Pain and its expression in six European countries: A survey

Our aim was to describe, in a simple yet wide survey, pain and its expression in six European countries (France, Switzerland, Italy, Spain, Portugal, Belgium) in patients suffering from low back pain or knee arthrosis. Of 34 600 files returned by 8650 general practitioners, 5359 files were randomly included in the analysis (low back pain: 2736, knee arthrosis: 2623). The questionnaires included a pain level assessment by the patient (VAS, verbal scale, verbal description) and by the physician (VAS), and questions concerning consequences of pain upon professional and domestic activity, leisure, sleep, mood and social relationships. The VAS scores were very similar from one country to another (mean patients' score: low back pain = 67.1 +/- 17.9 mm, knee arthritis = 60.2 +/- 18.8 mm; mean physicians' score: low back pain = 59.7 +/- 17 mm, knee arthritis = 53.3 +/- 17.4 mm). Underestimation by the physician, already well known, was also very similar from one country to another, and was clearly observed for moderate pain but was absent for severe pain. The other assessment criteria were also very similar. The patients' complaints were numerous and most of them described multiple consequences of pain on their daily life. In conclusion, this survey indicates a somewhat similar situation for pain expression by the patient, with rather significant consequences for both pathologies. It implies that the management of pain and the attitude of mind of a physician faced with any patient from these six countries should be the same. It confirms also that the VAS is a very reliable and useful tool.