Prevalence of pain and receipt of pain management in persons receiving inpatient psychiatric services in Ontario

Abstract

Background: Pain significantly impacts health and quality of life but is often underreported and poorly managed among persons with mental illness. Objective: The goal was to examine the prevalence of pain and receipt of pain management among individuals who have received inpatient psychiatric services in Ontario, and to identify characteristics associated with receipt of pain management. Methods: Anonymized population-level data were analyzed from the Ontario Mental Health Reporting System, based on the interRAI Mental Health assessment. Pain prevalence was based on the interRAI Pain Scale with a score that is ≥1. Bivariate and multivariate analyses considered personal (age, sex), social (partner status, residence admitted from, financial trade off in previous month, reported trauma), functional (cognitive performance), and clinical (previous psychiatric admissions, highest number of alcoholic drinks in single sitting, substance use in last month, health instability, psychiatric diagnoses, intellectual or developmental disability, and multimorbidity) to identify factors linked to receiving pain management. Results: Approximately 22% (n=69,529) experienced pain, but only 49% (n=34,470) of those in pain received pain management. At the multivariate level, several factors were significantly associated with increased odds of receiving pain management, including age 25–44 years (OR=1.164, 95% CI=1.096-1.236), 45-64 years (OR=1.219, 95% CI=1.147-1.295), financial trade-off (OR=1.185, 95% CI=1.113-1.260), use of opiates in the previous week (OR=1.751, 95% CI=1.661-1.845), self-reported trauma (OR=1.477, 95% CI=1.414-1.542), and a diagnosis of substance use disorder (OR=1.247, 95% CI=1.151-1.352). Conversely, residence prior to admission (hospital: OR=0.812, 95% CI=0.782-0.843); homeless: OR=0.816, 95% CI=0.739-0.901); correctional facility: OR=0.721, 95% CI=0.609-0.853), substance use in the last week (inhalants: OR=0.667, 95% CI=0.534-0.833; stimulants: OR=0.919, 95% CI=0.850-0.994), psychiatric diagnoses (psychotic disorders: OR=0.701, 95% CI=0.644-0.764; bipolar disorders: OR=0.770, 95% CI=0.701-0.845; depressive disorders: OR=0.837, 95% CI=0.773-0.906; personality disorders: OR=0.765, 95% CI=0.689-0.849; medication-induced disorders: OR=0.604, 95% CI=0.411-0.887; intellectual or developmental disability: OR=0.848, 95% CI=0.775-0.928), and health instability (OR=0.733, 95% CI=0.703-0.763) were significantly associated with lower odds of pain management. Conclusion: Less than half of those in pain received pain management. Current findings highlight personal, social, functional, clinical and service use factors are associated receipt of pain management. Future research should prioritize a holistic approach to care in inpatient psychiatry that includes appropriately addressing pain.