Skip to main content
Download PDF

Health-related quality of life of Malaysian patients with chronic non-malignant pain and its associated factors: a cross-sectional study

BMC Musculoskeletal Disorders volume 23, Article number: 400 (2022) Cite this article

Abstract

Background

Chronic pain has a major impact on a patient’s quality of life, affecting physical and psychological functioning. It has debilitating consequences on social and economic aspects too. This study aimed to explore the status of health-related quality of life (HRQoL) of Malaysian patients suffering from chronic non-malignant pain.

Methods

Four hospitals offering pain clinic services were involved in this multicentre cross-sectional study conducted between June and September 2020. Adult patients who had been diagnosed with non-malignant chronic pain lasting for at least three months and able to communicate in English or Malay language were recruited in this study. Participants were informed about the study and were made aware that their participation was entirely voluntary. A battery of questionnaires consists of the EuroQol-5 dimensions-5 levels questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS), the Pain Self-Efficacy questionnaire (PSEQ) and the Pain Catastrophizing Scale (PCS) were self-administered by the patients. Besides, a structured questionnaire was used to collect their socio-demographic information, pain condition, sleep quality and working status. Participants’ usage of pain medications was quantified using the Quantitative Analgesic Questionnaire (QAQ).

Results

A total of 255 patients participated in this study. A median EQ-5D index value of 0.669 (IQR: 0.475, 0.799) and a median EQ VAS score of 60.0 (IQR: 50.0, 80.0) were recorded. Malay ethnicity (Adj. B: 0.77; 95% CI: 0.029, 0.126; p = 0.002) and a higher level of self-efficacy (Adj. B: 0.008; 95% CI: 0.006, 0.011; p < 0.001) were predictors of a better HRQoL, while suffering from pain in the back and lower limb region (Adj. B: -0.089; 95% CI: − 0.142, − 0.036; p = 0.001), the use of a larger amount of pain medications (Adj. B: -0.013; 95% CI: − 0.019, − 0.006; p < 0.001), and a higher degree of pain magnification (Adj. B: -0.015; 95% CI: − 0.023, − 0.008; p < 0.001) were associated with a poorer HRQoL.

Conclusions

These findings suggested that Malay ethnicity and a higher level of self-efficacy were predictors of a better HRQoL in patients with chronic pain, whereas pain-related factors such as higher usage of medication, specific pain site and pain magnification style were predictors of poorer HRQoL.

Peer Review reports

Background

Pain is defined as an “unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” [1]. It can be classified based on either its aetiology (i.e., nociceptive, neuropathic, or mixed pain) or duration (i.e., acute or chronic pain). According to the International Association for the Study of Pain, pain is only considered chronic if it lasts for at least 3 months [2, 3]. In Asia, the prevalence of chronic pain widely ranges from 7.1% in Malaysia to 34.9% in Hong Kong [4, 5]. Chronic pain becomes more common as people age, with 15.2% of Malaysia’s elderly suffering from it [5].

Chronic pain has various clinical, social and economic consequences. In the UK, the management of chronic pain incurs a cost of £69 million annually [6]. Similarly, approximately ¥5 billion was spent on the management of low back pain between 1995 and 1997 in Japan [7]. In Malaysia, patients with chronic pain are highly dependent on the public healthcare facilities for care [5], and it is clear that the financial burden falls mainly on the public healthcare system.

Several studies reported that patients with chronic pain had a similar health-related quality of life (HRQoL) to those with end-stage cancer [8] but a lower HRQoL than those with stroke [9]. Frequent and intense pain [10], as well as chronic pain with neuropathic characteristics, have been shown to reduce their HRQoL [11]. Apart from persistent discomfort, the multiple physical and psychological changes associated with chronic pain have greatly affected the lives of patients, mainly by causing depression, sleep disturbance, changes in their personality and social relationships [6, 8, 12], absenteeism and productivity loss [13]. Thus, chronic pain is a medical condition that has a significant impact on a patient’s quality of life, both in physical and psychological functioning.

