A Clinical Description of Chronic Pain in a General Population Using ICD-10 and ICD-11 (The HUNT Pain Examination Study)

Published:September 18, 2021DOI:


      • Clinical examinations confirm a high prevalence of chronic pain found by questionnaires.
      • Most individuals with chronic pain have more than one chronic pain condition.
      • Most chronic pain conditions cannot be explained by known diseases.
      • Most individuals with chronic pain have chronic musculoskeletal pain.


      The purpose was to present a total description, distribution, and ranking of chronic pain conditions in the general population. This was based on structured clinical examinations of a random sample from a population-based survey (HUNT3) with a calculated oversampling of participants with chronic pain. Supplemented with access to hospital reports, the examination was performed by experienced physicians and psychologists using a consistent definition of chronic pain as well as ICD-10- and the new ICD-11-classification. The main findings were that a higher proportion of the 551 participants had chronic pain assessed by clinical examination (399) than by self-report in a survey the same day (337). Among those with examination-verified chronic pain estimated from HUNT3 to represent 27.9% of the general population, 63% had chronic primary pain, 81% musculoskeletal pain, and 77% more than one chronic pain condition. When separating chronic primary from chronic secondary pain according to ICD-11, the weighted prevalence was 17.7% for chronic pain conditions of unknown and 10.2% of known cause. When all the participants’ conditions were accounted for, the most prevalent was nonspecific low back (10.8%) and neck pain (7.6%). Participants with chronic primary pain did not have significantly more psychopathology than those with chronic secondary pain: 14.5% versus 12.5%.
      Perspective: Since this study confirms the high prevalence in self-report surveys and indicates that two thirds of chronic pain conditions cannot be explained by underlying diseases, this huge health and societal problem should be solved primarily on a public health level directed toward prevention and rehabilitation.

