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Exploring the relationships between multisite musculoskeletal pain, pain characteristics, and physical function: a
Wren Burton1,2, Yan Ma3,4, Cynthia R Long5
1Osher Center for Integrative Health, Brigham and Women's Hospital, Harvard Medical School, 850 Boylston St. Suite #422, Boston, MA, 02445, USA. wmburton@bwh.harvard.edu.
Objective:
Multisite musculoskeletal pain is highly prevalent and negatively impacts physical function through several potential mechanisms. However, it remains unclear how the number of affected pain regions relates to function. This study explored associations between different aspects of pain (global pain intensity, catastrophizing, kinesiophobia, pain interference) and physical function in individuals with multisite pain.
Methods:
This cross-sectional analysis included 101 participants aged 18-85 years. Multisite pain was assessed across eight anatomic regions, using binary questions, with scores based on total affected sites. A composite function score was derived via principal component analysis from self-reported physical function, objective gait speed, and clinician-assessed dynamic balance. Hierarchical multivariable linear regression models examined the associations between number of pain regions and composite function, adjusting for age, sex and BMI, with sequential addition of global pain intensity, catastrophizing, kinesiophobia, and pain interference.
Results:
Participants (aged 40 ± 17.6; 69% women) reported a median of 2 (IQR 1-3) pain regions. After adjusting for demographics, a greater number of reported pain regions correlated with worse composite physical function (ß: -0.16; 95% CI (-0.31 to -0.01); R² = 0.520, ΔR² = 0.205). Global pain intensity explained additional variance in physical function (ß: -0.20; 95% CI -0.30 to -0.10);R² = 0.589, ΔR² = 0.069), whereas catastrophizing, kinesiophobia, and pain interference contributed minimally.
Conclusions:
Greater number of pain regions was associated with worse composite function, and global pain intensity explained additional variance in this relationship. The independent contributions of catastrophizing, kinesiophobia, and pain interference to composite function were minimal when examined alongside this cumulative pain burden, though findings should be interpreted with caution and replicated in larger samples, with longitudinal designs to clarify the directionality of these relationships. Results are consistent with biopsychosocial understandings of multisite pain in which cumulative pain burden, psychological factors, and functional outcomes are interconnected through overlapping pathways.