The HRQoL could be measured by using either a disease-specific or a generic approach. Although the disease-specific approach (e.g., Brief Pain Inventory) captures the symptoms or functions of a patient [14], it does not allow comparisons across different medical conditions. Therefore, the generic approach has become more popular in recent years, and some instruments developed for this purpose even provide health state utility values for cost-utility analyses [11, 14], which enable more effective decision making and resource allocation. In Malaysia, studies on chronic pain mainly focused on the effectiveness of different treatment modalities and procedures, while the HRQoL of patients with chronic pain is yet to be explored. As pain is perceived differently across cultures and regions [15], this study aimed to explore the HRQoL of Malaysian patients suffering from chronic non-malignant pain using a generic approach.

Methods

A multicentre cross-sectional study was undertaken between June and September 2020 in four hospital-based pain clinics, which provide clinical service to approximately more than 400 patients with non-malignant chronic pain altogether monthly. The study was approved by the Medical Research & Ethics Committee (NMRR-20-558-53,144 (IIR), Ref: KKM/NIHSEC/P20–754(5)). Adults (≥18 years of age) who had non-malignant pain lasting for at least 3 months and being seen in the pain clinic during the data collection period were included in the study, whereas those who were unable to communicate in English or Malay language were excluded. All eligible patients were approached to participate during the study period.

Data collection

Written consent was obtained from all the study participants. A structured questionnaire was used to collect self-reported socio-demographic information, pain intensity (minimum, usual, and maximum pain scores) at the time of the study and within 1 month before the study, as well as sleep quality and working status within 1 month of the study. Additionally, participants were required to complete four validated questionnaires. The first two questionnaires were the EuroQol-5 dimensions-5 levels (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS), which measured their HRQoL [16]. In the EQ-5D-5L, the participants rated their physical and mental condition on the day of study using a 5-level scale, from which an EQ-5D index value was generated. They also indicated their perceived health status on a VAS ranging from 0 to 100 in the EQ VAS. The Pain Self-efficacy Questionnaire (PSEQ) was used to measure the degree of self-efficacy in daily functioning while coping with chronic pain [17]. The Pain Catastrophizing Scale (PCS) was used to assess the degree of catastrophizing in three aspects, namely rumination, helplessness and magnification of pain [18]. The scoring system, outcome measurement and psychometric properties of all the four instruments are summarized in Table 1. The participants were allowed to choose either English or Malay versions of each instrument in responding to the questionnaires.

Table 1 Four validated questionnaires used in this study and their psychometric properties
Full size table

The medical history of each participant was extracted from their medical records using a standardized data collection sheet. Information collected included their clinical diagnosis, as well as both pharmacological and non-pharmacological treatments received. The medications used to manage the pain within 1 month before the study were also recorded, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, selective serotonin and norepinephrine reuptake inhibitors (SSRIs and SNRIs), tricyclic antidepressants (TCAs), muscle relaxants and anticholinergic drugs. The use of these pain medications was subsequently quantified based on the Quantitative Analgesic Questionnaire (QAQ) [24], in which a higher QAQ score represented a larger amount of medication used. The maximum dose of each medication was set based on the Malaysian Pain Management Handbook, the Malaysian Low Back Pain Management Guideline and the Malaysian Drug Formulary [25,26,27].

Data analysis

The descriptive analysis of categorical variables was summarized as frequencies and percentages. Numerical variables were summarized as means and standard deviations (SDs), or as medians with interquartile ranges (IQRs). The primary endpoint of this study was the HRQoL of the participants which was expressed as an EQ-5D index value, calculated based on the Malaysian value set [20]. Furthermore, the predictors of HRQoL were identified using the stepwise multiple linear regression analysis, with the p-value set at 0.05. Interaction terms were checked for the final model. All statistical analysis was conducted using the SPSS version 20.0 (IBM, New York).