      Key words

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bair MJ
        • Robinson RL
        • Katon W
        • Kroenke K.
        Depression and pain comorbidity: A literature review.
        Arch Intern Med. 2003; 163: 2433-2445
        • Ballantyne JC.
        Opioids for the treatment of chronic pain: Mistakes made, lessons learned, and future directions.
        Anesthesia Analgesia. 2017; 125: 1769-1778
        • Bouhassira D
        • Attal N
        • Alchaar H
        • Boureau F
        • Brochet B
        • Bruxelle J
        • Cunin G
        • Fermanian J
        • Ginies P
        • Grun-Overdyking A.
        Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4).
        Pain. 2005; 114: 29-36
        • Breivik H
        • Collett B
        • Ventafridda V
        • Cohen R
        • Gallacher D.
        Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment.
        Euro J Pain. 2006; 10: 287-333
        • Eriksen J
        • Jensen MK
        • Sjogren P
        • Ekholm O
        • Rasmussen NK.
        Epidemiology of chronic non-malignant pain in Denmark.
        Pain. 2003; 106: 221-228
        • Fayaz A
        • Croft P
        • Langford R
        • Donaldson L
        • Jones G.
        Prevalence of chronic pain in the UK: A systematic review and meta-analysis of population studies.
        BMJ Open. 2016; 6e010364
        • Gallotta S
        • Bruno V
        • Catapano S
        • Mobilio N
        • Ciacci C
        • Iovino P.
        High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?.
        World J Gastroenterol. 2017; 23: 103
        • Hartvigsen J
        • Hancock MJ
        • Kongsted A
        • Louw Q
        • Ferreira ML
        • Genevay S
        • Hoy D
        • Karppinen J
        • Pransky G
        • Sieper J.
        What low back pain is and why we need to pay attention.
        Lancet North Am Ed. 2018; 391: 2356-2367
        • Jensen TS
        • Baron R
        • Haanpää M
        • Kalso E
        • Loeser JD
        • Rice ASC
        • Treede RD.
        A ned definition of neurotic pain.
        Pain. 2011; 152: 2204-2205
        • Johannes CB
        • Le TK
        • Zhou X
        • Johnston JA
        • Dworkin RH.
        The prevalence of chronic pain in United States adults: Results of an Internet-based survey.
        J Pain. 2010; 11: 1230-1239
        • Kalso E
        • Allan L
        • Dellemijn PL
        • Faura CC
        • Ilias WK
        • Jensen TS
        • Perrot S
        • Plaghki LH
        • Zenz M.
        Recommendations for using opioids in chronic non-cancer pain.
        Euro J Pain. 2003; 7: 381-386
        • Kamaleri Y
        • Natvig B
        • Ihlebaek CM
        • Benth JS
        • Bruusgaard D.
        Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population.
        Euro J Pain. 2008; 12: 742-748
        • Kaye AD.
        Clinical and professional aspects of opioid prescribing for pain physicians.
        Pain Phys. 2017; 20: S1-S2
        • Krokstad S
        • Langhammer A
        • Hveem K
        • Holmen T
        • Midthjell K
        • Stene T
        • Bratberg G
        • Heggland J
        • Holmen J.
        Cohort profile: The HUNT study, Norway.
        Int J Epidemiol. 2012; 42: 968-977
        • Landmark T
        • Dale O
        • Romundstad P
        • Woodhouse A
        • Kaasa S
        • Borchgrevink PC.
        Development and course of chronic pain over 4 years in the general population: The HUNT pain study.
        Euro J Pain. 2018; 22: 1606-1616
        • Landmark T
        • Romundstad P
        • Dale O
        • Borchgrevink PC
        • Kaasa S.
        Estimating the prevalence of chronic pain: Validation of recall against longitudinal reporting (the HUNT pain study).
        Pain. 2012; 153: 1368-1373
        • Langhammer A
        • Krokstad S
        • Romundstad P
        • Heggland J
        • Holmen J.
        The HUNT study: Participation is associated with survival and depends on socioeconomic status, diseases and symptoms.
        BMC Med Res Method. 2012; 12: 143
        • Maixner W
        • Fillingim RB
        • Williams DA
        • Smith SB
        • Slade GD.
        Overlapping chronic pain conditions: Implications for diagnosis and classification.
        J Pain. 2016; 17: T93-T107
        • March L
        • Smith EU
        • Hoy DG
        • Cross MJ
        • Sanchez-Riera L
        • Blyth F
        • Buchbinder R
        • Vos T
        • Woolf AD.
        Burden of disability due to musculoskeletal (MSK) disorders.
        Best Practice Res Clin Rheumatol. 2014; 28: 353-366
        • McWilliams LA
        • Cox BJ
        • Enns MW.
        Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample.
        Pain. 2003; 106: 127-133
        • Noormohammadpour P
        • Mansournia MA
        • Koohpayehzadeh J
        • Asgari F
        • Rostami M
        • Rafei A
        • Kordi R.
        Prevalence of chronic neck pain, low back pain, and knee pain and their related factors in community-dwelling adults in Iran.
        Clin J Pain. 2017; 33: 181-187
        • Rustøen T
        • Wahl AK
        • Hanestad BR
        • Lerdal A
        • Paul S
        • Miaskowski C.
        Prevalence and characteristics of chronic pain in the general Norwegian population.
        Euro J Pain. 2004; 8: 555-565
        • Schopflocher D
        • Taenzer P
        • Jovey R.
        The prevalence of chronic pain in Canada.
        Pain Res Management. 2011; 16: 445-450
        • StataCorp
        Stata Statistical Software: Release 15.
        StataCorp LP, College Station. TX2015
        • Steingrímsdóttir ÓA
        • Landmark T
        • Macfarlane GJ
        • Nielsen CS.
        Defining chronic pain in epidemiological studies: A systematic review and meta-analysis.
        Pain. 2017; 158: 2092-2107
        • Treede R-D
        • Rief W
        • Barke A
        • Aziz Q
        • Bennett MI
        • Benoliel R
        • Cohen M
        • Evers S
        • Finnerup NB
        • First MB.
        Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the: International Classification of Diseases (ICD-11).
        Pain. 2019; 160: 19-27
        • Tsang A
        • Von Korff M
        • Lee S
        • Alonso J
        • Karam E
        • Angermeyer MC
        • Borges GL
        • Bromet EJ
        • Demytteneare K
        • de Girolamo G
        • de Graaf R
        • Gureje O
        • Lepine JP
        • Haro JM
        • Levinson D
        • Oakley Browne MA
        • Posada-Villa J
        • Seedat S
        • Watanabe M
        Common chronic pain conditions in developed and developing countries: Gender and age differences and comorbidity with depression-anxiety disorders.
        J Pain. 2008; 9: 883-891
        • Vos T
        • Abajobir AA
        • Abate KH
        • Abbafati C
        • Abbas KM
        • Abd-Allah F
        • Abdulkader RS
        • Abdulle AM
        • Abebo TA
        • Abera SF.
        Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016.
        Lancet North Am Ed. 2017; 390: 1211-1259
        • Ware Jr., JE
        • Sherbourne CD
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Wolfe F
        • Smythe HA
        • Yunus MB
        • Bennett RM
        • Bombardier C
        • Goldenberg DL
        • Tugwell P
        • Campbell SM
        • Abeles M
        • Clark P
        • Fam AG
        • Farber SJ
        • Fiechter JJ
        • Franklin M
        • Gatter RA
        • Hamaty D
        • Lessard J
        • Lichtbroun AS
        • Masi AT
        • Mccain GA
        The American College of Rheumatology 1990 criteria for the classification of fibromyalgia.
        Arthritis Rheum. 1990; 33 (Report of the Multicenter Criteria Committee): 160-172
        • World Health Organization
        International Statistical Classification of Diseases and Related Health Problems. 1. World Health Organization, Geneva, Switzerland2004