et al., 2022). The World Health Organization has estimated that osteoarthritis affects nearly 10% of men and 18% of women aged >60 years; rheumatoid arthritis affects 0.3–1% of the general population and is more prevalent among women and in developed countries; and low back pain affects nearly everyone at some point in time and about 4–33% of the population at any given point (Veronese et al., 2022). However, the problem is not confined to adults, with an estimated prevalence of chronic pain in children and adolescents of 25% and with a third reporting the pain to be severe. In addition, the impact of chronic pain is expected to increase as the effects of population aging become apparent, and increased levels of obesity and lack of physical activity will increase the prevalence of conditions associated with chronic pain. As it appears, both the incidence and prevalence of pain in the global population at any point in time seem to depend on the interaction among multiple factors. Many of these factors are directly relevant to chronic pain predictions, assessments, management, and prognoses, and others will be important in the attempt to identify new targets for therapeutic intervention (Cruz et al., 2022). Factors popularly classified together in this regard include: Age While there is a paucity of evidence examining chronic pain in children and adolescents, the available literature suggests that older patients have a higher prevalence of chronic pain than younger groups of patients. Advanced age and chronic pain (and its reporting) have a complex interrelationship, whereby multi-morbidity is independently associated with chronic pain (Hawker et al., 2021). With increasing age comes increasing multi-morbidity; the more advanced a patient’s age, the more they are likely to have experienced noxious stimuli or injury that can trigger chronic pain. For example, in people with shingles, those aged 50–54 years have an 8% chance of developing post-herpetic neuralgia, whereas those aged 80–84 years have a 21% chance of its development (Choi et al., 2021). Assessing pain in older patients can be complex, particularly because older adults are often reticent to discuss or disclose the level of their pain. Age-related disease processes, such as cognitive decline and dementia, can make identifying and managing chronic pain more difficult. Also, age-related disease processes, such as cognitive decline and dementia, can make identifying and managing chronic pain more difficult. Characteristics of pain, including duration and severity, area of the body affected, and the number of sites of pain, were found to be indicators for ongoing pain in older women, but these were less relevant in older men. Chronic pain is not limited to older age groups, however. A study from across 42 countries identified that self-reported chronic pain among adolescent populations was common: 20.6% of young people experienced pain in at least two sites of headache, stomach, and backache. Chronic pain affects up to 30% of those aged 18–39 years. Younger age seems to be a risk factor for chronic post-surgical pain. Gender According to the available body of evidence, men are reportedly less likely to report or experience chronic pain than women, and girls are more likely to report pain in multiple sites than boys (Lunde et al., 2022). Several reviews have studied how gender (role) and sex (biological) differences are related to the way men and women experience pain (Windgassen et al., 2022). An early systematic review submitted that women who experience pain are more likely to use maladaptive coping strategies, which predispose them to chronic pain and poorer functional ability. Women have been shown to have
lower pain thresholds and tolerance and are more likely to experience greater intensity and unpleasantness with pain. The evidence also suggests that women have different sensitivities to analgesia. When corrections are made for the prevalence of pain in the different genders, women are more likely to seek treatment for their pain. Multiple pain-related clinical studies from specialist pain clinics have submitted a reporting rate of women that is twice the rate of men. Women also reportedly showed a higher level of pain intensity and higher pain- related disability than men. Although there is insufficient information on the mechanisms behind these sex-specific differences in pain perception and pain prevalence, there is some evidence for the role of estrogens and genetics, including sex-specific differences in the contribution of pain- related genes (Wang et al., 2020). Employment status People who are not in employment because of ill health or disability are more likely to have chronic pain than those who are employed. Occupational risk factors for chronic pain include poor job control, expectations of a return to work (including fear around a recurring injury), lack of work autonomy or the ability to modify work, job satisfaction, and higher perceived level of difficulty of job requirements. Chronic neck and shoulder pain was found to be an independent predictor of chronic pain and related to work stress. Non-manual workers were less likely to report chronic pain than people who hold manual occupations (Suur-Uski et al., 2022). A similar study also demonstrated that chronic pain relates to working status: Chronic pain was present in 78.9% of those who were unemployed, but only in 39.8% of those in paid employment and 42.4% of those in voluntary or unpaid work. This relationship, however, may be bidirectional in that people with chronic pain may be less likely to be at work because of their pain (Sheikhzadeh et al., 2021). The extent of the burden on healthcare from chronic pain has also been related to the education level and socioeconomic level of patients. A score to assess work disability from pain leading to absent days demonstrated that, in both genders, more locations of pain, smoking, less education, and obesity were related to a higher risk of time off work as a result of pain. Ethnicity and cultural background Evidence comparing the incidence and prevalence of pain from different regions of the world suggests that there are substantial and complex ethnic variations in the prevalence and outcomes of pain-related conditions, although the mechanisms behind these remain poorly understood. A report demonstrated how Caucasian patients have been found to experience less pain and less pain-related disability than Black patients. In another survey of 500, 000 people in the UK, those who self-identified as white were less likely to report chronic pain than those reporting Black, Asian, or mixed ethnicity. However, once adjusted for income employment, and adverse life events, the association between self-reported ethnicity and chronic pain was significantly attenuated. The prevalence of chronic pain and its associated disability is greater in developing countries than in developed countries (Verma & Tiwari, 2022). Socioeconomic background Population studies reliably show that the prevalence of chronic pain is inversely related to socioeconomic factors. Those who are socioeconomically deprived are not only more likely to experience chronic pain than people from more affluent areas, but they are also more likely to experience more severe pain and a greater level of pain-related disability. People who have low levels of education, perceived income inequalities, and high levels of neighborhood deprivation are more likely to
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