How Hospital Patients Experience Pain the Previous 24 Hours–A Prevalence Assessment of Pain in Five Hospitals in Sweden

  • Anna Peterson
    Address correspondence to Anne Söderlund Schaller, Ph.D., R.N., Pain and Rehabilitation Centre, University Hospital, s-581 83 Linköping, Sweden.
    ain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
    Search for articles by this author
  • Anne Söderlund Schaller
    ain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
    Search for articles by this author
Published:September 06, 2022DOI:



      Previous studies show that pain is common among hospital inpatients.


      This study measures the prevalence of pain and the impact of pain on sleep in patients admitted to five hospitals in Sweden.


      The patients were admitted to a surgical or a medical ward. They answered on a self-reported questionnaire about their average pain intensity and how much their pain interfered with their sleep the previous 24 hours, on a 010 numerical rating scale (NRS).


      Of the 500 patients, 308 experienced pain (62%), (NRS 3) and 111 (22%) rated their pain as NRS 7. We found no difference between surgical and medical specialty regarding pain prevalence. The results suggest that roughly the same proportion of patients with pain also experienced poor sleep due to pain265 patients (53%) reported pain interference on sleep, NRS 3.

      Conclusions and Clinical Implications

      This study shows that there is still an unacceptable high pain prevalence in inpatients and that patients experience pain as negatively impacting their sleep. Future pain care is likely to include a more comprehensive implementation strategy for the dissemination of knowledge, especially related to the complex context of today’s healthcare system. That is, the possibility that anchoring new knowledge also benefits the patient is probably associated with optimization of the structural context. Future research should take this question further by examining how the organizational structure should be optimized for the dissemination of knowledge in healthcare professionals about pain and pain interference with sleep.


