Associations of Graded Chronic Non-Cancer Pain Severity With Well-Being and Modifiable Lifestyle Behaviour: Findings From a Danish Population-Based Cross-Sectional Survey

Background

The Graded Chronic Pain Scale-Revised (GCPS-R) framework enables a standardised measure of disease severity and was incorporated into the national disease surveillance in Denmark in 2023. Novel dose–response associations between GCPS-R-systemised disease severity, general health, well-being, and modifiable lifestyle behaviour were analysed to enhance awareness of risk associations related to chronic non-cancer pain disease severity.

Methods

A cross-sectional study including 8329 non-cancer participants aged 16 years and older from the Danish National Health Survey 2023. The participants completed a comprehensive self-reported questionnaire on general health, well-being, and modifiable lifestyle behaviour, including the GCPS-R framework. Multivariate-adjusted odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using logistic regression models for dichotomous outcomes related to general health, well-being, and modifiable lifestyle behaviour adjusted for sex, age, area of residence, BMI, country of origin, education and marital status.

Results

The GCPS-R score had strong positive dose–response associations with odds of poor/fair general health, showing ORs 1.66 (95% CI: 1.32–2.10) in mild-impact, 6.08 (5.02–7.37) in bothersome-impact, and 13.53 (11.53–15.88) in high-impact compared with no chronic non-cancer pain. The GCPS-R score had overall strong positive associations with odds of poor well-being outcomes and moderate positive associations with odds of unhealthy modifiable lifestyle behaviour outcomes concerning illicit drugs, obesity, sedentary lifestyle, unhealthy diet and tobacco.

Conclusions

The GCPS-R framework is applicable in national surveys enabling graded measures for associations related to chronic non-cancer pain disease severity. Unified cross-country strategies for national surveillance could strengthen the evidence base for equitable public health policies.

Significance Statement

Chronic non-cancer pain is a highly prevalent disease associated with elevated risks of several bio- psychosocial health conditions. However, whether risks related to chronic non-cancer pain vary by disease severity is currently unknown. Hellmann et al. found the validated GCPS-R framework useful in national survey-based disease surveillance. The GCPS-R-systemised disease severity measures classified in no, low-impact, bothersome-impact, and high-impact chronic non-cancer pain enabled nuanced knowledge about such risk associations, being a fundamental base in planning targeted healthcare strategies for improved chronic non-cancer pain management.