Abstract
This study was performed to test whether the risk of developing chronic widespread pain (CWP) in those with regional pain was augmented in those with symptoms of neuropathic pain (NP). Persons free of CWP completed the Douleur Neuropathique 4 (scores ≥3 indicating NP); demographics; Hospital Anxiety and Depression scale; Pittsburgh Sleep Quality Index; and pain medications. Participants were classified as having no pain, regional pain with no symptoms of NP ((Equation is included in full-text article.)), or regional pain with symptoms of NP (NP). At the 12-month follow-up, participants with CWP were identified. Logistic regression estimated the odds ratio, with 95% confidence intervals, of CWP in the (Equation is included in full-text article.)and NP groups compared with no pain, and NP compared with (Equation is included in full-text article.). Partial population attributable risks estimated the proportion of CWP attributable to baseline (Equation is included in full-text article.)or NP exposure. One thousand one hundred sixty-two participants completed the baseline DN4 and provided pain data at follow-up: 523 (45.0%) had no baseline pain, 562 (48.4%) (Equation is included in full-text article.), and 77 (6.6%) NP. One hundred fifty-three (13.2%) had CWP at 12 months: 19 (3.6%) no pain, 108 (19.2%) (Equation is included in full-text article.), and 26 (33.8%) NP. (Equation is included in full-text article.)(2.9 [1.9-4.3]) and NP (2.1 [1.1-4.0]) predicted CWP after adjusting for demographics, Hospital Anxiety and Depression scale, Pittsburgh Sleep Quality Index, and medications. The partial population attributable risk was 41.3% (25.2-54.0) for (Equation is included in full-text article.)and 6.0% (0.1-11.6) for NP. The NP group were not more likely to develop CWP when compared directly with (Equation is included in full-text article.)(1.5 [0.8-2.8]). Neuropathic pain was relatively rare and predicted a small number of new-onset CWP cases. Using these estimates, treatments targeting NP would at best prevent 6% of CWP cases.
Highlights
Chronic widespread pain (CWP), the clinical hallmark of fibromyalgia,[47] is a significant health burden: it affects 11% of the general population,[31] is associated with higher disability,[44] and increases mortality[30] most likely through reduced physical function.[40]
Logistic regression estimated the odds of CWP first in the neuropathic pain (NP) and NP groups compared with the no pain group, second in the NP group compared with the NP group, and for the individual pain characteristics with those participants not reporting the characteristic being classified as the referent group
The proportion of participants classified as CWP at follow-up was significantly higher among those with NP (19.2%) and those with NP (33.8%), when compared with the proportion in those reporting no pain at baseline (3.6%)
Summary
Chronic widespread pain (CWP), the clinical hallmark of fibromyalgia,[47] is a significant health burden: it affects 11% of the general population,[31] is associated with higher disability,[44] and increases mortality[30] most likely through reduced physical function.[40]. The heritability of NP and CWP is correlated and the genetic predisposition to NP shared with CWP.[35] There are no prospective studies testing whether the risk of developing CWP in those with regional pain is augmented by the presence of NP.
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