      NRS (numeric rating scale), NRS-P (NRS for pain as NRS-P), NRS-S (NRS for pain interference with sleep as NRS-S)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Allen E.
        • Williams A.
        • Jennings D.
        • Stomski N.
        • Goucke R.
        • Toye C.
        • Slayter S.
        • Clarke T.
        • McCullough K.
        Revisiting the pain resource nurse role in sustaining evidence-based practice changes for pain assessment and management.
        Worldviews Evid Based Nurs. 2018; 15: 368-376
        • Andersson V.
        • Bergman S.
        • Henoch I.
        • Ene K.W.
        • Otterström-Rydberg E.
        • Simonsson H.
        • Ahlberg K.
        Pain and pain management in hospitalized patients before and after an intervention.
        Scandinavian Journal of Pain. 2017; 15: 22-29
        • Atkinson T.M.
        • Rosenfeld B.D.
        • Sit L.
        • Mendoza T.R.
        • Fruscione M.
        • Lavene D.
        • Shaw M.
        • Li Y.
        • Hay J.
        • Cleeland C.S.
        • Scher H.I.
        • Breitbert W.S.
        • Basch E.
        Using confirmatory factor analysis to evaluate construct validity of the Brief Pain Inventory (BPI).
        Journal of Pain and Symptom Management. 2011; 41: 558-565
        • Beck S.L.
        • Dunton N.
        • Berry P.H.
        • Brant J.M.
        • Guo J.W.
        • Potter C.
        • Spornitz B.
        • Eaton J.
        • Wong B.
        Dissemination and implementation of patient-centered indicators of pain care quality and outcomes.
        Medical Care. 2019; 57: 159-166
        • Blågestad T.
        • Pallesen S.
        • Grønli J.
        • Tang N.K.
        • Nordhus I.H.
        How perceived pain influence sleep and mood more than the reverse: A novel, exploratory study with patients awaiting total hip arthroplasty.
        Frontiers in Psychology. 2016; 7: 1689
        • Blågestad T.
        • Pallesen S.
        • Lunde L.H.
        • Sivertsen B.
        • Nordhus I.H.
        • Grønli J.
        Sleep in older chronic pain patients: A comparative polysomnographic study.
        Clinical Journal of Pain. 2012; 28: 277-283
        • Boveldt N.
        • Vernooij-Dassen M.
        • Burger N.
        • Ijsseldijk M.
        • Vissers K.
        • Engels Y.
        Pain and its interference with daily activities in medical oncology outpatients.
        Pain Physician. 2013; 16: 379-389
        • Cleeland C.C.S.
        The Brief Pain Inventory User Guide.
        2009 (Retrieved March 7, 2014 from)
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the Brief Pain Inventory.
        Annals of the Academy of Medicine, Singapore. 1994; 23: 129-138
        • Cook A.J.
        • Brawer P.A.
        • Vowles K.E.
        The fear-avoidance model of chronic pain: validation and age analysis using structural equation modeling.
        Pain. 2006; 121: 195-206
        • Damico V.
        • Murano L.
        • Cazzaniga F.
        • Dal Molin A.
        Pain prevalence, severity, assessment and management in hospitalized adult patients: A result of a multicenter cross sectional study.
        Annali dell'Istituto Superiore di Sanita. 2018; 54: 194-200
        • Das S.K.
        • Dhar S.S.
        • Panigrahi A.
        Prevalence of pain and its characteristics in hospitalized patients in an Indian teaching hospital.
        Pain Management Nursing. 2019; 21: 299-303
        • El Tumi H.
        • Johnson M.I.
        • Dantas P.B.F.
        • Maynard M.J.
        • Tashani O.A.
        Age-related changes in pain sensitivity in healthy humans: A systematic review with meta-analysis.
        European Journal of Pain. 2017; 21: 955-964
        • Fregoso G.
        • Wang A.
        • Tseng K.
        • Wang J.
        Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain.
        Pain Physician. 2019; 22: 479-488
        • Friesgaard K.D.
        • Paltved C.
        • Nikolajsen L.
        Acute pain in the emergency department: Effect of an educational intervention.
        Scandinavian Journal of Pain. 2017; 15: 8-13
        • Frohnhofen H.
        Pain and sleep: A bidirectional relationship.
        Zeitschrift fur Gerontolgie und Geriatrie. 2018; 51: 871-874
        • Gagliese L.
        • Melzack R.
        Chronic pain in elderly people.
        Pain. 1997; 70: 3-14
        • Gan T.J.
        Poorly controlled postoperative pain: prevalence, consequences, and prevention.
        Journal of Pain Research. 2017; 10: 2287-2298
        • Gerbershagen K.
        • Gerbershagen H.J.
        • Lutz J.
        • Cooper-Mahkorn D.
        • Wappler F.
        • Limmroth V.
        • Gerbershagen M.
        Pain prevalence and risk distribution among inpatients in a German teaching hospital.
        Clinical Journal of Pain. 2009; 25: 431-437
        • Glare P.
        • Aubrey K.R.
        • Myles P.S.
        Transition from acute to chronic pain after surgery.
        Lancet. 2019; 393: 1537-1546
        • Gregory J.
        • McGowan L.
        An examination of the prevalence of acute pain for hospitalised adult patients: A systematic review.
        Journal of Clinical Nursing. 2016; 25: 583-598
        • Gunnarsdottir S.
        • Zoega S.
        • Serlin R.C.
        • Sveinsdottir H.
        • Hafsteinsdottir E.J.G.
        • Fridriksdottir N.
        • Gretarsdottir E.T.
        • Ward S.E.
        The effectiveness of the Pain Resource Nurse Program to improve pain management in the hospital setting: A cluster randomized controlled trial.
        International Journal of Nursing Studies. 2017; 75: 83-90
        • Hartwell E.E.
        • Pfeifer J.G.
        • McCauley J.L.
        • Moran-Santa Maria M.
        • Back S.E
        Sleep disturbances and pain among individuals with prescription opioid dependence.
        Addictive Behaviors. 2014; 39: 1537-1542
        • Henoch I.
        • Sawatzky R.
        • Falk H.
        • Fridh I.
        • Jakobsson Ung E.
        • Sarenmalm E.K.
        • Ozanne A.
        • Ohlén J.
        • Falk K.
        Symptom distress profiles in hospitalized patients in Sweden: A cross-sectional study.
        Research in Nursing & Health. 2014; 37: 512-523
      1. Intensivvård, S. F. f. A. o. (2010). Riktlinjer för postoperativ smärtbehandling. Retrieved Month XX, XXXX, from, access date April 22, 2022

