|Year : 2015 | Volume
| Issue : 1 | Page : 36-40
Prevalence of pain among rural adults seeking medical care through medical camps in Tamil Nadu
Logaraj Muthunarayanan, Balaji Ramraj, John Kamala Russel
Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India
|Date of Web Publication||1-Dec-2014|
Department of Community Medicine, SRM Medical College Hospital and Research Centre, Kattankulathur - 603 203, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: One of the most common complaints of the patient seeking medical care is pain, and it has been recognized by the World Health Organization as a problem of global importance. Objectives: The aim was to estimate the prevalence of pain among people above the age of 40 years, to identify the common sites of pain complaints and to study the association of body mass index (BMI) with musculoskeletal pains. Materials and Methods: A cross-sectional study was carried out among 1246 participants through our weekly medical camp in 12 villages of Kattankulathur block in Kancheepuram District of Tamil Nadu from August 2013 to October 2013. Individuals over the age of 40 years who had attended our medical camp with complaint of pain (intermittent or continuous) for 1 month or longer were included in the study. Descriptive data were presented as measures of central tendency and dispersion. Chi-square test was used for analyzes of categorical variables. Results: Nearly 51.1% of the respondents reported some form of pain. The prevalent sites of pain include knee pain (18.6%), low back pain (8.9%), generalized body pain (7.8%), multiple joint pain (4.9%) and pain in the legs (2.7%). Prevalence of musculoskeletal pain in men and women were 32.7% and 53.7%, respectively. Respondents with BMI more than 25 are at higher risk of suffering from knee pain, hip pain, low back pain and leg pain and it was found statistically significant for Knee pain and low back pain. Conclusion: An appropriate strategy and guidelines have to be developed to manage the problem of pain among above 40 years age group at primary care level of the rural communities in India.
Keywords: Musculoskeletal pain, prevalence of pain, rural adults, site of pain
|How to cite this article:|
Muthunarayanan L, Ramraj B, Russel JK. Prevalence of pain among rural adults seeking medical care through medical camps in Tamil Nadu. Indian J Pain 2015;29:36-40
|How to cite this URL:|
Muthunarayanan L, Ramraj B, Russel JK. Prevalence of pain among rural adults seeking medical care through medical camps in Tamil Nadu. Indian J Pain [serial online] 2015 [cited 2019 Dec 7];29:36-40. Available from: http://www.indianjpain.org/text.asp?2015/29/1/36/145944
| Introduction|| |
One of the most common complaint of the patient seeking medical care is pain, and it has been recognized by the World Health Organization (WHO) as a problem of global importance.  Globally, it has been estimated 1 in 5 adults suffer from pain and another 1 in 10 adults are diagnosed with chronic pain each year.  Pain is a universal phenomenon affecting all population irrespective of age, sex, race and geographical area. Pain may be acute, chronic or intermittent affecting one's day to day life. Chronic pain has a significant impact on individual's normal sleep, performance of household and other social activities, depression, sexual relations, strained relationship with family and friends and carry great economic cost (both direct and indirect). Not many studies have been done in Indian rural population of Tamil Nadu. Community oriented program from the control of rheumatic diseases, a global initiative of the WHO/International League of Associations from Rheumatology, was done among rural western India. , The main objectives of this study was to estimate the prevalence of pain among people above the age of 40 years, to identify the common sites of pain complaints and to study the association of body mass index (BMI) with musculoskeletal pains.
| Materials and Methods|| |
A cross-sectional study was carried out among 1246 participants through our weekly medical camp conducted in 12 villages selected conveniently in the rural field practice area, attached to the Department of Community Medicine, of Kattankulathur block in Kancheepuram District of Tamil Nadu from August 2013 to October 2013. Individuals over the age of 40 years who had attended our medical camp with complain of pain (intermittent or continuous) for 1 month or longer were included in the study. All patients with acute, chronic and intermittent pain were included in the study. Pain includes musculoskeletal pain like low back pain, shoulder pain, neck pain, osteoarthritis pains such as knee pain and hip pain, etc. Other pains include pain in the legs, upper abdominal and lower abdominal pain, pain in eyes, ear and throat and headache. Patients with pain associated with trauma or injury were excluded from the study. The study was approved by the Institutional Ethics Committee. Data were entered on Microsoft Excel spread sheet and analyzed using standard statistical software packages. Descriptive data were presented as measures of central tendency and dispersion. Chi-square test was used for analyzes of categorical variables.
| Results|| |
A total of 1264 participants over the age of 40 years formed the study population with a mean age being 54.56 years (standard deviation ±11.17). [Table 1] depicts the sex distribution of the study population comprising 76.3% (964) women and 23.7% (300) men. About 38.6% of them were in the age group of 40-49 years, followed by 50-59 years (25.9%) and 60-69 years (22.5%).
