Rheumatology Advance Access originally published online on November 4, 2006
Rheumatology 2007 46(4):666-671; doi:10.1093/rheumatology/kel363
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The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study
Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, 1Endocrine Sciences Research Group, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, 2University Department of Psychiatry, Royal Liverpool University Hospital, Liverpool, L69 3GA, 3Department of Psychiatry, Rawnsley Building, The University of Manchester, M13 9WL and 4Epidemiology Group, Department of Public Health, University of Aberdeen, School of Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
Correspondence to: Dr John McBeth, Arthritis Research Campaign (ARC) Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK. E-mail: john.mcbeth{at}manchester.ac.uk
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Abstract |
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Objective. Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community.
Methods. In a population-based prospective study, 3171 adults aged 25–65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory.
Results. 324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales.
Conclusion. Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.
KEY WORDS: Pain, Psychosocial, Risk factors, Prospective
Submitted 29 March 2006;
revised version accepted 21 September 2006.
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