Results

A total of 360 patients with non-malignant chronic pain were approached and 255 of whom participated in the study, yielding a response rate of 70.8%. The patients excluded were those who declined to participate (n = 40), were unable to communicate in English or Malay (n = 57), had visual impairment (n = 1), had an acute exacerbation of pain or felt unwell at the time when they were approached (n = 7). Only 246 patients completed the survey and were included in the final analysis. Approximately half of them were female (61.4%), of Malay ethnicity (50.8%) and had a secondary education level (58.2%) (Table 2). Approximately 40% either lost their job (21.1%) or had their job scope adjusted (22.4%) due to pain, while some were on sick leave frequently (13.4%).

On average, the participants experienced pain for 6 (IQR: 2, 12) years, had been followed up at one of the pain clinics for 2.5 years (IQR: 0.8, 6.2), and had 1 (IQR: 0, 2) comorbidity. Most of them had one pain site (69.1%), and only one had four pain sites. The most common pain sites were the back, sacrum, buttock and the lower limb region (71.1%), and 76.4% of them suffered from neuropathic pain. A total of 35 patients had at least one psychiatric disorder, with depressive disorder (11.4%) as the most common diagnosis. In the 1 month before this study, more than half (69.8%) of the participants experienced continuous pain, with a median minimum pain score of 3 (IQR: 2, 5) and a median maximum pain score of 8 (IQR: 7, 9). Less than 10% did not take any medications to relieve the pain (QAQ score = 0), more than half took their medication as prescribed (65.9%), while 24.8% reduced the dose or frequency of their medications. The characteristics and health conditions of participants are summarized in Table 2.

Table 2 Characteristics and health conditions of participants in the one month before the day of study (n = 246)
Full size table

The patients reported a median pain score of 5 (IQR: 4, 7) on the day of the study, and only 4.1% of them reported a health state of 11,111 in the EQ-5D-5L questionnaire, which represented having no problem in any of the five dimensions tested. More than half of them had no difficulty with self-care (63.0%). However, 65.9% of patients reported having a moderate to a severe problem with pain/discomfort, followed by usual activity (42.6%), mobility (39.5%) and anxiety/depression (33.0%) (Fig. 1). A median EQ-5D index value of 0.669 (IQR: 0.475, 0.799) and a median EQ VAS score of 60.0 (IQR: 50.0, 80.0) were recorded.

Fig. 1
figure 1

The distribution of EQ-5D-5L responses among participants by dimension and level

Full size image

Predictors of HRQoL included ethnicity, pain site, QAQ score, PSEQ sum score and the magnification subscore of PCS (Table 3). Participants of Malay ethnicity recorded a better HRQoL (Adj. B: 0.77; 95% CI: 0.029, 0.126; p = 0.002). Additionally, a better HRQoL was recorded in the participants with greater self-efficacy represented by the PSEQ sum score (Adj. B: 0.008; 95% CI: 0.006, 0.011; p < 0.001). On the contrary, a poorer HRQoL was more likely to occur among those who suffered from pain in the back, sacrum, buttock or lower limb region, as opposed to those who did not experience pain in these regions. (Adj. B: -0.089; 95% CI: − 0.142, − 0.036; p = 0.001). Those who had a higher level of pain magnification, as indicated by the PCS sub-scale score of magnification, were more likely to have a poorer HRQoL (Adj. B: -0.015; 95% CI: − 0.023, − 0.008; p < 0.001). Also, patients who used more pain medications, as indicated by a higher QAQ score, were more likely to have a poorer HRQoL (Adj. B: -0.013; 95% CI: − 0.019, − 0.006; p < 0.001).

