In this study, individuals with chronic pain who had used healthcare services in the previous year had poorer health than symptomatic responders who had not used services, even after adjusting for pain severity. Since non-presentation of symptoms had no adverse impact on health status, there appears to be little point in trying to detect and treat individuals not currently presenting to healthcare services with their chronic pain, particularly given the current scarce resources for chronic pain management. Few previous studies have investigated the clinical importance of symptoms hidden in the community. Coyne et al
found that the short-term outcome for undetected patients with depression in primary care was better than that for detected patients, concluding that increasing the detection of depression in primary care was unlikely to improve outcomes.4
In a study of Rose angina and ischaemic heart disease (IHD), women whose IHD was documented by GPs didn't appear to do any better than those whose IHD was not documented.5
It has also been suggested that many patients with symptoms of minor illness obtain little benefit from their encounter with the healthcare system.14
We were able to use data from a large-scale study in the community, with a good response rate. This is one of the few studies to look at the clinical significance of symptoms hidden in the community, rather than simply describing the proportion of symptoms not presented to healthcare services. We have, however, only been able to assess the clinical significance of non-presented symptoms in terms of self-reported health status as measured by the SF-36. Other aspects of the clinical impact; for example, mortality and the incidence of comorbidity such as depression, need to be examined. Similar research is also needed to determine the clinical significance of other symptoms that commonly occur in the community, in order to inform decisions about the relevance of treatment and screening programmes.