Chronic pain linked to disability in SA

Pain affects South Africans’ daily life and functioning, and researchers have highlighted it as an urgent public health concern that must be prioritised without delay.

According to a new research study, led by researchers at the University of Cape Town (UCT), pain is also closely linked to disability in South Africa. Titled, “Chronic pain is associated with disability: Results from a large population-based survey in South Africa” and published in Pain Reports – an open-access, peer-reviewed journal, the study surveyed more than 10 000 adults and provides a clear picture of how pain affects South Africans’ daily life and functioning. To reach their findings, researchers conducted a cross-sectional, descriptive, secondary analysis of data from the 2016 South African Demographic of Health Survey – a nationally representative household survey.

“Chronic pain is the leading cause of disability worldwide.”

“Chronic pain is the leading cause of disability worldwide, but very little data has existed for South Africa until now. This study confirms that chronic pain is not only common but also has meaningful impact on people’s ability to think clearly and move freely,” said Dr Murray McDonald, a PhD candidate and lead author of the study.

Pain and disability

The study concurred with previous research, which highlighted that 18.3% of South African adults live with chronic pain – pain that lasts three months or more. Of those individuals, 27.8% experience some form of disability as a result of the pain. Disability was assessed using the internationally recognised Washinton Group on Disability items and statistical data was performed using R software. This approach allowed researchers to examine how widespread chronic pain is in South Africa, and how strongly it correlates with functional limitations in daily life.

Dr McDonald’s study revealed a robust relationship between chronic pain and challenges with cognition – people with chronic pain were more likely to report cognitive difficulties like thinking, remembering and concentrating; and mobility – chronic pain was moderately strongly associated with challenges with mobility, this means people found it harder to walk, move around or perform physical tasks.

“These limitations can affect every aspect of daily life, from employment and education to social participation and overall quality of life. The fact that more than a quarter of people with chronic pain experience disability, shows that the impact of chronic pain is far broader than pain alone,” McDonald said.

However, the research found that chronic pain does not impact self-care like bathing and getting dressed. Further, a small sample of participants, with high-impact chronic pain (HICP) – pain that limits daily functioning – comprised 1.7% of the population and represented almost one in ten people with chronic pain. Members of this group tended to be older women who were more likely to receive government grants and reported poor overall health.

For McDonald, these findings are important because chronic pain is often invisible and misunderstood.

“By showing clear links to disability, the study makes a persuasive case for recognising chronic pain as a significant public health issue requiring focused attention,” he said.

Filling a gap

According to Professor Romy Parker, the director of the Pain Management Unit in UCT’s Department of Anaesthesia and Perioperative Medicine, and co-author of the study, despite its strong connection with disability and reduced quality of life, chronic pain has been under recognised in low- and middle-income countries for too long. Therefore, the study fills an important gap.

“The fact that nearly one in five adults in South Africa lives with chronic pain should be viewed as a call to action for health systems, policymakers, employers and the public,” Professor Parker said.

Parker said what the study has identified on the HICP subgroup, as well as on impact on cognition and mobility is notable.

“This reinforces what many people living with chronic pain report: the experience is multidimensional.”

“[In the HICP subgroup] these individuals have much greater levels of disability and poorer health overall. Understanding their needs is essential for designing effective interventions,” she said. “The strong association with cognitive and mobility difficulties suggest that chronic pain affects both physical and mental functioning. This reinforces what many people living with chronic pain report: the experience is multidimensional – affecting far more than just the site of pain.”

Reduce the burden of pain

Based on the findings, Parker said several steps can be taken to reduce the burden of chronic pain and its association with disabilities in South Africa.

• Integrate chronic pain into national health planning – chronic pain should be recognised as a significant contributor to disability. Public health strategies and resource allocation should reflect this burden.

• Refine existing surveys and initiate further studies – further surveys should monitor treatments and barriers to healthcare to better understand how chronic pain is managed in South Africa. The concept of HICP requires further refinement.

• Support people with HICP – this group faces the greatest health and social challenges. Tailored interventions, financial support mechanisms and targeted clinical pathways can improve outcomes.