Home Medicine Prevalence and characteristics of chronic pain: Experience of Niger
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Prevalence and characteristics of chronic pain: Experience of Niger

  • Hamid Assadeck , Moussa Toudou Daouda EMAIL logo , Fatimata Hassane Djibo , Djibo Douma Maiga and Eric Adehossi Omar
Published/Copyright: October 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 17 Issue 1

Abstract

Introduction

Chronic pain is a major health problem, considered as a disease in its own right. The prevalence of chronic pain is estimated to be between 2% and 40% in adult populations. In Niger, there are no data on chronic pain.

Aims

This study was designed to provide the demographic, clinical and etiological profile of chronic pain in patients from Niger in order to create a database on chronic pain in Niger.

Patients and methods

Our study is prospectively conducted at the department of external consultation of the Hôpital National de Niamey over a period of 10 months from 31 May 2016 to 30 January 2017 collecting all cases of chronic pain. The demographic, clinical and etiological characteristics of all patients were collected and analyzed.

Results

During the period of the study, 1927 patients consulted at the department of external consultation of the Hôpital National de Niamey, among which 411 patients had chronic pain (21.33% [95% CI: 19.53% and 23.13%]). The average age was 48.28 years (±12.84) with 51.6% of patients aged over 50 years. The male sex was predominant (61.8%). The most common sites of chronic pain were legs (25.5%), back (14.4%), neck (13.6%), knees (13.4%) and feet (13.1%). Osteoarthritis was the most common cause of chronic pain (35.5%), followed by herniated disc (22.2%), spondylodiscitis (14.6%) and migraine (4.1%). Significantly patients aged 50-59 years suffered from neck and legs pain (p value < 0.001). Significantly chronic headaches and rheumatoid arthritis were more common in women while osteoarthritis, herniated disc and spondylodiscite were more common in men (p value = 0.001). Significantly osteoarthritis and herniated disc were more common in patients older than 40 years (p value < 0.001).

Conclusion

Our study provides demographic, clinical and etiological data of chronic pain in patients from Niger, and shows that chronic pain is a common reason for consultation in Niger concerning 1 in 5 patients with a high prevalence among men and patients aged over 40 years.

Keywords: Chronic pain; Prevalence; Niger

1 Introduction

Chronic pain is a major health problem, considered as a disease in its own right [1]. It affects mainly women and patients aged over 60 years [2]. The prevalence of chronic pain is estimated to be between 2% and 40% in adult populations [3]. The most common causes of chronic pain are musculoskeletal and joint pathologies (30-40%), neck and back pain (30%), headache and migraine (7%) [4]. In Niger, there are no data on chronic pain.

The purpose of this study is to provide the demographic, clinical and etiological characteristics of chronic pain in patients from Niger in order to create a database in Niger on this pathology.

2 Materials and methods

2.1 Data source

We conducted a prospective and descriptive study over a period of 10 months from May 2016 to January 2017, at the department of external consultation of the Hôpital National de Niamey (HNN), Niger. It is the largest urban and tertiary-care referral centre in Niger. It covers an area of 23120.50 m2 and comprises 36 buildings with a beds capacity of 790. This hospital attracts people from all corners of the country to seek medical care. Ethical approval was obtained from the Institutional Review Committee of this hospital. For the collection of the data, we have crafted a computerized exploitation sheet including the following informations: age, sex, duration of pain, pain site, type of pain, and etiologic diagnosis retained by the physicians.

We considered the pain to be chronic, any pain persistent or recurrent evolving for more than 3 months [5].

2.2 Study population

Our study included 411 patients without age limit according to the following criteria: 1) pain persistent or recurrent evolving for more than 3 months whatever its nature and its site, and 2) patients who consulted at the department of external consultation of the HNN during the period of the study (May 2016 to January 2017). Patients with pain which evolved less than 3 months had not been included in the study as well as those suffering from chronic pain with cancer. For each patient, we collected the following information: age, sex, duration of pain, pain site, type of pain, and etiologic diagnosis retained by the physicians.