The overall prevalence of pain was 37% among men and 55.5% among women. [Table 2] depicts the main site of pain among men and women. Nearly 51.1% of the respondents presented with some form of pain. Knee pain (18.6%), low back pain (8.9%), generalized body pain (7.8%), multiple joint pain (4.9%) and pain in the legs (2.7%) were more prevalent. Women complained pain commonly over the following sites (knee pain 19.7%, low back pain 10.3%, generalized body pain 8.6%, multiple joint pain 5.6% and pain in the legs 3.1%) whereas they were less common among men (knee pain 15%, generalized body pain 5.3%, low back pain 4.7%, multiple joint pain 2.6% and pain in the legs 1.3%). The epigastric pain was more in men (2.9%) compared to women (2.2%). Other pains like shoulder pain, hip pain and neck pain were more in women (2.2%, 2.1% and 2.1%) compared to men (1.6%, 0.3% and 0.7%) respectively.
[Figure 1] and [Figure 2] depict the prevalence of musculoskeletal pain in men and women. 53.7%(518/964) of women had complained of musculoskeletal pain compared to men with 32.7%(98/300) (musculoskeletal pain). The proportion of patients with musculoskeletal pain was high (56.2%) among the age of above 80 years followed by 50-59 years age group with 51.5%.
|Figure 1: Distribution of musculoskeletal and other pains among men and women|
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[Table 3] shows the age distribution and the site of pain. Even though, nearly 56.2% of the study subjects above the age of 80 did not report any symptoms, higher prevalence of knee pain (20.8%), shoulder pain (8.3) and multiple joint pains (6.3%) were reported. Respondents between age group of 40-49 years reported higher prevalence of low back pain (10%), leg pain (4.1%) and headache (4.1%) compared with other age group. The proportion of knee pain was almost similar in the age groups of 50-59 years and above 80 years. Body pain (12.2%) was the most common symptoms reported in the age group of 70-79.
[Table 4] shows the association between BMI and musculoskeletal pain. Respondents with BMI more than 25 are at higher risk of getting knee pain, hip pain, low back pain and leg pain and this was found statistically significant for knee pain (P < 0.0001), hip pain (P = 0.06) and low back pain (P = 0.03).
| Discussion|| |
Nearly half of the patients above the age group of 40 years complained of pain. Dureja et al. in their study through telephonic cross-sectional survey for the evaluation of point prevalence of chronic pain in eight cities and their suburbs across India reported a prevalence of 22% in Chennai.  The main site of pain in our study was in the order of knee, low back, body multiple and leg pain. Dureja et al. in his study reported pain in knee, leg and joints.  Ng et al. in his study in Hong Kong revealed severe chronic pain in 31.9% respondents with headache, back pain, and joint pains being the most common site of pain.  Picavet et al. had shown 44.4% prevalence of musculoskeletal pain, which includes 21.2% low back pain, 15.1% shoulder pain and 14.3% neck pain in the Netherlands. 
The prevalence of pain was 37% among males and 55.5% among females. Johannes et al. had reported a prevalence of chronic pain among US adults as 30.7% and the prevalence was higher for females (34.3%) than males (26.7%) and increased with age.  Thomas et al. reported an overall prevalence of pain above the age of 50 as 66.2% and pain were similar across age with a higher rate in females.  Hasselstrφm et al. reported that little <30% of the patients, who were treated at a primary care practice, had some kind of medically defined pain problem, requiring the attention of the General Practice.  Brattberg et al. had reported prevalence of obvious pain was 50% among males as well as females. Pains in the neck, shoulders, arms, lower back and legs were most frequent.  Minaur et al. reported among Australian community the most common sites of current pain were low back (12.5%), knee (11.2%), and shoulder (8.9%).  Haq et al. reported overall point prevalence of musculoskeleletal pain was 26.3%. The point prevalence estimates of musculoskeletal pain in rural, communities in Bangladesh were 26.2% (women 31.3%, men 21.1%), Most commonly affected sites were low back, knees, hips, and shoulders. 
