The role of pain hypersensitivity in development of chronic widespread pain: A retrospective cohort study

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Authors: John C Licciardone, Jennifer Beal, Nicole Fakes, Breanna Herron, Colleen Jacobs, and Aditi Vasudevan
Page Range: 45-53
Published in: Journal of Pain Management, 16#1 (2023)
ISSN: 1939-5914

Table of Contents

ABSTRACT

It is unclear if pain hypersensitivity, such as that elicited by pressure palpation of tender points in classical cases of fibromyalgia, is a cause or manifestation of chronic widespread pain (CWP). This study aimed to determine if pain hypersensitivity is an independent risk factor for progression from localized pain to CWP. Adult participants with chronic low back pain enrolled in the PRECISION Pain Research Registry from October 2017 through September 2022 were eligible for inclusion in this retrospective cohort study. The Pain Sensitivity Questionnaire was administered at enrollment and CWP was assessed to exclude participants with prevalent cases. The Cox proportional hazards model was then used to measure CWP risk at quarterly intervals for up to 36 months while simultaneously controlling for potential confounders. The mean age of 1,243 participants at enrollment was 53.1 years (SD, 13.4 years) and 76.1% were female. Their mean total pain sensitivity was 4.3 (SD, 1.9) and there were 320 (25.7%) prevalent CWP cases reported. Pain hypersensitivity was associated with CWP in the multivariable analysis of the overall sample (OR, 2.11; 95% CI 1.42-3.14; P < 0.001). A total of 252 (27.3%) incident cases of CWP were reported among 923 participants in the inception cohort over 36 months of follow-up. Pain hypersensitivity was not associated with CWP risk in the multivariable analysis of this cohort (HR, 1.06; 95% CI, 0.76-1.49; P = 0.73). However, pain catastrophizing emerged as an independent CWP risk factor. Pain hypersensitivity appears to be a manifestation rather than cause of CWP. Keywords: Pain hypersensitivity, chronic widespread pain, fibromyalgia, chronic low back pain, pain catastrophizing

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