A systematic review of risk factors associated with transitioning from regional musculoskeletal pain to chronic widespread pain

Abstract

Chronic widespread pain has limited treatment options and is associated with pronounced negative individual and socioeconomic consequences. Patients with local or regional pain may be at a risk for developing chronic widespread pain. Knowledge of such risk factors can help prevent chronic widespread pain. This study systematically reviews the literature that examines risk factors associated with developing chronic widespread after developing chronic regional pain. We conducted a three-step database search in Medline. Four articles from the authors' files formed a core set of articles that were used to validate the search strategy. We conducted a systematic quality assessment of the included studies. Based on risk estimations reported in six prospective population-based studies and one retrospective study on pain, this study identified five risk factors: female sex, higher age, family history of pain, depressed mode and pain sites at baseline. As only a few studies were recovered, the impact of these factors is unclear. Spreading of pain from local or regional pain to widespread pain occurs in a large proportion of the general population. Few studies have addressed similar risk factors and the few risk factors associated with the transition from chronic regional pain to chronic widespread pain are inconsistent. Studies that focus on this transition have included few subjects and few possible risk factors. Future studies should explore more possible risk factors.

Even Worse — Risk Factors and Protective Factors for Transition from Chronic Localized Low Back Pain to Chronic Widespread Pain in General Practice

“…[34][35][36][37] Beyond that, female sex seems to be a risk factor for the onset of CWP among patients with CLBP. [9][10][11] The results of our study confi rm this assumption.…”

“…There are discrepancies to the systematic review by Larsson et al , 10 who reported an association of "age" and "depression" with pain generalization. However, apart from methodological limitations, none of the included studies investigated the infl uence of somatization, which may have confounded the association of depression and onset of CWP.…”

“…Pain generalization occurred in 18% (minimum 9% to maximum 25%) of the subjects. 10 Identifi ed risk factors were female sex, higher age, family history of pain, depressed mood, and pain sites. The data were based on 6 studies, 5 of which 4-8 were population-based prospective studies.…”

Endocannabinoids and Related Lipids in Chronic Pain: Analytical and Clinical Aspects

“…Compared to patients with a localized or regional chronic pain, CWP patients experience multiple pain sites and often experience high levels of anxiety and depression [14]. Although CWP often starts as a local or regional pain condition [15], the cause of the spreading of the pain remains unclear. Risk factors for CWP include female, higher age, depression, and family history of pain, but there is no clear consensus [15].…”

“…Although CWP often starts as a local or regional pain condition [15], the cause of the spreading of the pain remains unclear. Risk factors for CWP include female, higher age, depression, and family history of pain, but there is no clear consensus [15]. Central and peripheral sensitization processes and defects in the inhibitory pain modulation pathways, as described above, could possibly explain the neurophysiological factors associated with CWP.…”