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Chronic Pain and Health Services Utilization: Is There Overuse of Diagnostic Tests and Inequalities in Nonpharmacologic Treatment Methods Utilization?

Azevedo, Luís Filipe MD*,†,‡; Costa-Pereira, Altamiro MD, PhD*,†,‡; Mendonça, Liliane MSc*,‡; Dias, Cláudia Camila MSc*,†; Castro-Lopes, José M. MD, PhD‡,§,∥

doi: 10.1097/MLR.0b013e3182a53e4e
Original Articles

Background: Few studies have described patterns and determinants of health services utilization (HSU) in chronic pain (CP) subjects. We aimed to describe these, in particular, regarding medical consultations (MCs), diagnostic tests (DTs), pain medicines (PMs) and nonpharmacologic treatment methods (NTM) utilization.

Methods: A cross-sectional nationwide study was conducted in a representative sample of the Portuguese population. The 5094 participants were selected using random digit dialling and were contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population.

Results: Prevalence of CP and CP with moderate to severe disability was 36.7% and 10.8%, respectively. Most CP subjects were being managed/treated by health professionals (81%) and had high levels of HSU. More than half of them had used imaging DT in the previous 6 months. Main factors associated with HSU were as follows: pain-related disability, intensity, duration, and depressive symptoms for MC utilization; sex, pain-related disability, and duration for PM utilization; and education level and depression diagnosis for NTM utilization.

Conclusions: The main drivers behind HSU are pain severity, psychological distress, and socio-economic determinants. An important set of benchmarks are presented regarding HSU in CP subjects, comprising useful tools for public health policy and decision-making. Results presented may suggest possible inequalities in the access to NTM, and interventions to improve access are encouraged. Moreover, possible indirect evidence of imaging DT overuse is presented, and it is recommended that their use in CP subjects should more closely follow existing guidelines.

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*Department of Health Information and Decision Sciences (CIDES), Faculty of Medicine

Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto

Centro Nacional de Observação em Dor (OBSERVDOR – Portuguese National Pain Observatory)

§Department of Experimental Biology, Faculty of Medicine

Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

L.F.A.—Study design, data collection, statistical analysis, and manuscript writing. A.C.-P.—Manuscript writing and revision. L.M.—Data collection. C.C.D.—Data management. J.M.C.-L.—General coordination of the research project, manuscript writing, and revision.

Supported by equal unrestricted research grants from the Portuguese local offices of Grünenthal, Pfizer, and Janssen Cilag. The sponsors did not participate in the design, conduct or publication of this study.

The authors declare no conflict of interest.

Reprints: Luís Filipe Azevedo, MD, Faculdade de Medicina da Universidade do Porto, Departamento de Ciências da Informação e da Decisão (CIDES), Rua Dr. Plácido da Costa, s/n, 4200-319 Porto, Portugal. E-mail:

© 2013 by Lippincott Williams & Wilkins.