2.3 Statistical analysis

In the descriptive analysis of the data, patient characteristics were expressed as percentages for the qualitative variables and mean ± standard deviation for the quantitative variables. The Chi- square test of Pearson was used to compare the variables. p value was considered statistically significant at p < 0.05. All data were analyzed by using SPSS software version 20.0 for Windows (SPSS Inc, Chicago, IL, USA).

3 Results

During the period of the study, 1927 patients were received at the department of external consultation of the HNN for various symptoms, among which 411 patients had chronic pain with a prevalence of 21.33% [95% CI: 19.53% and 23.13%]. We noted a male predominance (61.8%, 95% CI: 59.4% and 64.2%) with a sex ratio at 1.62 (Table 1). The average age of the patients was 48.28 years (±12.84) with 55.5% (95% CI: 50.7% and 60.3%) of the patients aged 40-59 years. The most common sites of chronic pain were legs (25.5%), back (14.4%), neck (13.6%), knees (13.4%) and feet (13.1%) (Table 1). Peripheral neuropathic pain was the most common (49.5%), followed by musculoskeletal pain (42.3%), orofacial pain and headache (7.5%) and central neuropathic pain (0.7%) (Table 2). Among the peripheral neuropathic pain, lum- bosciatic and cervicobrachial neuralgia were the most common in 35% and 11.4% respectively which are secondary to a herniated disc or spondylodiscitis or osteoarthritis. Osteoarthritis was the most common cause of chronic pain (35.5%), followed by herniated disc (22.2%), spondylodiscitis (14.6%) and migraine (4.1%) (Table 2). Significantly patients aged 50 to 59 years suffered from neck pain and legs pain (p value <0.001) (Table 3). There was no significant difference between the sexes in the pain site (p value 0.567) and in the type of pain (p value = 0.076). Significantly chronic headaches and rheumatoid arthritis were more common in women (p value = 0.001) while osteoarthritis, herniated disc and spondylodiscitis were more common in men (Table 4). Significantly arthritis and migraine were more common in patients less than 40 years of age (p< 0.001) (Table 3). Osteoarthritis and herniated disc were common in patients over the age of 40 years. Significantly neuropathic pain was more common in patients over 50 years of age, while musculoskeletal pain and headache and orofacial pain were more common in patients less than 50 years of age (p value = 0.005) (Table 3).

Table 1

demographic and clinical characteristics ofthe patients (n - 411).

Variables Values
Sex Females 38.2% (95% CI: 33.5% and 42.9%)
Males 61.8% (95% CI: 59.4% and 64.2%)
Sex ratio (males/females) 1.62
Age (years) Average 48.28± 12.84
Median 50
Average/female 46.29± 12.2
Average/male 49.51 ± 13.1
8-18 2.4%
19-29 5.6%
30-39 13.4%
40-49 27%
50-59 28.5%
≥60 23.1%
Pain site Neck 13.6%
Elbow 0.7%
Back 14.4%
Shoulder 1.2%
Knee 13.4%
Leg 25.5%
Jaw 0.2%
Hand 8.3%
Muscle 1.2%
Foot 13.1%
Head 7.5%
Chest 0.7%

Table 2

etiologies and types of pain.