Table 3 Predictors of the EQ-5D-5L index value among patients with chronic pain (n = 246)
Full size table

Discussion

This study quantified the HRQoL of Malaysian patients with chronic non-malignant pain and reported its corresponding health utility values and predictors. The median health utility value of the patients with chronic pain reported in this study (0.669) is lower than that of the general Malaysian population (median: 1.0; IQR: 0.925, 1.075) [21], suggesting that chronic pain negatively affects quality of life. Furthermore, it is noted that chronic pain affected HRQoL to a greater extent as compared with other diseases, such as diabetes mellitus, cardiovascular diseases, chronic obstructive pneumonia disease, human immunodeficiency virus infection, chronic kidney disease and neoplasm [28]. This could be due to the various consequences of chronic pain, which compromise not only one’s physical function but also social life [10]. This study provides insight into the impact of chronic pain on the quality of life of patients, calling for greater attention to the effectiveness of pain management.

Several predictors of patients’ HRQoL were also identified in this study. Malay patients are more likely to have better HRQoL than patients of other ethnic groups. Although ethnic variation in HRQoL has not been reported in previous studies from Malaysia [29,30,31,32], a similar trend was shown in the US and England [33, 34]. Such variations were associated with differences in socioeconomic and health status among ethnic groups [33, 34]. A study conducted in Singapore, which is socio-culturally similar to Malaysia, also found that ethnicity has an impact on the HRQoL in addition to socioeconomic status [35, 36]. This implies the role of cultural diversity in health belief and perception. Although cultural influences on pain experience and expression are documented in other countries [15, 37], such information is currently limited in Malaysia. It is thus important to explore cultural differences in perceptions of pain as well as HRQoL among Malaysian patients.

Apart from ethnicity, this study also revealed that individuals who experienced pain involving back to lower limb region have a poorer HRQoL. This is consistent with the previous studies which suggest that HRQoL among patients with low back and knee pain is generally poorer [38,39,40]. Pain in the back and lower limbs commonly limits one’s physical function and mobility [41, 42], and affects one’s capacity to work [43]. Given its negative effect on patients, various treatment modalities are recommended to manage chronic pain. Nevertheless, an early intervention on pain in the back or lower limbs is also important to minimize its chronic complications. Besides the pain site, poorer HRQoL was also found in patients who used a larger amount of pain medications. Therefore, it is important to consider the use of non-pharmacological methods [44] in the management of chronic pain, such as exercise and acupuncture, which could help to provide alternative to manage pain instead of only relying on the pain medications in coping with pain.

Previously, when pain catastrophizing was studied as a single construct, it had already been shown to reduce the HRQoL of patients [45,46,47]. This study shows that, from the three dimensions of pain catastrophizing (i.e., rumination, helplessness and magnification), pain magnification significantly reduced patients’ HRQoL. A patient who magnifies pain tends to exaggerate the threat associated with pain. Such behaviour has been observed to have an impact on the physical aspect of HRQoL, likely as a result of a greater perceived barrier to activity involvement [48]. Thus, psychological interventions are expected to play an important role in pain management, as they assist patients dispel negative thoughts and live a better life [22, 49]. On the other hand, patients with higher self-efficacy had better HRQoL, which was consistent with previous literature [50]. Self-efficacy has been associated with improved physical function, reduced affective distress and lower pain severity in patients with chronic pain [51, 52]. Therefore, it is essential to assist patients in enhancing their self-efficacy in order to improve the outcome of pain management.

Strengths and limitations

To the best of our knowledge, this is the first study assessing and quantifying the HRQoL of Malaysian patients with chronic non-malignant pain. Findings could serve as the baseline for comparisons with other diseases, as well as for cost-utility analysis of interventions on chronic pain in Malaysia. However, the data collection in this study was based mainly on self-reporting, and recall bias is therefore possible.

Conclusion

This study reported the HRQoL utility value of patients with chronic non-malignant pain. Malay ethnicity and a higher level of self-efficacy were predictors of a better HRQoL, but suffering from pain in the back and lower limb region, the use of a larger amount of pain medications, and a higher degree of pain magnification were associated with poorer HRQoL.

Availability of data and materials

All data generated or analysed during this study are included in this published article.

