Unspecified Pain, Chronic Pain and High-Impact Chronic Pain in Lesotho, Southern Africa: a Population-based Cross-sectional study

Abstract Background. Pain and its associated disorders are among the most common causes of disability and contributors to healthcare costs globally. Pain is understudied in Africa and there are no data on high-impact chronic pain from this region. In a population-based survey in Lesotho, Southern Africa, we assessed the prevalence of unspecified pain, chronic pain and high-impact chronic pain, and their determinants. Method. We conducted a household-based, cross-sectional survey among adults ≥18 years old in 120 randomly sampled villages across Butha Buthe and Mokhotlong districts in Lesotho. Unspecified pain, chronic pain, and high-impact chronic pain were defined as current or recurrent pain regardless of duration; pain on most days of the week lasting for 3 or more months; and chronic pain with restriction of routine activities, respectively. Result. Among the 6039 adults included, the median age was 39 years (interquartile range: 27-58), 3153/6039 (52.2%) were female. Overall, 1194 (19.8%) had unspecified pain (95% confidence interval [CI]: 18.8 – 20.8); 909 (15.1%) had chronic pain (95% CI: 14.2 – 16.0); and 428 (7.1%) had high-impact chronic pain (95% CI: 6.5 – 7.8) corresponding to 47.1% among the participants with chronic pain. Higher age groups were associated with increasing odds of unspecified pain, chronic pain and high-impact chronic pain. Male participants were less likely to have unspecified pain (adjusted odds ratio [aOR], 0.68; 95% CI: 0.56 – 0.82; p < 0.001). There was no association between sex and chronic pain or high-impact chronic pain. Participants living in less wealthy households had higher odds of high-impact chronic pain. Furthermore, high-impact chronic pain was associated with hypertension (aOR, 1.47; 95% CI: 1.14 – 1.90; p = 0.003), diabetes mellitus (aOR, 1.86; 95% CI: 1.27 – 2.74; p = 0.002), moderate to high risk of depression (aOR, 4.93; 95% CI: 2.75 – 8.86; p < 0.001), and moderate to high risk of generalized anxiety disorder (aOR, 2.85; 95% CI: 1.18 – 6.92; p = 0.023). Conclusion. Prevalence of chronic pain, including high impact chronic pain was high in this population-based survey in Lesotho. Its association with further non-communicable chronic conditions, such as hypertension and diabetes, supports the need for health systems to provide integrated chronic care, including the management of chronic pain.