Chronic Widespread Pain Patients More Likely to Die Early

Chronic Widespread Pain Patients More Likely to Die Early

Lifestyle may explain excess mortality in fibromyalgia and other chronic pain patients

https://www.medpagetoday.com/Rheumatology/Fibromyalgia/66955?xid=nl_mpt_Weekly_Education_2017-08-02&eun=g5705800d1r

People who have chronic widespread pain die earlier than those without chronic pain, reported new research from the United Kingdom, and lifestyle may play a significant role in their mortality.

Chronic widespread pain patients who participated in UK Biobank — a cohort of 500,000 people ages 40 to 69 recruited throughout Great Britain — had a mortality risk ratio (MRR) of 2.43 (95% CI 2.17-2.72), according to Gary J. Macfarlane, MD, PhD, of the University of Aberdeen, and colleagues. This excess risk was substantially reduced after adjusting for low levels of physical activity, high body mass index (BMI), poor quality diet, and smoking.

“The evidence is now clear that persons with chronic widespread pain experience excess mortality,” the researchers wrote in Annals of the Rheumatic Diseases. “UK Biobank results considerably reduce uncertainty around the magnitude of excess risk, and demonstrate that the risk is unlikely to be due to the experience of pain per se, but is substantially explained by lifestyle factors associated with having pain (poor diet, low levels of physical activity, smoking, higher BMI).”

It’s the largest study to examine the relationship between chronic widespread pain and mortality, the authors indicated, and has considerably more detailed information about potential mediators of any excess risk associated with widespread pain and death.

UK Biobank included 7,130 participants who reported “pain all over the body” for more than 3 months, and 281,718 people who did not have chronic pain. These two sub-cohorts represented the study population for the current analysis. Both groups had the same median age (58 years), but the chronic pain group was less likely to be male (36.3% versus 50%) and more likely to be heavier than normal weight (80.4% versus 63.5%). They also were twice as likely to be a current smoker (18.6% versus 9.3%) and were less physically active. Participants in UK Biobank were recruited throughout Great Britain from 2006 to 2010; information about deaths in this group was available through mid-2015.

The researchers found that, after adjusting for age and sex and excluding deaths that occurred in the first two years, participants with chronic widespread pain had a more than twofold risk of dying in the follow-up period. Adjusting for age and sex, they found that excess risk of death stemmed from cancer (MRR 1.73; 95% CI 1.46-2.05), cardiovascular disease (MRR 3.24; 95% CI 2.55-4.11), respiratory disease (MRR 5.66; 95% CI 4.00-8.03), and other disease-related causes (MRR 4.04; 95% CI 3.05-5.34).

They also examined to what extent factors associated with pain also predicted death. They found that age- and gender-adjusted risk of death was higher for participants in the two highest BMI categories than for people of normal weight: those who were 35-39 kg/m2 had an MRR of 5.54 (95% CI 5.08-6.03), and those 40kg/m2 or greater had an MRR of 9.02 (95% CI 8.23-9.89). They also observed that participants who reported no walking, versus those walking 1-100 minutes per week, had an MRR of 4.15 (95% CI 3.77-4.57). People who reported no moderate physical activity, versus those who reported 1-60 minutes of moderate physical activity per week, had an MRR of 2.95 (95% CI 2.74-3.19). Risk of death also was higher in current smokers, who had an MRR of 2.54 (95% CI 2.39-2.70) versus non-smokers.

When they adjusted the risk models to see how lifestyle variables like BMI, physical activity, smoking, and diet might attenuate the relationship between chronic widespread pain and excess mortality, they still saw an excess risk of cardiovascular and respiratory deaths, but no longer an excess risk of cancer death.

Lifestyle factors are important intervention targets for patients with chronic widespread pain, the authors concluded. They observed that optimal management of fibromyalgia should include exercise, for example, but that is not often provided in a structured way to help patients make long-term behavioral changes.

“Few patients with chronic widespread pain or fibromyalgia receive specific supported care in improving diet or stopping smoking,” they wrote. “The data from this study show that changing the habits of persons with chronic widespread pain to be similar to persons without chronic widespread pain could reduce mortality by around 35%.”

The researchers also incorporated their results into a meta-analysis with five other published reports to evaluate evidence linking pain and mortality. Studies included in the meta-analysis were observational, used a population sampling frame, identified widespread pain or chronic widespread pain (including fibromyalgia), and quantified the relationship between chronic widespread pain and death.

“The meta-analysis of this relationship shows that all 6 studies find excess mortality and estimate the excess risk across all studies at 59%, although there is significant heterogeneity,” the authors wrote. “Similar excesses of cancer and cardiovascular mortality are observed.”

“In UK Biobank, adjustment for lifestyle factors substantially reduced the excess risk, and this observation is consistent with them mediating the relationship between chronic widespread pain and mortality,” they added.

