Which Patients With Chronic Pain Do The Primary Care Refers to a Tertiary Hospital in a Developing Country? Experience From a University Hospital

Purpose: The study aimed to profile patients with uncontrolled chronic pain referred from primary care to a tertiary hospital in a developing country, and identify factors associated with pain intensity, interference, and its link with mental health.

Design: Cross-sectional design.

Methods: Data from 906 adult patients with nonmalignant chronic pain during their first visit to the multidisciplinary pain center at the State University of Rio de Janeiro in 2019 were used. The brief pain inventory and the Hospital Anxiety and Depression Scale questionnaire assessed pain intensity, its impact on daily activity, and symptoms of anxiety and depression.

Results: The population was predominantly female (68.8%), over 50 (66.3%), with less than 11 years of education (86.5%), and 75.2% were overweight or obese. Most (81.9%) reported moderate or severe pain, significantly interfering with daily activities (>50%). The lower back was the most commonly affected site. Widespread pain was present in 43.6% of patients. High scores for anxiety (67.4%) and depression (52.2%) were observed. Severe pain was predominantly seen in middle-aged women and individuals with high levels of anxiety and depression.

Conclusion: Patients with uncontrolled chronic pain referred from primary care to a tertiary hospital were predominantly female, overweight or obese, and exhibited a high prevalence of depression and anxiety. Their pain significantly interfered with daily activities.

Clinical implications: The study provides valuable insight into the biopsychosocial characteristics of uncontrolled chronic pain patients in primary care, emphasizing the importance of implementing multidisciplinary approaches to manage chronic pain effectively within primary care settings.