C. Higgins1, S. Sharma2, T. Hales1, I. Bimali2, P.A. Cameron1, B.H. Smith1, L. Colvin1
1University of Dundee, Dundee, United Kingdom, 2Kathmandu University School of Medical Sciences, Department of Physiotherapy, Dhulikhel, Nepal
Background: Chronic pain disproportionately affects people living in low- and middle-income countries (LMICs). Although the burden of chronic pain in these countries is shown to be high, high-quality epidemiological studies are scarce. Current estimates of pain prevalence and burden in one such LMIC, Nepal, are either vicarious or based on small samples using non-validated instruments. Nepal Health Research Council recently identified musculoskeletal pain conditions as a research priority for the first time. With this in mind, there is an urgent need for an improved evidence-base to inform pain service provision in LMICs. Understanding pain epidemiology will help identify the need for evidence-base to inform resource allocation and specialised pain service provision in Nepal.
Purpose: The study aimed to better understand the burden of chronic pain in rural Nepal. Specifically, we aimed to estimate chronic pain prevalence (with and without neuropathic components); pain characteristics; loci of pain; and its sociodemographic and psychological correlates.
Methods: In this cross-sectional study, 530 adult community residents from a rural village in Nepal were interviewed, using a door-to-door survey. Data were collected using a range of reliable and valid Nepali instruments: a specifically-designed screening questionnaire; the Leeds Assessment of Neuropathic Symptoms and Signs; four Patient-Reported Outcome Measurement Information System (PROMIS) Short-Forms (Pain Intensity, Pain Interference, Sleep Disturbance and Depression); the Connor-Davidson Resilience Scale; and the Pain Catastrophizing Scale.
Results: Non-neuropathic chronic pain (Non-NeuP) prevalence was 54%, with a 12% prevalence of neuropathic pain (NeuP; 23% of those with chronic pain). Participants had a median duration of chronic pain of 24 months (Non-NeuP, 24 months; NeuP, 12 months). Thirteen percent of total chronic pain sample had mild pain, 72% had moderate pain, and 15% had severe pain. Chronic pain was associated with older age, being married, religious affiliation (being Hindus), higher-caste based on the social construct (being Brahmin or Chettri), poor educational attainment, and active occupations (e.g., farming). A high prevalence of knee/calf pain (47%) was found, with few associations between this pain locus and a range of sociodemographic (age, lower educational attainment) and clinical characteristics (history of osteoarthritis, depression scores). Other common loci of pain were head (22%), shoulder (19%), and abdomen (12%), followed by low back pain, wrist and hand pain, and elbow pain (6% each).
Conclusion(s): We have shown that chronic pain with and without neuropathic component is highly prevalent in rural Nepal, with particular impact in specific sociodemographic groups. Knee/calf pain was the most common locus of pain.
Implications: Findings can inform the development of pain services, highlight knowledge gaps and direct future research especially in light of newly-identified governmental health research priorities.
Funding, acknowledgements: Global Challenges Research Fund, University of Dundee, Dundee, Scotland, UK.
Keywords: Pain, Chronic pain, Neuropathic pain
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Kathmandu University School of Medical Sciences
Committee: Institutional Research Committee
Ethics number: 121/19
All authors, affiliations and abstracts have been published as submitted.