4 Responses

  1. To who it may concern, feel free to use my story of this horrible malady and the the Hell the now uninformed Public and some of the Media are putting us legitimate Chronic Pain Sufferers through! It is no more than local emotional Abuse ( and border line Domestic Emotional Terrorism )!on a scale with only Biblical proportions!To the Editor and Associates I have taken this opportunity to share my heart breaking story in hopes these witch hunting Opiate ill informed skeptics will read and understand that we as Millions Of Legitimate Chronic Pain Sufferers would have no life without Medically prescribed Opiates by a physicians care and strictly monitored monthly urine and blood test. Please remember that An Opinion Before A Thorough Investigation Is The Epitome Of Ignorance! And that a little more compassion from the Medical Field and its representatives could have saved my beautiful Stepdaughters life. Let me say this! A person who has a addictive personality will abuse anything that helps them feel better. I have taken Oxycontin for 14 years , I have had 24 major surgery’s in the past12 years. I have so much physical pain I can not even get out of bed with out pain meds and when I run out I run out and just lay in bed praying the Lord relieve me of this horrible condition and I pray God you pain medicine skeptics never go through what I go through every day of my life when the only thing you have to do is threaten what help I get, Shame on them! There will always be drug abuse and as the so called war on Illegal Drugs has failed all this will! All you do is stoke and aid the drug pushers business to knew heights in the Black Market of Heroin while trying to deprive folks as me to this horrible movement! My Stepdaughter committed suicide 4 years ago because of being treated like a drug addict by her family and doctors when all along she suffered from Lupus and Fibromyalgia which I believe was brought on by a deadly car crash at 18 , she told me between that which I was being put through and what they were putting her through she was not going to be able to live her life in such a hell brought on by people like the Biased Uniformed Skeptics that are on a witch hunt to out law Opiates and pain meds that give us some sort of a life . As a retired Police officer and worked indirectly close to the DEA, you people do not have a clue how thrilled you are making the illegal opiate trade and think of my Late Stepdaughter as you continue on with this 2017 Version of the ( 1940s Propaganda Film named REEFER MADNESS )movement to outlaw opiates! Just like the slaughter of children at Sandy Hook if there would have just been gun laws , my God they were Gun Laws , the guns that murdered all those 20 children were all registered and owned by a school teacher! You fight Drug Addiction in Elementary education by teaching all children the dangers of Booze and Tobacco which if these witch hunters want for us to know the real truth but they do not. I miss my Stepdaughter so much and some of us will continue on the fight to protect our right to feel better and function without fear of these witch hunters trying to convince us to commit suicide . And they are trying to do exactly THAT and are now being successful in this under the table practice of Human Genocide!
    The under line real truth it seems THESE witch hunters would rather us Chronic Pain sufferers commit suicide are and DRINK all the BOOZE we can drink! The Federals legalized it ( ALCOHOL) knowing its a more deadly drug than Strychnine. And just because the DEA has miserably failed with their witch hunt type movement on drugs why do they continuous fully deprive us sick people of our Constitutional Rights to be Happy in that pursuit of with Professional Physicians to take meds that give us relief of this horrible malady of Chronic Pain ! May God have mercy on their miserable souls they that seek to destroy us Chronic Pain Sufferers only and little hope of temporary relief of this horrible Chronic Pain Illness.
    Sincerely,
    Wayne S. Swanson II

  2. Simple,give them EFFECTIVE PAIN MEDICINE so it doesn’t physically hurt to MOVE,, dahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh,,,,,,maryw

    • Exactly, Mary. My dad’s health was never very good due to him being physically disabled and chronically-ill, however, when they quit giving him the pain med he’d taken for over 30 years, I watched him physically (and mentally) deteriorate. When he was on oxycodone, he could use his walker or cane to walk short distances (which was good for him). Within a year or so of his pain meds, he ended up in his wheelchair 24/7, unable to put just a few seconds of pressure on his hips. After this, his diabetes spun out of control because he could no longer get any exercise (he was also on oxygen 24/7, COPD, emphysema, chronic kidney failure, congestive heart failure, rheumatoid arthritis along with the 30 year old sepsis he carried in his hips – which had a drain surgically implanted so the nasty pus would drain outside his body instead of back in – 8 hip surgeries on one and two on the other due to asvascular necrosis in both hips – first set of surgeries were botched. It took him about 4 years to find another surgeon willing to clean up the fist surgeon’s mess. After he was yanked of his medication, he could no longer ride in a car and missed his only grandson’s high school graduation, which took place less than 5 miles from his house. He was in severe pain and could not even stand to put a few seconds of pressure on his hips to stand up and get in car. About six months prior to his death, he could only get to his dr appts by ambulance. Other than his dr appts, he went no where. When he was on his pain medication, I’d pick him up every day on my way to pick my son up from school. That’s not particularly exciting for most, but to him, getting out of the house even for just a few minutes meant so much to him. He was also able to go on 3 vacations with us (driving through Smokey Mountains, driving through Colorado and driving through Glacier and Yellowstone). He was able to go with us ONLY because his pain medication reduced his pain. Once they yanked him off, he could not even stroll himself onto his deck or take care of his beloved dog (which I adopted and brought her down to his house just about every day). So many people take it for granted that they’re able to load a dishwasher, get in and out of a car, put their own shoes on, take their fur-babies outside to potty, etc. I truly wish people would understand the difference that adequate pain relief can have on a person who is chronically ill and in severe pain.

    • I want to add that I’m so grateful for those years he was allowed pain medication. I have some wonderful, funny memories of him going on vacation with us. My dad hurt badly through his life and never complained (even when they yanked him off his med). He was active writing and calling our elected officials and loved to joke around and laugh. I think that’s the only way he stayed sane.

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