Introduction : Chronic Non Cancer pain is one of the most common causes of mental and physical disabilities , and is the most common reason for seeking medical care. Another important aspect is the elevated public and private costs generated by absence from work, insurance and healthcare. Studies throughout the past 2 decades have shown a large variability of prevalence rates of pain. Since there might not be an effective treatment to relieve chronic pain, harmful effect on all aspects of quality of life is not un-expectable. Chronic Pain is defined by the American Society of the Interventional Pain Physicians as: Pain that persists beyond the usual course of an acute disease or a reasonable time for any injury to heal that is associated with chronic pathologic processes that cause continuous pain or pain at intervals for months or years. In an epidemiologic study in Scotland, the prevalence of significant chronic pain was 14.1% . In another study, among Australian adult population, 17% of men and 20% of women reported daily chronic pain . For chronic pain that interferes with daily life, the corresponding percentages were 11% and 13.5% .Chronic pain is often associated with a reduced sense of well being. Several studies indicated that socio-demographic differences exist among the patients with chronic pain. Gender differences are reported in chronic pain, which indicate that women are more sensitive to painful stimuli than men . Some research also showed significant reduction in QL followed by chronic pain .So, the aiming of this survey was to show how extent chronic non cancer pain affect quality of life of Eastern province Saudi patients by using Arabic version of SF-36 questionnaire .The Short Form (36) Health Survey is a 36-item patient-reported, measure health status and abbreviated variant of it. The SF-36 is commonly used in health economics As a variable in the quality-adjusted life year calculation to determine the cost-effectiveness of a health treatment. The original SF-36 came out from the Medical Outcome Study, MOS, done by the RAND Corporation. Since then a group of researchers from the original study released a commercial version of SF-36 while the original SF-36 is available in public domain license free from RAND.The SF-36 Questionnaire has been translated to different languages and validated by psychometric assessment. The Arabic version is an example.
Methodology: This is a cross-sectional interview based study. This study included 314 patients , who complain from chronic non cancer pain . attending the pain management clinic and rehabilitation center in Dammam Medical Complex . the data collected over period of 3 month (February - March – April) 2015 . Inclusion criteria for this study are: Both gender, age between 16 and 70 years, non cancer pain lasting more than 3 month, pain score of 3/10 or more on numerical rating scale. While exclusion criteria are : age less than 16 or more than 70 years, noncommunicable patients, psycatric patient., pain duration less than 3 month, cancer pain , score less than 3/10 by NRS. All patients were evaluated as face-to-face interview, regarding demographic data (gender, age and educational level), as will as each patient map the site of his pain ,and specify duration of the pain . Patients rate pain severity as worst , average and at its best using NRS . Then Quality of life was assessed by SF-36.. that include eight scales: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional and Mental Health. The score for each scale varies from 0 to 100, and the higher the score the better the quality of life. Two final measures are used: Physical Health and Mental Health.The SF-36 has excellent metric properties (sensitivity, validity and reliability) and has been translated and validated for the Arabic language.
Results :The study comprised of 316 patients attending the pain management clinic of Dammam Medical Complex. Their age ranged from 16 to 70 with an average of 45 years, females were of a higher percent (84%). Duration of pain ranged from one month to 30 years, the average scores for their pain were 3 for minimum pain and 9 for maximum pain experienced and an average of 6 for pain experienced most of the time. Table 1 displays the previous characteristics classified by type of pain.
The overall median score percent of SF-36 dimensions, median ranged from 0% for RP and RE till 62% for SF. The correlation between each item and its hypothesized dimension was higher than the correlations with other SF-36 dimensions. For all dimensions, Cronbach alpha coefficients indicated high internal consistency; Cronbach alpha was lowest for GH (0.532) and VT (0.686) and highest for PF (0.777) and RE (0.813). Ceiling and floor effects were well below the cutoff of 20% except for RP and RE where flooring was higher than 50%. The median score % of the 8 dimensions of SF 36 survey and the composite physical and mental score % classified by gender, education and type of pain. In general, mental components were of higher scores than physical components. Males were of higher scores than females. Higher educational levels were of higher scores. The median scores did not differ statistically according to the type of pain.
The scores of Sf-36 health survey dimensions decreased with older age, longer duration of pain and higher degrees of pain. It shows that the correlations ranged between weak to intermediate intensity.
Discussion : Entering the studied factors (sex, age education, duration of pain, degrees of pain (minimum, maximum and pain degree most of the time)) into general linear model(MANOVA) with log composite physical and mental scores; only the following factors were found to be significant determinants : higher duration of pain and higher maximum pain score were found to decrease composite physical component of quality of life (p=0.047and p=0.002, respectively), while the older age and higher minimum and maximum pain scores were found to decrease composite mental component of quality of life (p=0.013, p=0.021 and p=0.044, respectively).
Conclusion :Based on our result it could be concluded that chronic non cancer pain in elderly patients with higher minimum and maximum of pain score certainly leads to poor mental component of QL. On the other hand, physical component of QL has poor relation with higher duration of pain and higher maximum pain score .Thus, in order to re-socialize the patients suffering chronic pain and decrease the impact of their pain on their QL, these findings should be considered in any kind of pain relief therapy.
References : Chronic Non-cancer Pain A Sires for Primary Care -- A Report From the Primary care Multiethnic Network (PRIME Net)Robert R. Leverence, MD; Robert L. Williams, MD, MPH; Michael Potter, MD; Douglas Fernald, MA; Mark Unverzagt, MD; Wilson Pace, MD; Bennett Parnes, MD; Elvan Daniels, MD; Betty Skipper, PhD; Robert J.Volk,PhD;AnthonyE.Brown,MD;Robert L.Rhyne,MD Health related quality of life and pain characteristics among Iranian patients suffering non-malignant chronic painSeyed Behnamedin Jameie,1 Narges Sadat ShamsHosseini,2 Atousa Janzadeh,3 Mohammad Sharifi,4 and Mahdie Kerdari5 Med J Islam Repub Iran. 2012 Aug; 26(3): 118–124.