Abbreviations

EQ VAS:

EuroQol visual analogue scale

EQ-5D-5L:

EuroQol-5 dimensions-5 levels

HRQoL:

Health-related quality of life

IQR:

Interquartile range

NSAID:

Nonsteroidal anti-inflammatory drug

PCS:

Pain catastrophizing scale

PSEQ:

Pain self-efficacy questionnaire

QAQ:

Quantitative analgesic questionnaire

SD:

Standard deviation

References

  1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;00(00):1–7.

    Google Scholar 

  2. Nicholasa M, Vlaeyen JWS, Rief W, Barke A, Aziz Q, Benoliel R, et al. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160:28–37.

    Article  Google Scholar 

  3. Aziz Q, Giamberardino MA, Barke A, Korwisi B, Baranowski AP, Wesselmann U, et al. The IASP classification of chronic pain for ICD-11: chronic secondary visceral pain. Pain. 2019;160(1):69–76.

    Article  PubMed  Google Scholar 

  4. Wong WS, Fielding R. Prevalence and characteristics of chronic pain in the general population of Hong Kong. J Pain. 2010;12(2):236–45.

    Article  PubMed  Google Scholar 

  5. Mohamed Zaki LR, Hairi NN. Chronic pain and pattern of health care utilization among Malaysian elderly population: National Health and morbidity survey III (NHMS III, 2006). Maturitas. 2014;79(4):35–41.

    Article  Google Scholar 

  6. Phillips CJ. The cost and burden of chronic pain. Rev Pain. 2009;3(1):2–5.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hani SS, Liew SM. The views and experiences of Malaysian primary care doctors in managing patients with chronic low back pain: a qualitative study. Malays Fam Physician. 2018;13(1):18–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Vartiainen P, Heiskanen T, Sintonen H, Roine RP, Kalso E. Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument. Pain. 2016;157(10):2269–76.

    Article  PubMed  Google Scholar 

  9. Manca A, Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, et al. Quality of life, resource consumption and costs of spinal cord stimulation versus conventional medical management in neuropathic pain patients with failed back surgery syndrome (PROCESS trial). Eur J Pain. 2008;12:1047–58.

    Article  PubMed  Google Scholar 

  10. Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457–67.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Torrance N, Lawson KD, Afolabi E, Bennett MI, Serpell MG, Dunn KM, et al. Estimating the burden of disease in chronic pain with and without neuropathic characteristics: does the choice between the EQ-5D and SF-6D matter? Pain. 2014;155:1996–2004.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wahl AK, Rustøen T, Rokne B, Lerdal A, Knudsen Ø, Miaskowski C, et al. The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population. Qual Life Res. 2009;18:971–80.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cousins MJ, Brennan F, Carr DB. Pain relief: a universal human right. Pain. 2004;112(1–2):1–4.

    Article  PubMed  Google Scholar 

  14. Whynes DK, McCahon RA, Ravenscroft A, Hodgkinson V, Evley R, Hardman JG. Responsiveness of the EQ-5D health-related quality-of-life instrument in assessing low back pain. Value Health. 2013;16:124–32.

    Article  CAS  PubMed  Google Scholar 

  15. Peacock S, Patel S. Cultural influences on pain. Rev Pain. 2008;1(2):6–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. EuroQol Research Foundation. EQ-5D-5L user guide. 2019: https://euroqol.org/publications/user-guides. Accessed 3 Mar 2020.

    Google Scholar 

  17. Nicolas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11:153–63.

    Article  Google Scholar 

  18. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524–32.

    Article  Google Scholar 

  19. Shafie AA, Vasan Thakumar A, Lim CJ, Luo N. Psychometric performance assessment of Malay and Malaysian English version of EQ-5D-5L in the Malaysian population. Qual Life Res. 2018;28:158–62.

