Clinical Characteristics of Pain Among Five Chronic Overlapping Pain Conditions

Richard Ohrbach, Sonia Sharma, Roger B Fillingim, Joel D Greenspan, Jonathan D Rosen, Gary D Slade, Richard Ohrbach, Sonia Sharma, Roger B Fillingim, Joel D Greenspan, Jonathan D Rosen, Gary D Slade

Abstract

Aims: To describe the pain characteristics of five index chronic overlapping pain conditions (COPCs) and to assess each COPC separately in order to determine whether the presence of comorbid COPCs is associated with bodily pain distribution, pain intensity, pain interference, and high-impact pain of the index COPC.

Methods: Data were from a convenience sample of 655 US adults, of whom 388 had one or more of the five COPCs: painful temporomandibular disorders, headache, low back pain, irritable bowel syndrome, and/or fibromyalgia. Data were collected using pain location checklists and self-report questions regarding pain attributes. The contributions of the COPCs to reported pain intensity and interference were assessed using multivariable regression models.

Results/conclusion: Heat maps from a pain body manikin illustrated that very little of the body was pain free within these COPCs. All pain attributes were the most severe for fibromyalgia and the least severe for irritable bowel syndrome. Within each index COPC, pain intensity, pain interference, and the proportion of participants with high-impact pain increased with each additional comorbid COPC up to four or more COPCs (including the index COPC) (P < .01). High-impact pain associated with an index COPC was influenced by type and number of comorbid COPCs, largely in a gradient-specific manner.

Figures

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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
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Questionnaire Used in the Study.
Fig 1
Fig 1
Heat map of manikin-based pain sites for pain lasting 1 day or longer within the prior 3 months for each index COPC. The color spectrum refers to the proportion of individuals with pain reported at the given site on the manikin. The skewed scaling of the color spectrum allows for the detection of body areas reported as painful by relatively few participants, with red color saturation starting at areas reported by approximately one-third of the participants. Non-COPC = individuals not meeting criteria for any of the five listed COPCs.
Fig 2
Fig 2
Pain characteristics for each index COPC. The index condition alone is represented by one COPC. Core measures from the Graded Chronic Pain Scale (GCPS) are measured as mean (standard error). The values of each measure are plotted for each index COPC according to the number of comorbid COPCs. Sample sizes (n) are based on weighted analyses: TMD = 107; headache = 201; IBS = 134; LBP = 99; fibromyalgia = 24. (a) Characteristic Pain Intensity (CPI). (b) Pain interference of index COPC. (c) Number of work days missed due to pain. (d) Percent (standard error) of individuals within each COPC reporting high-impact pain (%HIP), as based on Grades 2b and above from the GCPS.

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