Chronic widespread pain and cause of death: a 25-year follow-up study

Chronic widespread pain (CWP) has been suggested as a risk factor for mortality in cardiovascular diseases and malignancies. Different definition of CWP makes it difficult to compare previous studies.

The aim was to study whether mortality and certain causes of death were increased among people with CWP and whether the definition of CWP influenced outcome.

This 25-year follow-up study included 2425 people from the general population, at baseline divided into 3 pain groups: CWP, chronic regional pain, and no chronic pain (NCP). Chronic widespread pain was defined according to the ACR1990 (CWP_ACR1990) and the more stringent WP2019 (CWP_WP2019) criteria. Causes of death were derived from official national register. Mortality, adjusted for age, sex, socioeconomic status, and smoking habits were analyzed with Cox regression.

Overall mortality was not higher in people with CWP_ACR1990 (hazard ratio [HR] 1.08, P = 0.484) compared with NCP but significantly higher when using CWP_WP2019 (HR 1.32, P = 0.033). People with CWP_WP2019 had a higher mortality in diseases of the circulatory system (HR 1.32, P = 0.033) but not for neoplastic diseases. CWP_ACR1990 showed an increased mortality in malignancies of digestive organs. An increased mortality in influenza, pneumonia, acute kidney failure, and chronic kidney disease was observed for the CWP_WP2019 definition.

The more stringent WP2019 definition of CWP showed an excess risk for death, especially within diseases of the circulatory system. The results suggest that WP2019 defines a more vulnerable group in the population. Chronic widespread pain should be acknowledged in the clinic as a risk factor for increased mortality.