    Google Scholar 

  20. Shafie AA, Vasan Thakumar A, Lim CJ, Luo N, Rand-Hendriksen K, Md Yusof FA. EQ-5D-5L valuation for the Malaysian population. Pharmacoeconomics. 2019;37:715–25.

    Article  PubMed  Google Scholar 

  21. Shafie AA, Hassali MA, Liau SY. A cross-sectional validation study of EQ-5D among the Malaysian adult population. Qual Life Res. 2011;2011(20):593–600.

    Article  Google Scholar 

  22. Cardosa M, Jamil Osman Z, Nicholas M, Tonkin L, Williams A, Abd Aziz K, et al. Self-management of chronic pain in Malaysian patients: effectiveness trial with 1-year follow-up. Transl Behave Med. 2012;2(1):30–7.

    Article  Google Scholar 

  23. Mohd Din FH, Hoe VCW, Chan CK, Muslan MA. Cultural adaptation and psychometric assessment of pain catastrophizing scale among young healthy Malay-speaking adults in military settings. Qual Life Res. 2015;24:1275–80.

    Article  CAS  PubMed  Google Scholar 

  24. Robinson-Papp J, George MC, Wongmek A, Nmashie A, Merlin JS, Ali Y, et al. The Quantitative Analgesic Questionnaire: a tool to capture patient-reported chronic pain medication use. J Pain Symptom Manage. 2015;50(3):381–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Surgical and Emergency Medicine Services Unit, Medical development section of the Medical development division, Ministry of Health Malaysia. Pain management handbook. 2013.

    Google Scholar 

  26. Mohamed Hussein AM, Deepak-Singh, Mansor M, Muhamed Kamil OI, Choy YC, Cardosa M et al. Malaysian low back pain management guideline. 2005.

  27. Ministry of Health Malaysia. Formulari ubat Kementerian Kesihatan Malaysia 1/2021. 2021.

    Google Scholar 

  28. Zhou T, Guan H, Wang LY, Zhang Y, Rui MJ, Ma AX. Health-related quality of life in patients with different diseases measured with the eq-5d-5l: a systematic review. Front Public Health. 2021;9:675523.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Wan Puteh SE, Siwar C, Zaidi MAS, Abdul KH. Health related quality of life (HRQOL) among low socioeconomic population in Malaysia. MC Public Health. 2019;19(551):1–8.

    Google Scholar 

  30. Azman AB, Sararaks S, Rugayah B, Low LL, Azlan AA, Geeta S, et al. Quality of life of the malaysian general population: results from a postal survey using the SF·3M. Med J Malaysia. 2003;58(5):694–711.

    CAS  PubMed  Google Scholar 

  31. Mohd Ashri MH, Abu Saad H, Adznam SNA. Factors associated with health-related quality of life among government employees in Putrajaya, Malaysia. Int J Environ Res Public Health. 2021;18(2626):1–17.

    Google Scholar 

  32. Wan Puteh SE, Noor Aizuddin A, Tumian NR, Sathar J, Mohamad SE. Health-related quality of life using EQ-5D among chronic myeloid leukaemia patients in health centres in Klang Valley, Malaysia. Plos One. 2021;16(8):e0256804.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Moriarty J, Butt J. Inequalities in quality of life among older people from different ethnic groups. Ageing Soc. 2004;24(5):729–53.

    Article  Google Scholar 

  34. Wallander JL, Fradkin C, Elliott MN, Cuccaro PM, Tortolero Emery S, Schuster MA. Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study. Qual Life Res. 2019;28:1761–71.

    Article  PubMed  Google Scholar 

  35. Thumboo J, Fong KY, Machin D, Chan SP, Soh C-H, Leong KH, et al. Quality of life in an urban Asian population:the impact of ethnicity and socio-economic status. Soc Sci Med. 2003;56:1761–72.

    Article  PubMed  Google Scholar 

  36. Ng TP, Lionel Lim CC, Jin A, Shinfuku N. Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore. Qual Life Res. 2005;14:1755–68.

