People with multimorbidity, i.e., two or more long-term health conditions, showed a greater association with chronic pain, according to a new study (“Prevalence of chronic pain in LTCs and multimorbidity: A cross-sectional study using UK Biobank”) by researchers from the University of Glassgow and published in the Journal of Multimorbidity and Comorbidity.

The team says their work represents the first study of the prevalence of chronic pain in people with a broad range of long-term conditions and different levels of multimorbidity.

“We examined the relationship between number/type of LTCs (N = 45) in UK Biobank participants (n = 500,295) who self-reported chronic pain lasting ≥3 months in seven body sites or widespread. Relative risk ratios (RRR) for presence/extent of chronic pain sites were compared using logistic regression adjusted for sociodemographic (sex/age/socioeconomic status) and lifestyle factors (smoking/alcohol intake/BMI/physical activity),” write the investigators.

“[In the study,] 218,648 participants self-reported chronic pain. Of these, 69.1% reported ≥1 LTC and 36.2% reported ≥2 LTCs. In 31/45 LTCs examined, >50% of participants experienced chronic pain. Chronic pain was common with migraine/headache and irritable bowel syndrome where pain is a primary symptom, but also with mental health conditions and diseases of the digestive system. Participants with >4 LTCs were over three times as likely to have chronic pain (RRR 3.56, 95% confidence intervals (CIs) 3.44–3.68) and 20 times as likely to have widespread chronic pain (RRR 20.13, 95% CI 18.26–22.19) as those with no LTCs.

Chronic pain is extremely common across a wide range of LTCs. People with multimorbidity were at higher risk of having a greater extent of chronic pain. These results show that chronic pain is a key factor for consideration in the management of patients with LTCs or multimorbidity.

The study found that over half (53.8%) of people with two or three long term conditions, and around 75% of those with four or more long-term conditions, reported at least one site of chronic pain. This means that, respectively, those people were twice as likely and four times as likely to experience chronic pain than that of a person with no long-term conditions.

Defining chronic pain

Chronic pain is defined as pain lasting for three months or more; and may be experienced in relation to a specific body site, such as low back pain, or be present in multiple sites of the body. A recent study reported that approximately 43% of U.K. adults live with chronic pain; and between 11% and 17% report widespread pain.

“This study is important because it highlights a much-neglected area of healthcare–namely the coexistence of chronic pain and multimorbidity,” explained Barbara Nicholl, PhD, senior lecturer at the university’s Institute of Health and Wellbeing. “Our study shows that the presence of chronic pain should be a key factor for consideration in the management of patients with two or more other long-term conditions. Going forward, this area needs more research and clinical consideration.

“It’s vital for healthcare providers to understand the impact of chronic pain on health-related outcomes in order to inform the needs and management of care in people who experience chronic pain alongside other long-term conditions.”

“These findings are important not only to improve our understanding of chronic pain associated with multiple long-term conditions but will also lead to improved management and treatments for the millions of people who experience the devastating impact of living with pain,” added Neha Issar-Brown, PhD, director of research at Versus Arthritis.

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