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Is Chronic Widespread Pain a Predictor of All-Cause Morbidity?
A 3 Year Prospective Population Based Study in Family Practice
UMESH T. KADAM, ELAINE THOMAS, and PETER R. CROFT ABSTRACT. Objective. To investigate whether chronic widespread pain predicts illness seen in general practice in a 3 year followup period. Methods. A postal questionnaire was conducted in an adult family practice population sample of 3968, and there were 2606 responders (66%). From the 2296 responders who consented to their record review, we identified 184 subjects with chronic widespread pain and assessed their outcome based on the first recorded morbidity within each of 15 categories during a 3 year followup period of computerized family practice records. Psychological distress at baseline was also measured using the Hospital Anxiety and Depression scale. Results. Of the survey responders, 2089 subjects (91%) completed the full 3 year followup period. Out of the 15 main morbidity categories examined, 11 were associated with pain status at baseline. The strongest associations between chronic widespread pain at baseline and subsequent morbidity, adjusted for age, sex, and social deprivation, were for musculoskeletal (MSK) disorders (rate ratio 4.36; 95% confidence interval 3.2–5.9), accidents (2.46; 95% CI 1.2–5.1), mental health disorders (2.24; 95% CI 1.5–3.3), dermatological disorders (2.16; 95% CI 1.6–2.9), and infections (1.96; 95% CI 1.3–2.9). Controlling for psychological distress reduced the strength of associations between chronic widespread pain and future morbidity, but 9 of the 11 were still statistically significant. In the 3 year followup period, an estimated 7.7% of all non-MSK and 12.6% of all MSK morbidity consultations were related to chronic widespread pain as reported at baseline. Conclusion. People who report chronic widespread pain subsequently consult more frequently about non-MSK and MSK problems than people with no pain, and this is not explained by psychological distress. The overall impact on healthcare use is substantial. Our study provides more evidence for overlap and links between morbidities that may be part of a larger pathological or somatization syndrome. (J Rheumatol 2005;32:1341-8) Key Indexing Terms:
PAIN From the Primary Care Sciences Research Centre, Keele University, Staffordshire, United Kingdom. Supported by a MRC Training Fellowship in Health Services Research for Dr. Kadam. U.T. Kadam, MD, MRC Fellow in Health Services Research; E. Thomas, PhD, Research Fellow in Biostatistics; P.R. Croft, MD, Professor of Epidemiology. Address reprint requests to Dr. U. Kadam, Primary Care Sciences Research Centre, Keele University, Staffordshire, ST5 5BG, United Kingdom. E-mail: u.kadam@cphc.keele.ac.uk Accepted for publication February 28, 2005. |