Zeng et al. reported Rheumatic symptoms were more prevalent in women than in men, and were more frequently seen in the elderly than in young people. The most frequently involved site was a low back followed by the knee and neck.  Dai et al. had reported symptoms occurred more frequently in the following sites: Knee 7.0% (95% CI: 6.4-7.6%), lower back 5.6%, shoulder 4.7%, and neck 2.4%. Women complained of rheumatic symptoms more frequently than men.  Chopra et al. reported among rural Indian population that neck (6%), lumbar (11.4%), shoulder (7.4%), elbow (6.5%), wrist (6.4%), hand (6.1%), knee (13.2%), calf (6.6%), and ankle (6.5%) were the common painful sites. 
In our study, the overall prevalence of knee pain was 18.6% with women 19.7% and men 15%. Chopra et al. had reported a slightly lower prevalence of knee pain (13.2%) among the rural population of India.  Fernandez-Lopez et al. reported 10.2% in Spain. National Health Care Surveys and the National Health Interview Survey in United States reported the knee is the most common site of joint pain regardless of age or gender.  The Burden of Pain among Adults in the United States Findings reports 13% of men and 18% of women showed overcrowding. 
Low back pain
The overall prevalence of low back pain was <10% in our study. Similar findings were reported by Chopra et al. with 11.4% lumbar pain among rural Indian population. In contrast, higher prevalence of LBP was reported by Mathew et al. and Sharma et al. where it was 28.4% and 23% respectively. , The prevalence of low back pain was more in case of women compared to men and was highest in the age group of 40-49 compared to other age group. Similar findings of low back pain being more in women (52.9%) and in the 41-50 age group (46.4%) was reported by Mathew et al.  Carmona et al. had reported prevalence of low back pain as 14.8% among the general population of Spain.  In our study, the prevalence of low back pain was higher in obese individual compared with normal weight (Odds Ratio - 1.5, 95%CI: 1.04-2.26). National Health Care Surveys and the National Health Interview Survey in United States stated that over one-quarter of adults aged 40 years and older report low back pain in the past 3 months. One in 3 older women and 1 in 4 older men report low back pain in the past 3 months. Prevalence increases with body weight-low back pain is reported by about 1 in 5 normal weight adults, 1 in 4 overweight adults, and 1 in 3 obese adults. 
In our study, only 1.7% of subjects reported neck pain with predominance in women (2.1%) than men (0.7%). A higher prevalence of neck pain (6.8%) was reported by Joshi et al. among the rural population in India. 
In our study, < of the rural respondents, one-third of the men and half of the women complained of musculoskeletal pain. The proportion of patients with musculoskeletal pain was high (56.2%) for above the age of 80 years, followed by 50-59 years age group (51.5%). The major musculoskeletal pains were knee pain, low back pain, body pain and multiple joint pain, hip pain, shoulder pain and neck pain. Joshi et al. had reported 1.1% hip pain, 13.7% knee pain and 12.6% low back pain among the rural population in population survey in the Pune region in India.  Haldiya et al. reported 11.6% among the rural population compliant of musculoskeletal pain and the major musculoskeletal pan were joint pain, back pain, joint stiffness and joint swelling with increasing number of musculoskeletal pain as age advances. 
Body mass index and joint pain
In our study, the overall prevalence of Knee pain, hip pain and back pain were 18.6%, 1.6% and 8.9% respectively. And the prevalence of pain for all three sites increased with increasing BMI. Persons with BMI >25 were 2.26, 2.25 and 1.53 odds of higher risk of knee pain, hip pain and low back pain respectively compared with the person with BMI <25. The association between BMI with knee pain and low back pain were statistically significant. Ross et al. reported the overall prevalence of significant knee, hip, and back pain were 21%, 14%, and 22%, respectively. Prevalence estimates increased with increased BMI for all three sites of pain. The relation between BMI and pain prevalence was stronger for knee pain. 
| Conclusion|| |
Our study revealed that nearly 40% of the patients above the age of 40 years attending the mobile clinic in the rural area had some form of pain and it was most commonly attributed to knee pain, low back pain and other musculoskeletal pain. As India is experiencing a demographic transition towards the geriatric population, the burden of pain in the community will be on the rise in the near future. An appropriate strategy and guidelines have to be developed to manage the problem of pain among the age group of above 40 years at primary care level of the rural communities in India.
| References|| |
Gureje O, Von Korff M, Simon GE, Water R. Persistent pain and wellbeing: A World Health Organisation study in primary care. J Am Med Assoc 1998;280:147-51.
