Chronic Pain Without Clear Etiology in Low- and Middle-Income Countries: A Narrative Review

Abstract

Globally, 8 of the top 12 disabling conditions are related either to chronic pain or to the psychological conditions strongly associated with persistent pain. In this narrative review, we explore the demographic and psychosocial associations with chronic pain exclusively from low- and middle-income countries (LMICs) and compare them with current global data. One hundred nineteen publications in 28 LMICs were identified for review; associations with depression, anxiety, posttraumatic stress, insomnia, disability, gender, age, rural/urban location, education level, income, and additional sites of pain were analyzed for each type of chronic pain without clear etiology. Of the 119 publications reviewed, pain was described in association with disability in 50 publications, female gender in 40 publications, older age in 34 publications, depression in 36 publications, anxiety in 19 publications, and multiple somatic complaints in 13 publications. Women, elderly patients, and workers, especially in low-income and low-education subgroups, were more likely to have pain in multiple sites, mood disorders, and disabilities. In high-income countries, multisite pain without etiology, female gender, and association with mood disturbance and disability may be suggestive of a central sensitization syndrome (CSS). Because each type of prevalent chronic pain without known etiology reviewed had similar associations in LMICs, strategies for assessment and treatment of chronic pain worldwide should consider the possibility of prevalent CSS. Recognition is especially critical in resource-poor areas, because treatment of CSS is vastly different than localized chronic pain.

Prevalence of and factors associated with low Back pain, thoracic spine pain and neck pain in Bashkortostan, Russia: the Ural Eye and Medical Study

“…The findings obtained in our study agree with observations made in previous investigations on other ethnic groups. The lifetime prevalence of low back pain was 54% in our study population of individuals aged 40+ years, which was higher than the prevalence reported in previous investigations of other study populations in other countries [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Urwin and colleagues estimated the frequency of musculoskeletal pain in different anatomical sites in an adult population in general medical practices in the Greater Manchester region in the UK [6].…”

“…To date, information about the prevalence of low back pain and neck pain in Russia and factors associated with the occurrence of low back and neck pain in Russia have been largely missing. In addition, information on the prevalence of low back pain, thoracic spine pain and neck pain have been relatively scarce for all other regions worldwide [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+ cohort

“… 12 , 37 Unlike other research, we did not confirm the association between the number of APSs and income. 34 , 49 , 50 Generally, these observed discrepancies across studies are difficult to interpret and methodological variations with regard to participants/samples and pain site definitions, age range, data analysis, and perhaps geo-linguistic–cultural differences may be responsible. 44 …”

<p>Practical approach to a patient with chronic pain of uncertain etiology in primary care</p>

“…However, depending on the definition, it is estimated that 25–30% of the world’s adult population will suffer from chronic pain during their lifetime 6,16. In general, the prevalence is higher among women, older individuals and those with mental stresses, depression and anxiety 17,18. In a considerable proportion of those with chronic pain, the etiology is uncertain (Box 1).…”