We followed a population-based cohort over a period of 10 years, including incident cases of both exposure and outcome and found a bidirectional relationship between pain and mental illness. Clinicians need to pay attention on both conditions, in patients seeking care due to mental illness or pain.

Context. Fear of pain resonates with most people, in particular, in relation to dying. Despite this, there are still people dying with unrelieved pain.Objectives. We quantified the risk, and investigated risk factors, for dying with unrelieved pain in a nationwide observational cohort study.Methods. Using data from Swedish Register of Palliative Care, we analyzed 161,762 expected deaths during 2011e2015. The investigated risk factors included cause of death, place of death, absence of an end-of-life (EoL) conversation, and lack of contact with pain management expertise. Modified Poisson regression models were fitted to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for dying with unrelieved pain.Results. Unrelieved pain during the final week of life was reported for 25% of the patients with pain, despite prescription of opioids PRN in 97% of cases. Unrelieved pain was common both among patients dying of cancer and of nonmalignant chronic diseases. Statistically significant risk factors for unrelieved pain included hospital death (RR ¼ 1.84, 95% CI 1.79e1.88) compared with dying in specialist palliative care, absence of an EoL conversation (RR ¼ 1.42, 95% CI 1.38e1.45), and dying of cancer in the bones (RR ¼ 1.13, 95% CI 1.08e1.18) or lung (RR ¼ 1.10, 95% CI 1.06e1.13) compared with nonmalignant causes.Conclusion. Despite almost complete prescription of opioids PRN for patients with pain, patients die with unrelieved pain. Health care providers, hospitals in particular, need to focus more on pain in dying patients. An EoL conversation is one achievable intervention. J Pain Symptom Manage 2019;58:784e791. Ó

Background Pain is a common complaint presented in healthcare, but most epidemiological pain research has focused either on single pain conditions or on the adult population. The aim of this study was to investigate the 2017 consultation prevalence of a wide range of pain conditions in the general population of young people. Methods We used the Skåne Healthcare Register, covering prospectively collected data on all healthcare delivered (primary and secondary care) to the population in the region of Skåne, southern Sweden (population 2017 n = 1,344,689). For individuals aged 1–24 in 2017 (n = 373,178), we calculated the consultation prevalence, stratified by sex and age, and the standardised morbidity ratio (SMR) to assess overall healthcare consultation. Results A total of 58,981 (15.8%) individuals consulted at least once for any of the predefined pain conditions. Of these, 13.5% (n = 7,996) consulted four or more times for pain. Abdominal pain, joint pain/myalgia, headache and back/neck pain were the most common complaints. Overall, females had higher consultation prevalence than males: 17.6% versus 14.1% (p < .0001). SMR was 1.82 (95% CI = 1.74–1.87) for females with pain and 1.51 (95% CI = 1.42–1.56) for males with pain. Consultation prevalence increased with age, but this pattern varied between sex and pain condition. Conclusions Among individuals under the age of 25, a significant proportion consult for pain already in early ages, and they also have high healthcare consultation rates for conditions other than pain. The even higher consultation rates among young females need additional attention, both in the clinic and in research. Significance We present comprehensive 1‐year healthcare consultation prevalence data covering all levels of care. A significant proportion of children, adolescents and young adults consult for different pain conditions at multiple occasions warranting greater clinical awareness.