Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality
1Arthritis Research Campaign (ARC) Epidemiology Unit, Epidemiology Research Group, Research School of Translational Medicine, University of Manchester, Manchester, 2ARC House, Chesterfield, 3National Primary Care Research and Development Centre, 4Psychiatry and Health Methodology Research Groups, School of Community Based Medicine, University of Manchester, Manchester, 5Tameside General Hospital, Ashton-Under-Lyne and 6Aberdeen Pain Research Collaboration (Epidemiology Group), Department of Public Health, University of Aberdeen, School of Medicine, Aberdeen, UK.
Correspondence to: J. McBeth, Arthritis Research Campaign (ARC) Epidemiology Unit, Epidemiology Research Group, Research School of Translational Medicine, Stopford Building, University of Manchester, Manchester, M13 9PT, UK. E-mail: john.mcbeth{at}manchester.ac.uk
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Abstract |
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Objectives. To test the hypothesis that individuals with regional and widespread pain disorders have an increased risk of mortality.
Methods. We conducted a prospective cohort study of 4515 adults. Subjects were an age- and sex-stratified sample who had participated in a population study of pain occurrence during 1996. Based on those reports subjects were classified as having no pain, regional pain or widespread pain. All subjects were identified on the National Health Service Central Register and followed up until April 2005, a total of 8.2 yrs, at which time information was obtained on vital status, and if applicable, date and cause of death. The relationship between pain status and subsequent death is expressed as mortality rate ratios with 95% CIs, adjusted for age, gender, ethnicity and practice.
Results. A total of 35.2% reported regional pain and 16.9% satisfied criteria for widespread pain. In comparison with those without pain, there was a 20% and 30% increased risk of dying over the follow-up period among subjects with regional and widespread pain, respectively. The specific causes of death in excess were cancer and cardiovascular disease. In addition, the mortality risk from both cancer and cardiovascular deaths was found to increase as the number of pain sites that subjects reported increased.
Conclusions. This study supports a previous observation that persons with regional and widespread pain are at an increased risk of cancer death. Possible mechanisms should be explored.
KEY WORDS: Pain, Musculoskeletal, Mortality, Cancer, Cardiovascular, Epidemiology, Population-based study, Prospective, Mechanisms
Submitted 7 January 2008;
revised version accepted 6 October 2008.
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J. McBeth, D. P. Symmons, A. J. Silman, R. Webb, and G. J. Macfarlane Comment on: Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality: reply Rheumatology, May 1, 2009; 48(5): 595 - 595. [Full Text] [PDF]
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