    Article  PubMed  Google Scholar 

  37. Lovering S. Cultural attitudes and beliefs about pain. J Transcult Nurs. 2006;17(4):389–95.

    Article  PubMed  Google Scholar 

  38. Muraki S, Akune T, Oka H, En-yo Y, Yoshida M, Saika A, et al. Impact of knee and low back pain on health-related quality of life in Japanese women: the research on osteoarthritis against disability (ROAD). Mod Rheumatol. 2010;20:444–51.

    Article  PubMed  Google Scholar 

  39. Ferrer-Peña R, Calvo-Lobo C, Aiguade R, Fernandez-Carnero J. Which seems to be worst? Pain severity and quality of life between patients with lateral hip pain and low back pain. Pain Res Manag. 2018;2018(9156247):1–7.

    Article  Google Scholar 

  40. Lee Y, Lee SH, Lim SM, Baek SH, Ha IH. Mental health and quality of life of patiets with osteoarthritis pain: the sixth Korea National Health and nutrition examination survey (2013–2015). Plos One. 2020;15(11):e0242077.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Coyle PC, Velasco T, Sions JM, Hicks GE. Lumbar mobility and performance-based function: an investigation in older adults with and without chronic low back pain. Pain Med. 2017;2017(18):161–8.

    Article  Google Scholar 

  42. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the health abc cohort and implications for the future. Pain Med. 2003;4(4):311–20.

    Article  PubMed  Google Scholar 

  43. Schaller A, Dejonghe L, Haastert B, Froboese I. Physical activity and health-related quality of life in chronic low back pain patients: a cross-sectional study. BMC Musculoskelet Disord. 2015;16(62):1–8.

    CAS  Google Scholar 

  44. Tick H, Nielsen A, Pelletier KR, Bonakdar R, Simmons S, Glick R, et al. Evdence-based nonpharmacologic strategies for comprehensive pain care: the consortium pain Taks force white paper. Explore. 2018;14(3):177–211.

    Article  PubMed  Google Scholar 

  45. Semeru GM, Halim MS. Acceptance versus catastrophizing in predicting quality of life in patients with chronic low back pain. Korean J Pain. 2019;32(1):22–9.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sewell M, Churilov L, Mooney S, Ma T, Maher P, Grover SR. Chronic pelvic pain – pain catastrophizing, pelvic pain and quality of life. Scand J Pain. 2018;2018:1–8.

    Google Scholar 

  47. Davoudi M, Rezaei P, Rajaeiramsheh F, Ahmadi SM, Taheri AA. Predicting the quality of life based on pain dimensions and psychiatric symptoms in patients with painful diabetic neuropathy: a cross-sectional prevalence study in Iranian patients. Health Qual Life Outcomes. 2021;19(49):1–9.

    Google Scholar 

  48. Craner JR, Gilliam WP, Sperry JA. Rumination, magnification, and helplessness: how do different aspects of pain catastrophizing relate to pain severity and functioning? Clin J Pain. 2016;32(12):1028–35.

    Article  PubMed  Google Scholar 

  49. Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006;121:181–94.

    Article  PubMed  Google Scholar 

  50. Yazdi-Ravandi S, Taslimi Z, Jamshidian N, Saberi H, Shams J, Haghparast A. Prediction of quality of life by self-efficacy, pain intensity and pain duration in patient with pain disorders. Basic Clin Neuro Sci. 2013;4(2):117–24.

    Google Scholar 

  51. Karasawa Y, Yamada K, Iseki M, Yamaguchi M, Murakami Y, Tamagawa T, et al. Association between change in self-efficacy and reduction in disability among patients with chronic pain. PLoS One. 2019;14(4):e0215404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain outcomes: a meta-analytic review. J Pain Res. 2014;15(8):800–14.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Director-General of Health Malaysia for permission to publish this article, Ms. Premaa Supramaniam and Ms. Lim Wei Yin for their assistance in statistical analyses, as well as all staff at sites who facilitated the completion of this study. The authors would also like to thank the EuroQol Research Foundation, Mapi Research Trust, Dr. Michael Nicholas and Dr. Robinson-Papp Jessica for allowing the use of the EQ-5D-5L, EQ VAS, PCS, PSEQ and QAQ in this study.