        • Jabusch K.M.
        • Lewthwaite B.J.
        • Mandzuk L.L.
        • Schnell-Hoehn K.N.
        • Wheeler B.J.
        The pain experience of inpatients in a teaching hospital: Revisiting a strategic priority.
        Pain Management Nursing. 2015; 16: 69-76
        • Jonsdottir T.
        • Aspelund T.
        • Jonsdottir H.
        • Gunnarsdottir S.
        The relationship between chronic pain pattern, interference with life and health-related quality of life in a nationwide community sample.
        Pain Management Nursing. 2014; 15: 641-651
        • Li K.K.
        • Harris K.
        • Hadi S.
        • Chow E.
        What should be the optimal cut points for mild, moderate, and severe pain?.
        Journal of Palliative Medicine. 2007; 10: 1338-1346
        • Ludvigsen E.S.
        • Flaeten Ø.
        • Gay C.L.
        • TarAngen M.
        • Granheim T.I.
        • Lerdal A.
        Pain and concomitant symptoms in medical and elective surgical inpatients: a point prevalence survey.
        Journal of Clinical Nursing. 2016; 25: 3229-3240
        • Makris U.E.
        • Abrams R.C.
        • Gurland B.
        • Reid M.C.
        Management of persistent pain in the older patient: A clinical review.
        JAMA. 2014; 312: 825-836
        • Melotti R.M.
        • Samolsky-Dekel B.G.
        • Ricchi E.
        • Chiari P.
        • Di Giacinto I.
        • Carosi F.
        • Di Nino G.
        Pain prevalence and predictors among inpatients in a major Italian teaching hospital. A baseline survey towards a pain free hospital.
        European Journal of Pain. 2005; 9: 485-495
        • Mystakidou K.
        • Parpa E.
        • Tsilika E.
        • Gennatas C.
        • Galanos A.
        • Vlahos L.
        How is sleep quality affected by the psychological and symptom distress of advanced cancer patients?.
        Palliative Medicine. 2009; 23: 46-53
        • Olsen B.F.
        • Valeberg B.T.
        • Jacobsen M.
        • Småstuen M.C.
        • Puntillo K.
        • Rustøen T.
        Pain in intensive care unit patients-A longitudinal study.
        Nursing Open. 2021; 8: 224-231
        • Peterson A.
        • Carlfjord S.
        • Schaller A.
        • Gerdle B.
        • Larsson B.
        Using education and support strategies to improve the way nurses assess regular and transient pain - A quality improvement study of three hospitals.
        Scandinavian Journal of Pain. 2017; 16: 15-21
        • Petrini L.
        • Matthiesen S.T.
        • Arendt-Nielsen L.
        The effect of age and gender on pressure pain thresholds and suprathreshold stimuli.
        Perception. 2015; 44: 587-596
        • Pieretti S.
        • Di Giannuario A.
        • Di Giovannandrea R.
        • Marzoli F.
        • Piccaro G.
        • Minosi P.
        • Aloisi A.M.
        Gender differences in pain and its relief.
        Annali dall'Istituto Superiore di Sanita. 2016; 52: 184-189
        • Purser L.
        • Warfield K.
        • Richardson C.
        Making pain visible: An audit and review of documentation to improve the use of pain assessment by implementing pain as the fifth vital sign.
        Pain Management Nursing. 2014; 15: 137-142
        • Rosen S.
        • Ham B.
        • Mogil J.S.
        Sex differences in neuroimmunity and pain.
        Journal of Neuroscience Research. 2017; 95: 500-508
        • Serlin R.C.
        • Mendoza T.R.
        • Nakamura Y.
        • Edwards K.R.
        • Cleeland C.S.
