Researchers Identify Best Data Source for Monitoring Chronic Pain Among Adults in the United States

According to a new review published in the Journal of Pain, the National Health Interview Survey (NHIS) is the best single surveillance source for monitoring chronic pain data in the United States. The NHIS is an annual interview survey that collects household health data representing the U.S. civilian, noninstitutionalized population. The review was conducted by researchers from the Centers for Disease Control and Prevention; the National Center for Complementary and Integrative Health (NCCIH); Kaiser Permanente Washington, Health Research Institute; Oak Ridge Institute for Science and Education; the Office of Pain Policy, National Institutes of Health; and Stanford University School of Medicine.

Monitoring the prevalence of chronic pain and how it is managed is especially important now because the opioid crisis has led to changes in pain treatment. For instance, health care providers are prescribing opioids less often and using new drug and nondrug treatment options instead. These treatment changes could either help or hurt those with pain. 

Researchers evaluated seven possible data sources for chronic pain surveillance in the United States. In addition to the NHIS, the data sources included the Medical Expenditure Panel Survey (MEPS), the National Health and Nutrition Examination Survey (NHANES), and the National Ambulatory Medical Care Survey (NAMCS).

Researchers studied the existing pain questions in the data sources and their inclusion of elements like pain persistence (duration), pain interference (how much pain restricts life or work activities), high-impact chronic pain (a standard that combines pain persistence and interference), pain bothersomeness (severity), body regions experiencing pain, pain management, and self-efficacy (how effectively people manage their pain). The potential for establishing case definitions of pain and pain-related health conditions with the questions was also evaluated. Overall, the researchers considered the following eight areas for each data source: usefulness, simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability. 

Findings showed a variety of pain-related questions that might be used for different aspects of national pain surveillance. The researchers concluded that the NHIS is the best single source of pain surveillance data because its questions are brief, have been tested and shown to be valid, and cover a broad range of pain-related areas important for addressing chronic pain. They noted that the variety of questions in the NHIS also offers the ability to analyze chronic pain across different subgroups of the population, either using the NHIS alone or combined with other data sources.

Some types of chronic pain surveillance are already underway, and now additional surveillance can start with the existing chronic pain questions in the NHIS, according to the researchers. Next steps include refining self-assessment questions and standardizing electronic health record data to a common data model for pain surveillance.