Etiologies ofpain Values
Arthritis Knee 1.3% 1.5%
Temporomandibular joint 0.2
Osteoarthritis Cervical 9.7% 35.5%
Elbow 0.2%
Shoulder 0.2%
Knee 8.8%
Lumbar 16.5%
Chronic headaches 1%
Sickle cell anaemia 1.9%
Herniated disc Cervical 2.7% 22.2%
Lumbar 19.5%
Thalamic ischaemia 0.7%
Migraine 4.1%
Myositis 1.2%
Post-zosteral neuralgia 0.7%
Trigeminal neuralgia 2.4%
Ankylosing polyarthritis 1%
Rheumatoid arthritis 2.7%
Diabetic polyneuropathy 1.7%
Spondylodiscitis Cervical 2.2% 14.6%
Dorsal 1%
Lumbar 11.4%
Carpal tunnel syndrome 0.7%
Tendinitis Elbow 0.5% 1.5%
Shoulder 1%
Other 6.6%
Types of pain
Musculoskeletal Tendinitis 42.3%
pain Rheumatoid arthritis
Ankylosing polyarthritis
Myositis
Osteoarthritis
Spondylodiscitis
Arthritis
Other
Peripheral Diabetic polyneuropathy 49.5%
neuropathic pain Carpal tunnel syndrome Post-zosteral neuralgia Lumbosciatic (35%) Cervicobrachial neuralgia (11.4%)
Central neuropathic pain Thalamic ischaemia 0.7%
Headaches and Migraine 7.5%
orofacial pains Chronic headaches Trigeminal neuralgia

Table 3

Sites, etiologies and types of pain by age groups.

Variables Age groups (years) p value
8-18 19-29 30-39 40-49 50-59 ≥60
Pain site
Neck 1 4 9 13 20 9 <0.001
Elbow 0 0 0 1 2 0
Back 1 4 12 18 15 9
Shoulder 0 0 0 1 3 1
Knee 6 4 2 15 10 18
Leg 0 2 7 19 43 34
Jaw 0 0 0 0 0 1
Hand 0 2 3 12 8 9
Muscle 0 1 2 1 1 0
Foot 0 3 13 25 5 8
Head 1 5 5 6 9 5
Chest 1 0 0 0 1 1
Etiologies of pain
Arthritis 2 2 1 0 0 1 <0.001
Osteoarthritis 0 0 15 41 45 45
Chronic headaches 0 0 0 0 4 0
Sickle cell anaemia 4 4 0 0 0 0
Herniated disc 0 1 0 20 40 30
Thalamic ischaemia 0 0 0 0 0 3
Migraine 1 5 5 3 2 1
Myositis 0 1 2 1 1 0
Post-zosteral neuralgia 1 0 0 0 1 1
Trigeminal neuralgia 0 0 0 3 3 4
Rheumatoid arthritis 0 0 2 4 2 3
Ankylosing polyarthritis 0 0 1 2 1 0
Diabetic polyneuropathy 0 0 1 0 2 4
Spondylodiscitis 1 10 18 17 11 3
Carpal tunnel syndrome 0 0 0 2 1 0
Tendinitis 0 0 0 2 4 0
Other 1 0 10 16 0 0
Types of pain
Headaches and orofacial pains 1 5 5 6 9 5 0.005
Musculoskeletal pain 8 11 28 50 40 36
Central neuropathic pain 0 0 0 0 0 3
Peripheral neuropathic pain 1 7 22 55 68 51

Table 4

Sites, types and etiologies of pain by sex.

Variables Sex p value
Males Females
Pain site
Neck 37 19 0.567
Elbow 3 0
Back 34 25
Shoulder 4 1
Knee 33 22
Leg 66 39
Jaw 1 0
Hand 21 13
Muscle 2 3
Foot 35 19
Head 15 16
Chest 3 0
Types of pain
Headaches and orofacial pains 15 16 0.076
Musculoskeletal pain 99 74
Central neuropathic pain 2 1
Peripheral neuropathic pain 138 66
Etiologies of pain
Arthritis 3 3 0.001
Osteoarthritis 91 55
Chronic headaches 0 4
Sickle cell anaemia 5 3
Herniated disc 66 25
Thalamic ischaemia 2 1
Migraine 9 8
Myositis 2 3
Post-zosteral neuralgia 3 0
Trigeminal neuralgia 6 4
Rheumatoid arthritis 0 11
Ankylosing polyarthritis 3 1
Diabetic polyneuropathy 5 2
Spondylodiscitis 33 27
Carpal tunnel syndrome 2 1
Tendinitis 6 0
Other 18 9

