan-Dec; 1: 2470547017704763.

Presenting Author

Nanuli Ninashvili

Poster Authors

Nanuli Ninashvili

MD, PhD

Tbilisi State Medical University

Lead Author

Mikheil Shavdia

Tbilisi State Medical University

Lead Author

Khatuna Tchaava

Tbilisi State Medical University

Lead Author

Nino Gegeshidze

Tbilisi State Medical University

Lead Author

Topics

  • Epidemiology