Long-Term Changes in Musculoskeletal Pain Sites in the General Population: The HUNT Study

Abstract

In a Norwegian prospective population-based cohort study, we examined whether the number of chronic musculoskeletal pain sites changed over an 11-year period, and if the number of pain sites at follow-up was associated with health-related and lifestyle factors at baseline. The study included data on 78,973 adults participating in the Nord-Trøndelag Health Study (HUNT) in 1995-1997 (HUNT2) and 2006-2008. Based on three categories of baseline pain sites, associations between baseline health-related, lifestyle, and demographic factors and number of pain sites at follow-up were analysed with linear regression models adjusted for age, sex, marital status, physical activity, education, and other chronic diseases.We also estimated within-subject associations. Regardless of pain extent at baseline, anxiety and/or depression, sleeping problems, smoking, and obesity were positively associated with number of pain sites at follow-up, while education and physical activity were inversely associated with number of pain sites. The within-subject analyses showed largely similar associations for the health-related factors, whereas associations of lifestyle factors were attenuated. The mean number of pain sites remained unchanged between the two surveys.Overall, our study revealed prospective associations between several factors and pain sites 11 years later, regardless of the number of pain sites at baseline. PerspectiveThis prospective study examines the association between development of pain and risk factors in the general population, on the basis of three categories of baseline pain sites. It also examines how these factors influence possible long-term changes in pain within individuals.We demonstrate that having no or few baseline pain sites may not differ in its risk factors compared with having multiple pain sites. This article provides an important contribution to the ongoing debate regarding the association between lifestyle, demographic, and M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 3 psychosocial risk factors, versus the course of multisite chronic pain. Additionally, we provide discussion on potential directions for clinical relevance and further research in this field.

Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort

“…Low education level was a predictor for an increase in the 3 characteristics of pain (Tables II-IV multivariable models 1) and a predictor of pain intensity in multivariable model 2. In cross-sectional studies, low education has been related to CP intensity (56)(57)(58) and spread (2,5,31,59). These associations may reflect physical exposures in working life that are more common among individuals with low education, which contribute to the development of CP (60).…”

“…Longitudinal studies have investigated how CP itself, socio-demographic factors and comorbidities impact CP over time (2)(3)(4)(5)(6)(7)(8); however, the results of those studies often do not agree, and do not cover all important characteristics of pain. Some studies have predicted the presence of chronic widespread pain and/or spreading (of pain on the body) (2,(4)(5)(6). Other studies have predicted new onset of CP (3).…”

Insomnia Really Hurts: Effect of a Bad Night's Sleep on Pain Increases With Insomnia Severity

“…Between 50 and 88% of people with chronic pain who seek medical help also complain about insomnia (7, 8) and, vice versa, at least 40% of people with insomnia have chronic pain (9, 10). Disrupted sleep further predicts the frequency (11), extent (12), and intensity (13) of pain in the general population. Other somatic complaints besides pain have also been linked to insomnia, although such associations have been studied less extensively (14–16).…”

Mechanistic bases for the adverse interaction of nicotine and chronic pain

“…Similar findings of smoking exacerbating painful sensory experiences have been noted for neuropathic pain conditions such as sciatica, in which both current and history of smoking predict the incidence (OR as high as 2.5) and persistence (OR as high as 2.3) of nerve pain [45]. Smoking is also strongly linked to fibromyalgia and chronic widespread musculoskeletal pain, with smokers reporting an increased number of pain sites over time compared to nonsmokers [46][47][48][49].…”