Chronic Pain and Mortality: A Systematic Review

Background Chronic pain is common, often widespread and has a substantial impact on health and quality of life. The relationship between chronic pain and mortality is unclear. This systematic review aimed to identify and evaluate evidence for a relationship between chronic pain and mortality. Methods A search of ten electronic databases including EMBASE and MEDLINE was conducted in March 2012, and updated until March 2014. Observational studies investigating the association between chronic or widespread pain (including fibromyalgia) and mortality were included. Risk of bias was assessed and a meta-analysis was undertaken to quantify heterogeneity and pool results. A narrative review was undertaken to explore similarities and differences between the included studies. Results Ten studies were included in the review. Three reported significant associations between chronic or widespread pain and mortality in unadjusted results. In adjusted analyses, four studies reported a significant association. The remaining studies reported no statistically significant association. A meta-analysis showed statistically significant heterogeneity of results from studies using comparable outcome measures (n = 7)(I2 = 78.8%) and a modest but non-significant pooled estimate (MRR1.14,95%CI 0.95–1.37) for the relationship between chronic pain and all-cause mortality. This association was stronger when analysis was restricted to studies of widespread pain (n = 5,I2 = 82.3%) MRR1.22(95%CI 0.93–1.60). The same pattern was observed with deaths from cancer and cardiovascular diseases. Heterogeneity is likely to be due to differences in study populations, follow-up time, pain phenotype, methods of analysis and use of confounding factors. Conclusion This review showed a mildly increased risk of death in people with chronic pain, particularly from cancer. However, the small number of studies and methodological differences prevented clear conclusions from being drawn. Consistently applied definitions of chronic pain and further investigation of the role of health, lifestyle, social and psychological factors in future studies will improve understanding of the relationship between chronic pain and mortality.

[1]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[2]  A. Woolf,et al.  The need to address the burden of musculoskeletal conditions. , 2012, Best practice & research. Clinical rheumatology.

[3]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[4]  K. Jordan,et al.  Incidence of prostate, breast, lung and colorectal cancer following new consultation for musculoskeletal pain: A cohort study among UK primary care patients , 2013, International journal of cancer.

[5]  P. Austin,et al.  Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. , 1999, The New England journal of medicine.

[6]  F. Wolfe,et al.  Mortality in fibromyalgia: A study of 8,186 patients over thirty‐five years , 2011, Arthritis care & research.

[7]  A. Breen,et al.  Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study. , 2007, Rheumatology.

[8]  D. Voskuil,et al.  Physical Activity and Breast Cancer: A Systematic Review , 2007, Epidemiology.

[9]  John Lewis,et al.  Is pain fatiguing? A structured evidence-based review. , 2003, Pain medicine.

[10]  A. Reunanen,et al.  Low Back Pain and Subsequent Cardiovascular Mortality , 1995, Spine.

[11]  O. Ekholm,et al.  A Population-based Cohort Study on Chronic Pain: The Role of Opioids , 2010, The Clinical journal of pain.

[12]  A. Silman,et al.  The prevalence and associated features of chronic widespread pain in the community using the 'Manchester' definition of chronic widespread pain. , 1999, Rheumatology.

[13]  John McBeth,et al.  Epidemiology of chronic musculoskeletal pain. , 2007, Best practice & research. Clinical rheumatology.

[14]  K. O. Forseth,et al.  Mortality rate and causes of death in women with self-reported musculoskeletal pain: Results from a 17-year follow-up study , 2013, Scandinavian journal of pain.

[15]  F. Wolfe,et al.  The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity , 2010, Arthritis care & research.

[16]  Blair H. Smith,et al.  Pain and subsequent mortality and cancer among women in the Royal College of General Practitioners Oral Contraception Study. , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[17]  M. Hochberg,et al.  Mortality in osteoarthritis. , 2008, Clinical and experimental rheumatology.

[18]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[19]  K. Fagerström,et al.  The epidemiology of smoking: health consequences and benefits of cessation. , 2002, Drugs.

[20]  P. Bath,et al.  Identification of risk factors for 15-year mortality among community-dwelling older people using Cox regression and a genetic algorithm. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[21]  P. Tugwell,et al.  The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. , 1990, Arthritis and rheumatism.

[22]  H. Bliddal,et al.  Increased cancer risk in patients referred to hospital with suspected fibromyalgia. , 2007, Journal of Rheumatology.

[23]  Kay Dickersin,et al.  Systematic reviews in epidemiology: why are we so far behind? , 2002, International journal of epidemiology.

[24]  R. Colligan,et al.  Status of patients with chronic pain 13 years after treatment in a pain management center , 1998, Pain.

[25]  Jill Hayden,et al.  Evaluation of the Quality of Prognosis Studies in Systematic Reviews , 2006, Annals of Internal Medicine.

[26]  FRCP W. J. MacLennan MD,et al.  The Elderly , 1984, Treatment in Clinical Medicine.