4 Discussion

In this prospective and descriptive study of 411 patients with chronic pain collected at the department of external consultation of the HNN over a period of 10 months from May 2016 to January 2017, we described the demographic, clinical and etiological characteristics of chronic pain In Niger. No study has been published previously by Niger on chronic pain to report on the demographic, clinical and etiological features of this pathology in Niger. Thus, we realized this study with the aim of creating a database on chronic pain in Niger. At the end of this study, the prevalence of chronic pain in Niger was 21.33%. We found a predominance of the sex male (61.8%), patients aged over 40 years (78.6%), and neuropathic pain (50.2%). Legs, back, neck, knees and feet were the most common seats of chronic pain.

A major health problem, chronic pain is a frequent reason for consultation. In our study, the prevalence of chronic pain was 21.33% corresponding to 1 in 5 patients received in consultation. According to the studies and method of recruitment of patients, the prevalence of chronic pain varies from less than 1 to 82% [2,3,4,6,7]. Several studies suggest that female sex is a major risk factor for chronic pain [2,4,6,8,9,10,11], while in our study the male sex was predominant (61.8%). Studies had shown that age is also a risk factor for chronic pain. Thus, Wong et al. [6] reported a peak of chronic pain in patients aged 40-49 years and then it decreases after 50 years. In our study, we found a peak of pain in patients aged 50-59 years and then it decreases after 60 years. Our result is similar to that reported by Hardt et al. [12] who reported a peak of chronic pain between 50 and 59 years, and then it declines after 60 years.

In our study, the most common pain sites were legs (25.5%), back (14.4%), neck (13.6%), knees (13.4%) and feet (13.1%). These results are similar to those of Wong et al. [6] who reported a predominance of leg pain (33%), back pain (29%) and head pain (19%). Neuropathic pain (central and peripheral) was the most common chronic pain (50.2%) in our study with a higher frequency in patients aged 50 years to older (29.7%). In this study, musculoskeletal and joint pathologies were the most common causes (86.8%) of chronic pain followed by headache and orofacial pain (7.5%). These results are similar to those reported by Breivik et al. [4].

Our study has some limitations. First, the study does not evaluate the cost of care for patients with chronic pain in Niger. Second, the study does not evaluate the relationship between chronic pain and the socioeconomic level of the patients, and the relationship between chronic pain and its impact on patients’ lives. Thirdly, the selection of the patients was very restrain concerning only patients who consulted at the HNN while a large proportion of the patients with chronic pain consulted with traditional practitioners. A door-to-door study is needed to determine the exact prevalence of chronic pain in Niger.

5 Conclusion

Chronic pain is a common reason for consultation at the HNN that affects 1 in 5 patients with a predominance of the sex male and patients aged over 40 years. Legs, back, neck, knees and feet were the most common sites of chronic pain in our study with a predominance of musculoskeletal and articular pathologies.

Highlights

  • Chronic pain is common reason for consultation in Niger with a prevalence of 21.33%.

  • Men and patients aged over 50 years were the most affected in 61.8% and 51.6%, respectively.

  • Musculoskeletal and joint pathologies were the most common causes (86.8%) of chronic pain in Niger.

Service de médecine et spécialités médicales, Hôpital National de Niamey, BP 238, Niamey, Niger

  1. Authors’ contributions: Dr. H. Assadeck designed the study and he conducted the recruitment of the patients and the analysis of the data. Dr. M. Toudou Daouda conducted a literature search and he wrote the manuscript in its entirety. Dr. F. Hassane Djibo, Pr. D. Douma Maiga and Pr. E. Adehossi contributed to subsequent versions. All authors approved the final version of the article.

  2. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  3. Ethical issues; The current study respected the ethical principles depicted in the Declaration of Helsinki, and it was approved by the local Institutional Review Committee.

  4. Conflicts of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Acknowledgements

None.

