The re-evaluation of the measurement of pain in population-based epidemiological studies: The SHAMA study

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BACKGROUND: While many pain patients rely on pain-relieving treatments to manage their pain, pain-related research commonly quantifies pain status using validated questionnaires without taking into account that information. This will lead to an underestimate of the burden of pain in the community. To ensure a more accurate assessment of the prevalence and severity of pain, this study aimed to develop a pain management questionnaire and to assess how much population-based pain estimates change when pain management is considered.

METHODS: This study was a cross-sectional population-based study in Grampian, north-east Scotland. A total of 4600 people, aged 25 years and over, were randomly selected from a population sample frame and sent a questionnaire on pain and pain management. Population estimates of pain were determined twice: with the use of standard pain status questionnaires ('current pain') and with the use of a newly developed enhanced pain status questionnaire to determine patients' estimated pain without pain management ('all pain').

RESULTS: The prevalence of current pain was 50.5% (95% CI = 48.0, 52.9). Of those who reported no current pain, 11.6% (95% CI = 9.4, 13.8) reported that they would have had pain had they not managed their pain. Thus, the all pain prevalence was 56.2% (95% CI = 53.7, 58.7). This difference in prevalence rates was statistically significant (difference = 5.7%; 95% CI = 2.2, 9.2). Likewise, participants' pain severity significantly increased when they estimated their pain without pain management (p < 0.001, Wilcoxon-signed rank test).

CONCLUSIONS: Failure to assess pain management information results in an underestimation of pain prevalence and severity. This should be considered in future epidemiological studies.

SUMMARY POINTS: Pain management information is currently not considered for the assessment of pain in epidemiological population-based studies.Since pain management can affect people's pain status drastically, it is likely that we currently underestimate the true burden of pain in studies assessing pain.Incorporating self-reported pain management information in an epidemiological study of pain led to significantly increased estimates of both pain prevalence and pain severity.It is therefore crucial to collect and take into account people's pain management information in future studies for a more accurate measurement of pain.

Original languageEnglish
Pages (from-to)134-141
Number of pages8
JournalBritish Journal of Pain
Issue number3
Early online date2 Sept 2014
Publication statusPublished - Aug 2015

Bibliographical note

We would like to thank the Institute of Applied Health Sciences (IAHS) at the University of Aberdeen for funding the PhD studentship of E.F
We would like to thank everyone who was involved in the study, including Professor Sir Lewis Ritchie (Director of Public Health, NHS Grampian), John Lemon (University of Aberdeen), Dr Fiona Garton (University of Aberdeen) and the Aberdeen Service User Group. Finally, we would like to acknowledge all data entry clerks (Maxx Livingstone, Rory Macfarlane, Georgia Mannion-Krase and Hazel Reilly) and participants of the study. We would also like to thank the Aberdeen Service Users Group of the Institute of Applied Health Sciences, University of Aberdeen. This study was conceived by G.J.M., G.T.J. and C.M.B. It was planned by all the authors and E.F. conducted the study. E.F. drafted the manuscript and all other authors critically reviewed the manuscript and provided important intellectual content.


  • pain
  • pain prevalence
  • pain severity
  • pain measurement
  • pain treatment use
  • epidemiology


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