To the Editor: The socioeconomic impact of chronic pain is now recognized as a major problem in many countries.1–4 Similar to chronic low back pain,5 rehabilitation and return to work are also important aspects of the management of patients with chronic pain. However, few data are available concerning the impact of chronic pain, apart from low back pain, on the work status of these patients. The objective of this study was, therefore, to describe the work status of a population of chronic pain patients of working age based on a French national cross-sectional survey.
A French national survey was conducted in 2008 by the Haute Autorité de la Santé (French National Authority for Health) at the initiative of the Société Française d’Etude et du Traitement de la Douleur (French branch of the International Association for the Study of Pain). All 288 units, centers or clinics specialized in the management of chronic pain in France were invited to participate in the survey and 180 effectively participated (62.5%). All new patients attending these structures completed a questionnaire concerning their sociodemographic characteristics and socioeconomic status more than a 2-week period in February 2008. The study presented here only concerns patients of working age (18 to 65 years) and excluded those patients for whom the questionnaire was not completed. Socioeconomic status was described. Working patients (students, employed, or seeking employment) were compared with those on sick leave (covered by French national health insurance or by workers’ compensation) by univariate and multivariate analyses (logistic model).
Of the 2896 patients included in the survey, 2148 were of working age (74.2%), and 173 were excluded due to missing questionnaires (8.1%). The final sample of 1975 patients presented a marked female predominance (N = 1328, 67.2%), with a mean age of 46.3 years (±11.0). The main presenting complaints (proportion >10%) were low back pain (N = 391, 19.8%), headache or facial pain (N = 375, 19.8%), neuropathic pain (N = 283, 14.3%), and fibromyalgia (N = 31, 11.7%). Analysis of work status (missing data in 156 cases, 7.9%) showed that 787 patients (43.3%) were employed at the time of the study (including 53 students), 121 were seeking employment (6.7%), 469 were on sick leave (23.8%, with a mean duration of 13.1 month ± 10.7, a median of 12 months and a range of 1 to 78 months) and 442 were retired or on an invalid pension. The mean duration of sick leave was similar for patients covered by workers’ compensation (14.4 months ± 11.0) and those covered by national health insurance (12.5 ± 10.6%, P > 0.05). Multivariate comparison of patients able to work and those on sick leave revealed a significant effect of age, chronic disease health insurance cover and type of pain: patients with cancer pain were more likely to be on sick leave than patients with low back pain (references), no difference was observed for other types of rheumatologic pain, multiple pain or other types of pain, and a protective effect in relation to sick leave for facial pain, visceral pain, or headache combined.
This study illustrates the large proportion of chronic pain patients of working age and the high rate of sick leave with possible social and work implications. More detailed studies on potential responses are necessary to refine these results and to evaluate the impact of socio-occupational management of these patients.
The authors thank all members of the 180 pain clinics that participated in the study, members of the SFETD for organization and funding, and the HAS team, which participated in data processing.
This study was supported by the Société Française d’Etude et du Traitement de la Douleur (French branch of the International Association for the Study of Pain).
Alexis Descatha, MD
UVSQ-AP-HP, Occupational Health Department
Poincaré University Hospital
INSERM, U687, Villejuif
UVSQ, Faculté de Médecine
Guillermo Jasso-Mosqueda, MD
Anne-Line Couillerot, MD
Catherine Rumeau-Pichon, MD
HAS (French National Authority for Health)
Service de l’Evaluation Médicale
Economique et Santé Publique, Saint-Denis, France
Anna Ozguler, MD
INSERM, U687, Villejuif
UVSQ, Faculté de Médecine
Jean Bruxelle, MD
AP-HP-Université Paris René Descartes
CETD, Hôpital Cochin
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