Unrelieved pain is a major global healthcare problem. International association for the study of pain. Section 4A. Available from: http://www.iasp-pain.org. [Last cited on 2014 Aug 09].
Chopra A, Saluja M, Patil J, Tandale HS. Pain and disability, perceptions and beliefs of a rural Indian population: A WHO/ILAR/COPCORD study. J Rheumatol 2002;29:614-21.
Joshi VL, Chopra A. Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD Bhigwan model. J Rheumatol 2009;36:614-22.
Dureja GP, Jain PN, Shetty N, Mandal SP, Prabhoo R, Joshi M, et al.
Prevalence of chronic pain, impact on daily life, and treatment practices in India. Pain Pract 2014;14:E51-62.
Ng KF, Tsui SL, Chan WS. Prevalence of chronic pain in Hong Kong adults. Hong Kong Med J 2007;13:28-9.
Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: Prevalences, consequences and risk groups, the DMC(3)-study. Pain 2003;102:167-78.
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: Results of an internet-based survey. J Pain 2010;11:1230-9.
Thomas E, Peat G, Harris L, Wilkie R, Croft PR. The prevalence of pain and pain interference in a general population of older adults: Cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain 2004;110:361-8.
Hasselström J, Liu-Palmgren J, Rasjö-Wrååk G. Prevalence of pain in general practice. Eur J Pain 2002;6:375-85.
Brattberg G, Thorslund M, Wikman A. The prevalence of pain in a general population. The results of a postal survey in a county of Sweden. Pain 1989;37:215-22.
Minaur N, Sawyers S, Parker J, Darmawan J. Rheumatic disease in an Australian Aboriginal community in North Queensland, Australia. A WHO-ILAR COPCORD survey. J Rheumatol 2004;31:965-72.
Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, et al.
Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: A COPCORD study. J Rheumatol 2005;32:348-53.
Zeng QY, Darmawan J, Xiao ZY, Chen SB, Chen R, Lin K, et al.
Risk factors associated with rheumatic complaints: A WHO-ILAR COPCORD study in Shantou, Southeast China. J Rheumatol 2005;32:920-7.
Dai SM, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM. Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: A COPCORD study. J Rheumatol 2003;30:2245-51.
Chopra A, Saluja M, Patil J, Tandale HS. Pain and disability, perceptions and beliefs of a rural Indian population: A WHO-ILAR COPCORD study. WHO-international league of associations for rheumatology. community oriented program for control of rheumatic diseases. J Rheumatol 2002;29:614-21.
Fernandez-Lopez JC, Laffon A, Blanco FJ, Carmona L, Episer Study Group. Prevalence, risk factors, and impact of knee pain suggesting osteoarthritis in Spain. Clin Exp Rheumatol 2008;26:324-32.
The Burden of Pain Among Adults in the United States Findings from the National Health and Nutrition Examination Survey, the National Health Care Surveys, and the National Health Interview Survey. Pfizer Medical Division; 2008. Available from: http://www.pfizer.com/files/products/PF_Pain.pdf. [Last cited on 2014 Aug 11].
Mathew AC, Safar RS, Anithadevi TS, Banu MS, Ravi Shankar SL, Rai BD, et al
. The prevalence and correlates of low back pain in adults: A cross sectional study from Southern India. Int J Med Public Health 2013;3:342-6.
Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in workage adults in rural North India. Indian J Med Sci 2003;57:145-7.
Carmona L, Ballina J, Gabriel R, Laffon A, Episer Study Group. The burden of musculoskeletal diseases in the general population of Spain: Results from a national survey. Ann Rheum Dis 2001;60:1040-5.
Haldiya KR, Mathur ML, Mathur NC, Mathur A. Epidemiology of Musculoskeletal Conditions in India. Dr. S. N. Medical College, Jodhpur Annual Report; 2009-2010.
Andersen RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR. Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obes Res 2003;11:1159-62.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]