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The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal


In addition to its high frequency and relevant individual and social impact, chronic pain (CP) has been shown to be a major contributor to increased healthcare utilisation, reduced labour productivity, and consequently large direct and indirect costs. In the context of a larger nationwide study, we aimed to assess the total annual direct and indirect costs associated with CP in Portugal. A population-based study was conducted in a representative sample of the Portuguese adult population. The 5,094 participants were selected using random digit dialling and contacted by computer-assisted telephone interviews. Questionnaires included the brief pain inventory and pain disability index. Estimates were adequately weighted for the population. From all CP subjects identified, a subsample (n = 562) accepted to participate in this economic study. Mean total annualised costs per CP subject of €1,883.30 were observed, amounting to €4,611.69 million nationally, with 42.7 % direct and 57.3 % indirect costs, and corresponding to 2.71 % of the Portuguese annual GDP in 2010. Only socio-demographic variables were significantly and independently associated with CP costs, and not CP severity, raising the possibility of existing inequalities in the distribution of healthcare in Portugal. The high economic impact of CP in Portugal was comprehensively demonstrated. Given the high indirect costs observed, restricting healthcare services is not a rational response to these high societal costs; instead improving the quality of CP prevention and management is recommended.

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We are most grateful to all the people who accepted to participate in this study for their support, time, and patience. We also thank all the interviewers who participated in the data collection process for their commitment and professionalism—Ana Alexandra Fonseca Vilela, Ana Cláudia Monteiro Grijó, Ana Sofia Soares Teixeira, Carla Rolanda Caetano Cid, Cláudia Marisa Neves Valente, Ema Cristina Ribeiro Fernandes Loja, João Tiago Ribeiro Machado Pimentel, Manuela Antónia Alves Marques de Oliveira, Patrícia Rosa Sousa Alves, Renata dos Santos Serra, and Teresa da Felicidade Vieira Quintas Ferreira.

Conflict of interest statements

This work was financially supported by equal unrestricted research grants from the Portuguese local offices of Grünenthal, Pfizer, and Janssen-Cilag and support obtained through a protocol established between the Faculty of Medicine, University of Porto, and the Directorate-General of Health (Direcção Geral de Saúde, DGS) and the Central Administration of the National Health System (Administração Central do Sistema de Saúde, ACSS) of the Portuguese Ministry of Health (Ministério da Saúde) as part of the National Program for Pain Control (Programa Nacional de Controlo da Dor). The sponsors did not participate in the design or conduct of this study; in the collection, management, analysis, or interpretation of data; or in the preparation, review, approval, or decision to submit this manuscript for publication. The authors are fully responsible for the contents of the manuscript and further declare that they have no conflict of interests.

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Correspondence to Luís Filipe Azevedo.

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Figure 1S. Flow chart of study subject selection and participation. (Supplementary material).

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Azevedo, L.F., Costa-Pereira, A., Mendonça, L. et al. The economic impact of chronic pain: a nationwide population-based cost-of-illness study in Portugal. Eur J Health Econ 17, 87–98 (2016).

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  • Chronic pain
  • Costs
  • Productivity
  • Cost of illness
  • Economic impact

JEL Classification

  • I10
  • I14
  • I18