As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes
Received 29 September 2017
Accepted for publication 9 November 2017
Published 26 January 2018 Volume 2018:11 Pages 237—254
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Katherine Hanlon
M Gabrielle Pagé,1,2 Maude Fortier,1 Mark A Ware,3–5 Manon Choinière1,6
1Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 2Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, 3Department of Family Medicine, 4Department of Anesthesia, Faculty of Medicine, 5Alan Edwards Centre for Research on Pain, McGill University, 6Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
Introduction: The presence of multiple coexisting chronic pain (CP) conditions (eg, low-back pain and migraines) within patients has received little attention in literature. The goals of this observational longitudinal study were to determine the prevalence of coexisting CP conditions, identify the most frequent ones and patterns of coexistence, investigate the relationships among patients’ biopsychosocial characteristics and number of CP conditions, and determine the impact of coexisting CP conditions on treatment response.
Patients and methods: A total of 3,966 patients attending multidisciplinary pain-treatment centers who were enrolled in the Quebec Pain Registry were included. Patients completed self-report and nurse-administered questionnaires before their first visit and 6 months later. Results were analyzed using descriptive statistics, factor and cluster analyses, negative binomials with log-link generalized linear models, and linear mixed-effect models.
Results: A third of patients reported coexisting CP conditions. No specific patterns of comorbidities emerged. The presence of coexisting CP conditions was associated with longer pain duration, older age, being female, and poorer quality of life. The presence of more than one CP condition did not have a clinically significant impact on treatment responses.
Discussion: The novelty of the study results relate to the heterogeneity that was found in the patterns of coexistence of CP conditions and the fact that having multiple CP conditions did not clinically impact treatment response. These results highlight the need for future research that examines causes of coexistence among CP conditions across the spectrum of CP, as opposed to focusing on specific conditions, and to examine whether multiple CP conditions impact on additional domains, such as treatment satisfaction. These results highlight the importance of studying the pathophysiological mechanisms underlying the development of coexisting CP conditions, in order eventually to prevent/minimize their occurrence and/or develop optimal treatment and management approaches.
Keywords: chronic pain, coexisting pain conditions, comorbidities, Quebec Pain Registry, cluster analysis
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