Risk factors for persistent chronic widespread pain: a community-based study

Background. Chronic widespread pain is the cardinal clinical feature of the fibromyalgia syndrome, which, in the majority of clinic patients, is persi stent. By contrast, in community-derived patients, pain is persistent in on ly half of the affected individuals, particularly those with psychological distress. Whether such distress is a consequence of the pain or a manifesta tion of a wider process of somatization which is associated with the persis tence of pain is unclear. Objectives. We tested in a large, prospective, population-based study thr h ypothesis that features of somatization predict the persistence of chronic widespread pain. Methods. In all, 252 (13%) of 1953 adult subjects selected from a populatio n register were classified as having chronic widespread pain based on a det ailed questionnaire which included a pain drawing. Thr patients also comple ted a number of psychosocial instruments which measure features known to be associated with somatization. Two hundred and twenty-five (91%) of the pat ients were successfully followed up after 12 months and provided data on pa in status using the same instruments. Results. In all, 126 (56%) patients reported chronic widespread pain at fol low-up. 74 (33%) reported other pain acid 25 (11%) reported no pain. Persis tent chronic widespread pain was strongly associated with baseline test sco res for high psychological distress and fatigue. In addition, these subject s were more likely to display a pattern of illness behaviour characterized by frequent visits to medical practitioners for symptoms which disrupt dail y activities. The prevalence of persistent pain increased with the number o f risk factors the subjects were exposed to. Conclusions. Although almost half of the eases of chronic widespread pain r esolved within 1 yr, this study has demonstrated for the first time that th ese subjects who display features of somatization are more likely to have w idespread pain which persists. These findings have implications for the ide ntification and treatment of poisons with persistent chronic widespread pai n.