        When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function.
        Pain. 1995; 61: 277-284
        • Silva M.A.
        • Pimenta C.A.
        • Cruz Dde A.
        Treinamento e avaliação sistematizada da dor: impacto no controle da dor do pós-operatório de cirurgia cardíaca [Pain assessment and training: the impact on pain control after cardiac surgery].
        Revista da Escola de Enfermagem da USP. 2013; 47: 84-92
        • Tan G.
        • Jensen M.P.
        • Thornby J.I.
        • Shanti B.F.
        Validation of the Brief Pain Inventory for chronic nonmalignant pain.
        Journal of Pain. 2004; 5: 133-137
        • Van Hecke A.
        • Van Lancker A.
        • De Clercq B.
        • De Meyere C.
        • Dequeker S.
        • Devulder J.
        Pain intensity in hospitalized adults: A multilevel analysis of barriers and facilitators of pain management.
        Nursing Research. 2016; 65: 290-300
        • Wadensten B.
        • Fröjd C.
        • Swenne C.L.
        • Gordh T.
        • Gunningberg L.
        Why is pain still not being assessed adequately? Results of a pain prevalence study in a university hospital in Sweden.
        Journal of Clinical Nursing. 2011; 20: 624-634
        • Watt-Watson J.
        • McGillion M.
        • Lax L.
        • Oskarsson J.
        • Hunter J.
        • MacLennan C.
        • Knickle K.
        • Victor J.C.
        Evaluating an innovative eLearning pain education interprofessional resource: a pre-post study.
        Pain Medicine. 2019; 20: 37-49
        • Wesselius H.M.
        • van den Ende E.S.
        • Alsma J.
        • Maaten Ter
        • J C.
        • Schuit S.C.E.
        • Stassen P.M.
        • de Vries O.J.
        • Kaasjager K.H.A.H.
        • Haak H.R.
        • van Doormaal F.F..Hoogerwerf
        • J J.
        • Terwee C.B.
        • van de Ven P.M.
        • Bosch F.H.
        • van Someren E.J.W.
        • Nanayakkara P.W.B
        Quality and quantity of sleep and factors associated with sleep disturbance in hospitalized patients.
        JAMA Internal Medicine. 2018; 178: 1201-1208
        • Wiklund T.
        • Gerdle B.
        • Linton S.J.
        • Dragioti E.
        • Larsson B.
        Insomnia is a risk factor for spreading of chronic pain: A Swedish longitudinal population study (SwePain).
        European Journal of Pain. 2020; 24: 1348-1356
        • Woo A.
        • Lechner B.
        • Fu T.
        • Wong C.S.
        • Chiu N.
        • Lam H.
        • Pulenzas N.
        • DeAngelis C.
        • Chow E.
        Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: A literature review.
        Annals of Palliative Medicine. 2015; 4: 176-183
        • World Medical Association
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
        • Yıldırım G.
        • Ertekin Pınar Ş.
        • Düger C.
        • Altıparmak S.
        • Gürsoy S.
        • Mimaroğlu C.
        The relation between pain perceived by the patients hospitalized in the algology clinic and their sleep and quality of life.
        Agri. 2015; 27: 89-96
        • Zachodnik J.
        • Andersen J.H.
        • Geisler A.
        Barriers in pain treatment in the emergency and surgical department.
        Danish Medical Journal. 2019; 66: A5529
        • Zoëga S.
        • Ward S.E.
        • Sigurdsson G.H.
        • Aspelund T.
        • Sveinsdottir H.
        • Gunnarsdottir S.
        Quality pain management practices in a university hospital.
        Pain Management Nursing. 2015; 16: 198-210