[27]  H. Bliddal,et al.  Mortality in a cohort of Danish patients with fibromyalgia: increased frequency of suicide. , 2010, Arthritis and rheumatism.

[28]  Mortality and cancer in patients with new musculoskeletal episodes: a cohort study. , 2010, The British journal of general practice : the journal of the Royal College of General Practitioners.

[29]  Jie Ge,et al.  Does physical activity reduce the risk of prostate cancer? A systematic review and meta-analysis. , 2011, European urology.

[30]  Y. Khang,et al.  Gender differences in self-rated health and mortality association: role of pain-inducing musculoskeletal disorders. , 2010, Journal of women's health.

[31]  A. Silman,et al.  Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality , 2008, Rheumatology.

[32]  S. Studenski,et al.  Fatigue Predicts Mortality in Older Adults , 2008, Journal of the American Geriatrics Society.

[33]  C. Power,et al.  Diet, lifestyle and chronic widespread pain: results from the 1958 British Birth Cohort Study. , 2011, Pain research & management.

[34]  B. Natvig,et al.  Localized or widespread musculoskeletal pain: Does it matter? , 2008, PAIN.

[35]  M. Makela,et al.  Prevalence of primary fibromyalgia in the Finnish population. , 1991, BMJ.

[36]  D. Warburton,et al.  Health benefits of physical activity: the evidence , 2006, Canadian Medical Association Journal.

[37]  I. Kåreholt,et al.  Pain and mortality risk among elderly persons in Sweden , 1998, Pain.

[38]  E. Tacconelli Systematic reviews: CRD's guidance for undertaking reviews in health care , 2010 .

[39]  Tania B. Huedo-Medina,et al.  Assessing heterogeneity in meta-analysis: Q statistic or I2 index? , 2006, Psychological methods.

[40]  H. Andersson Increased mortality among individuals with chronic widespread pain relates to lifestyle factors: A prospective population-based study , 2009, Disability and rehabilitation.

[41]  M. Speechley,et al.  Chronic pain in Canada--prevalence, treatment, impact and the role of opioid analgesia. , 2002, Pain research & management.

[42]  A. Mykletun,et al.  Levels of anxiety and depression as predictors of mortality: the HUNT study , 2009, British Journal of Psychiatry.

[43]  A. Silman,et al.  The prevalence of chronic widespread pain in the general population. , 1993, The Journal of rheumatology.

[44]  H. Andersson The course of non‐malignant chronic pain: a 12‐year follow‐up of a cohort from the general population , 2004, European journal of pain.

[45]  Douglas G. Altman,et al.  Systematic Reviews in Health Care , 2001 .

[46]  J. Pearl,et al.  Causal diagrams for epidemiologic research. , 1999, Epidemiology.

[47]  C. Crane,et al.  Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links , 2006, Psychological Medicine.

[48]  T. Brandon,et al.  Pain as a motivator of smoking: effects of pain induction on smoking urge and behavior. , 2008, Journal of abnormal psychology.

[49]  J. Penttinen Back pain and risk of fatal ischaemic heart disease: 13 year follow up of Finnish farmers , 1994, BMJ.

[50]  A. Silman,et al.  Association of widespread body pain with an increased risk of cancer and reduced cancer survival: a prospective, population-based study. , 2003, Arthritis and rheumatism.

[51]  F. Wolfe,et al.  Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia , 2011, The Journal of Rheumatology.

[52]  S. Bergman Psychosocial aspects of chronic widespread pain and fibromyalgia , 2005, Disability and rehabilitation.

[53]  M. McDonagh,et al.  The American College of Rheumatology 1990 criteria for the classification of fibromyalgia , 2011 .

[54]  B. Collett,et al.  Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment , 2006, European journal of pain.

[55]  J. House,et al.  Social isolation kills, but how and why? , 2001, Psychosomatic medicine.

[56]  Blair H. Smith,et al.  Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study , 2010, European journal of pain.

[57]  W. Katon,et al.  Depression and pain comorbidity: a literature review. , 2003, Archives of internal medicine.

[58]  A. Silman,et al.  Widespread body pain and mortality: prospective population based study. , 2001, BMJ : British Medical Journal.

[59]  Blair H. Smith,et al.  Symptom experience and subsequent mortality: results from the West of Scotland Twenty-07 study , 2006, BMC Health Services Research.

[60]  K. Kroenke,et al.  Physical symptoms as a predictor of health care use and mortality among older adults. , 2005, The American journal of medicine.

[61]  G. Jones,et al.  Is the report of widespread body pain associated with long-term increased mortality? Data from the Mini-Finland Health Survey. , 2007, Rheumatology.

[62]  R. Lipton,et al.  Mechanisms of association between obesity and chronic pain in the elderly , 2011, PAIN®.

[63]  Ulf Lindblom,et al.  CLASSIFICATION OF CHRONIC PAIN , 2004 .