Is chronic pain a distinct diagnosis in primary care? Evidence arising from the Royal College of General Practitioners' Oral Contraception study

Background and Objectives. There is a case for considering chronic pain as a distinct diagnosis in primary care, independent of its cause or body site, to allow development of common management strategies. This study examined the prevalence and factors associated with chronic pain among women still in the Royal College of General Practitioners' Oral Contraception Study, and compared the factors associated with chronic pain arising at different body sites, to examine the support for this case. Methods. A survey of 11 797 women examined the presence and site(s) of chronic pain, and other health factors. Socio-demographic factors, attendance at the family doctor for the pain and self-rated health were examined for their association with any chronic pain and site-specific chronic pain. Results. Thirty-eight percent of women reported any chronic pain, for which most had attended their family doctor. Manual social class, former oral contraceptive use and area of residence were independently associated with any chronic pain. Chronic pain at different sites was associated with different socio-demographic factors, and different proportions of women consulting their family doctor or reporting unfavourable health. These proportions rose with the number of reported sites of chronic pain. Conclusions. The findings confirm the high prevalence of chronic pain and its importance to primary care. They suggest that chronic pain occurrence at different body sites varies across population subgroups, with differences in its impact on health. These differences call into question the independence of a chronic pain diagnosis. However, other factors common to any chronic pain support the development of common management and prevention strategies in primary care, and the variations highlighted will inform the targeting of these. The number of sites of chronic pain may be more important than the actual site(s) in determining its impact.