Family Practice Vol. 17, No. 4, 352
© Oxford University Press 2000
Chronic pain in primary care
University of Kuopio, Department of Public Health and General Practice, P.O.B. 1627, Fin 70211 Kuopio, Finland.
Smith et al.1 in their recent review on chronic pain in primary care drew attention to the fact that most research on chronic pain has emerged from special clinics rather than from primary care. This consequently limits the validity of the findings.
In 1996, over a 4-week period (1 week in each season), we conducted a national survey in Finland on pain patients in primary health care. We took a representative sample of 25 health centres of all 250 Finnish primary health care centres. Pain was the main reason for 29% of patient visits and, additionally, a secondary reason for a further 11% of the total 5646 patient visits. One-fifth of the pain patients had suffered from pain for >6 months, and three out of every 10 had suffered from pain for at least 3 months. The older the patients were, the more often they complained of continuous or daily pains. One in every four patients 
70 years old complained of continuous pains. According to the ICPC classification, musculoskeletal symptoms were the most common reasons (52%) for seeing a physician due to pain.2
In their article, Smith et al. emphasized the point that chronic pain can have a profound impact on patients' lives, on their sense of self and identity. In our study, we used a modified Nottingham Health Profile instrument to assess the impact of chronic pain on the patients' well-being. Those chronic pain patients who had suffered from pain for >6 months reported deleterious consequences of pain as follows: limitations to physical activities (49%), work (25%), hobbies (16%) and looking after the home (13%). Twenty percent of patients reported sleep disturbances, 4% were distressed, 3% were depressed and 1% reported disturbances in sexual activity as a consequence of the pain. Thus our results demonstrate that chronic pain is a complex problem, and we support the claim of Smith et al. that chronic pain needs to be understood in a multidimensional way if one is to achieve effective management.
We also estimated the economic consequences of pain at the national level. In Finland, with its 5 million inhabitants in 1996, there were more than 4 million visits to primary health care doctors due to pain. The costs of one visit, including doctors' salaries, patients' laboratory tests, X-ray, referrals, pain killers, physical rehabilitation and sick leave, totalled 2470 FMK (412 Ecu) per patient. Public primary health care centres account for two-thirds of the total ambulatory care in Finland. Thus pain plays a major role at a national level, consuming >13 billion FMK (2.2 billion Ecu). That is >3% of the gross national product of Finland.
References
1
Smith BH, Hopton L, Chambers WA. Chronic pain in primary care. Fam Pract 1999; 16: 475–482.
2 Mäntyselkä P. Patient Pain in General Practice. Kuopio: Kuopio University Publications D. Medical Sciences 165, 1998 (in Finnish with English summary).
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