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Received: 2017-04-21
Revised: 2017-06-13
Accepted: 2017-07-05
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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https://doi.org/10.1016/j.sjpain.2017.07.008
Keywords for this article
Chronic pain; Prevalence; Niger

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  1. Observational study
  2. Perceived sleep deficit is a strong predictor of RLS in multisite pain – A population based study in middle aged females
  3. Clinical pain research
  4. Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation
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  6. The Functional Barometer — An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain — Differences in age gender and origin of pain
  7. Clinical pain research
  8. Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain
  9. Observational study
  10. Chronic disruptive pain in emerging adults with and without chronic health conditions and the moderating role of psychiatric disorders: Evidence from a population-based cross-sectional survey in Canada
  11. Educational case report
  12. Management of patients with pain and severe side effects while on intrathecal morphine therapy: A case study
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  14. Behavioral inhibition, maladaptive pain cognitions, and function in patients with chronic pain
  15. Observational study
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  17. Original experimental
  18. Patient perspectives on wait times and the impact on their life: A waiting room survey in a chronic pain clinic
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  27. Clinical pain research
  28. COMBAT study – Computer based assessment and treatment – A clinical trial evaluating impact of a computerized clinical decision support tool on pain in cancer patients
  29. Original experimental
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  31. Editorial comment
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  35. Original experimental
  36. Comparison of spatial summation properties at different body sites
  37. Editorial comment
  38. Behavioural inhibition in the context of pain: Measurement and conceptual issues
  39. Clinical pain research
  40. A randomized study to evaluate the analgesic efficacy of a single dose of the TRPV1 antagonist mavatrep in patients with osteoarthritis
  41. Editorial comment
  42. Quantitative sensory tests (QST) are promising tests for clinical relevance of anti–nociceptive effects of new analgesic treatments
  43. Educational case report
  44. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl
  45. Editorial comment
  46. Severe side effects from intrathecal morphine for chronic pain after repeated failed spinal operations
  47. Editorial comment
  48. Opioids in chronic pain – Primum non nocere
  49. Editorial comment
  50. Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
  51. Observational study
  52. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
  53. Clinical pain research
  54. Opioid tapering in patients with prescription opioid use disorder: A retrospective study
  55. Editorial comment
  56. Sleep, widespread pain and restless legs — What is the connection?
  57. Editorial comment
  58. Broadening the fear-avoidance model of chronic pain?
  59. Observational study
  60. Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
  61. Editorial comment
  62. The burden of central anticholinergic drugs increases pain and cognitive dysfunction. More knowledge about drug-interactions needed
  63. Editorial comment
  64. A case-history illustrates importance of knowledge of drug-interactions when pain-patients are prescribed non-pain drugs for co-morbidities
  65. Editorial comment
  66. Why can multimodal, multidisciplinary pain clinics not help all chronic pain patients?
  67. Topical review
  68. Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics
  69. Editorial comment
  70. A new treatable chronic pain diagnosis? Flank pain caused by entrapment of posterior cutaneous branch of intercostal nerves, lateral ACNES coined LACNES
  71. Clinical pain research
  72. PhKv a toxin isolated from the spider venom induces antinociception by inhibition of cholinesterase activating cholinergic system
  73. Clinical pain research
  74. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain
  75. Editorial comment
  76. Towards a structured examination of contextual flexibility in persistent pain
  77. Clinical pain research
  78. Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance
  79. Editorial comment
  80. Is the search for a “pain personality” of added value to the Fear-Avoidance-Model (FAM) of chronic pain?
  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
  84. A glimpse into a neglected population – Emerging adults
  85. Observational study
  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
  88. Randomized, double-blind, placebo-controlled, dose-escalation study: Investigation of the safety, pharmacokinetics, and antihyperalgesic activity of L-4-chlorokynurenine in healthy volunteers
  89. Clinical pain research
  90. Prevalence and characteristics of chronic pain: Experience of Niger
  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
  102. Targeting cytokines for treatment of neuropathic pain
  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
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