Funding

The researchers did not receive any funding for this study.

Author information

Authors and Affiliations

  1. Clinical Research Centre (CRC), Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia

    Ju-Ying Ang & E-Li Leong

  2. Clinical Research Centre (CRC), Hospital Sultanah Bahiyah, Ministry of Health, Km6, 256, 05460, Alor Setar, Kedah, Malaysia

    Huan-Keat Chan

  3. School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Gelugor, Penang, Malaysia

    Asrul Akmal Shafie

  4. Pharmacy Department, Hospital Pulau Pinang, Ministry of Health, Jalan Residensi, 10990, George Town, Pulau Pinang, Malaysia

    Shi-Qi Lee

  5. Department of Anaesthesiology and Intensive Care, Hospital Pulau Pinang, Ministry of Health, Jalan Residensi, 10990, George Town, Pulau Pinang, Malaysia

    Punita Mutiah & R. Usha S. Rajah

  6. Department of Anaesthesiology and Intensive Care, Hospital Selayang, Ministry of Health, Selayang - Kepong Hwy, 68100, Batu Caves, Selangor, Malaysia

    Ronald Vei-Meng Lim

  7. Department of Anaesthesiology and Intensive Care, Hospital Sultanah Bahiyah, Ministry of Health, Km6, 256, 05460, Alor Setar, Kedah, Malaysia

    Chia-Ming Loo & Lee-Choo Yeoh

  8. Pain management Unit,Department of Anesthesiology and Intensive Care, Hospital Selayang, Ministry of Health, Selayang - Kepong Hwy, 68100, Batu Caves, Selangor, Malaysia

    Mazlila Meor Ahmad Shah

  9. Management Science University, University Drive, Off Persiaran Olahraga, 40100, Shah Alam, Selangor, Malaysia

    Zubaidah Jamil Osman

  10. Pain Management Clinic, Department of Anaesthesiology and Intensive Care, Hospital Raja Permaisuri Bainun, Ministry of Health, Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia

    Devanandhini Krisnan

  11. Department of Anaesthesiology and Intensive Care, Hospital Raja Permaisuri Bainun, Ministry of Health, Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia

    Kavita Bhojwani

Authors
  1. Ju-Ying Ang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E-Li Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huan-Keat Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Asrul Akmal Shafie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shi-Qi Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Punita Mutiah
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ronald Vei-Meng Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chia-Ming Loo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Usha S. Rajah
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mazlila Meor Ahmad Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zubaidah Jamil Osman
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lee-Choo Yeoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Devanandhini Krisnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kavita Bhojwani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AJY involved in the study conception, data analysis and interpretation, project administration, writing the original draft and editing the manuscript. LEL involved in the study conception, data analysis and interpretation, project administration, reviewing and editing the manuscript. CHK and AAS involved in the study conception, data interpretation, reviewing and editing the manuscript. LSQ, PM, RLVM, LCM involved in data acquisition, reviewing and editing the manuscript. RUR, MMAS, ZJO, YLC, DK and KB involved in the study conception, data acquisition and interpretation, reviewing and editing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ju-Ying Ang.

Ethics declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Research & Ethics Committee (NMRR-20-558-53144 (IIR), Ref: KKM/NIHSEC/P20–754 (5)). A written informed consent was obtained from all participating patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ang, JY., Leong, EL., Chan, HK. et al. Health-related quality of life of Malaysian patients with chronic non-malignant pain and its associated factors: a cross-sectional study. BMC Musculoskelet Disord 23, 400 (2022). https://doi.org/10.1186/s12891-022-05354-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-022-05354-1

Keywords

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us