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Research ArticleOriginal Research

Prevalence and Impact of Comorbid Widespread Pain in Adults with Chronic Low Back Pain: A Registry-Based Study

John C. Licciardone and Vishruti Pandya
The Journal of the American Board of Family Medicine July 2020, 33 (4) 541-548; DOI: https://doi.org/10.3122/jabfm.2020.04.190456
John C. Licciardone
the Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX (JCL, VP).
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Vishruti Pandya
the Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX (JCL, VP).
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  • Article
  • Figures & Data
  • References
  • Info & Metrics
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Article Figures & Data

Figures

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    Figure 1.

    Flow of patients through the study.

  • Figure 2.
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    Figure 2.

    Clinical measures over 12 months of followup according to widespread pain group. Abbreviations: NRS, numeric rating scale; RMDQ, Roland-Morris Disability Questionnaire; SPADE, sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue; WP, widespread pain. Greater scores represent worse status on each clinical measure. Error bars represent 95% CI. P-values were computed using repeated measures analysis of variance. All WP groups were significantly different from one another in post-hoc comparisons for all clinical measures. A significant back-related disability X time interaction effect was also observed (P = .01).

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    Table 1.

    Baseline Sociodemographic, Clinical, and Psychological Characteristics of Patients (N = 358)

    CharacteristicNo.%
    Age, y
        21–4911131
        50–5912836
        60–7911933
    Sex
        Male10028
        Female25872
    Race
        White24869
        Non-White11031
    Ethnicity
        Non-Hispanic31387
        Hispanic4513
    Highest educational level
        High school diploma or lower9125
        Post-high school or some college14240
        College degree or higher12535
    Cigarette smoking status
        Never or former smoker29783
        Current smoker6117
    Chronic low back pain duration
        Less or equal to 5 y12836
        Greater than 5 y23064
    History of low back surgery
        No30184
        Yes5716
    Ever unemployed or unable to do usual work for one month or longer due to low back pain
        No22463
        Yes13437
    Ever received disability or workers' compensation benefits relating to low back pain
        No27376
        Yes8524
    Ever involved in a lawsuit or legal claim relating to low back pain
        No32190
        Yes3710
    History of comorbidities
        Herniated disc
            No23265
            Yes12635
        Sciatica
            No24167
            Yes11733
        Osteoarthritis
            No24268
            Yes11632
        Osteoporosis
            No31989
            Yes3911
        Heart disease
            No32190
            Yes3710
        Hypertension
            No21861
            Yes14039
        Diabetes
            No28379
            Yes7521
        Asthma
            No25672
            Yes10228
        Depression
            No19254
            Yes16646
    Pain catastrophizing (PCS score)
        Low (0–8)11231
        Moderate (9–22)12334
        High (23–52)12334
    Pain self-efficacy (PSEQ score)
        Low (0–28)11733
        Moderate (29–42)11632
        High (43–60)12535
    Current use of opioids for low back pain
        No22763
        Yes13137
    • Abbreviations: PCS, Pain Catastrophizing Scale; PSEQ, Pain Self-Efficacy Questionnaire.

    • View popup
    Table 2.

    Factors Associated with Widespread Pain (N = 358)

    FactorUnivariate AnalysisMultivariate Analysis
    OR95% CIPOR95% CIP
    Age, y
        21–491……1……
        50–591.60.8–3.3.171.30.6–3.1.49
        60–791.20.6–2.4.561.70.6–4.5.30
    Sex
        Male1……1……
        Female1.20.6–2.1.661.50.7–3.4.34
    Race
        White1……1……
        Non-White3.61.6–8.3.0024.11.5–10.8.01
    Ethnicity
        Non-Hispanic1……1……
        Hispanic1.20.5–3.1.651.80.6–5.5.29
    Highest educational level
        High school diploma or lower1……1……
        Post-high school or some college1.00.4–2.4.921.80.6–5.2.26
        College degree or higher0.20.1–0.6.0010.60.2–1.8.38
    Cigarette smoking status
        Never or former smoker1……1……
        Current smoker3.01.1–8.7.041.30.4–4.5.68
    Chronic low back pain duration
        Less than or equal to 5 y1……1……
        Greater than 5 y1.60.9–2.8.131.60.8–3.2.19
    History of low back surgery
        No1……1……
        Yes1.20.5–2.6.720.70.3–2.1.58
    History of comorbidities
        Herniated disc
            No1……1……
            Yes1.40.8–2.7.261.20.5–2.7.67
        Sciatica
            No1……1……
            Yes1.00.6–1.9.930.90.4–1.9.79
        Osteoarthritis
            No1……1……
            Yes1.40.7–2.6.331.00.5–2.4.92
        Osteoporosis
            No1……1……
            Yes1.30.5–3.50.610.80.2–2.90.77
        Heart disease
            No1……1……
            Yes1.20.5–3.3.711.70.5–5.7.40
        Hypertension
            No1……1……
            Yes1.30.7–2.4.390.90.4–1.9.70
        Diabetes
            No1……1……
            Yes2.51.0–6.0.0461.80.6-5.4.28
        Asthma
            No1……1……
            Yes1.00.5–1.9.990.60.3–1.3.18
        Depression
            No1……1……
            Yes2.51.3–4.6.0040.80.4–2.0.69
    Pain catastrophizing (PCS score)
        Low (0–8)1……1……
        Moderate (9–22)4.32.2–8.7<.0014.72.1–11.0<.001
        High (23–52)12.14.6–32.2<.0016.82.1–22.1.002
    Pain self-efficacy (PSEQ score)
        Low (0–28)1……1……
        Moderate (29–42)0.40.2–1.0.0520.70.2–2.1.55
        High (43–60)0.20.1–0.4<.0010.70.2–2.2.52
    Currently using opioids for low back pain
        No1……1……
        Yes3.51.7–7.5.0012.10.8–5.4.12
    • Results are for widespread pain (either non-persistent or persistent) relative to no widespread pain. Multivariate analysis included all univariate factors.

    • Abbreviations: PCS, Pain Catastrophizing Scale; PSEQ, Pain Self-Efficacy Questionnaire; OR, odds ratio; CI, confidence interval.

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The Journal of the American Board of Family     Medicine: 33 (4)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 4
July-August 2020
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Prevalence and Impact of Comorbid Widespread Pain in Adults with Chronic Low Back Pain: A Registry-Based Study
John C. Licciardone, Vishruti Pandya
The Journal of the American Board of Family Medicine Jul 2020, 33 (4) 541-548; DOI: 10.3122/jabfm.2020.04.190456

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Prevalence and Impact of Comorbid Widespread Pain in Adults with Chronic Low Back Pain: A Registry-Based Study
John C. Licciardone, Vishruti Pandya
The Journal of the American Board of Family Medicine Jul 2020, 33 (4) 541-548; DOI: 10.3122/jabfm.2020.04.190456
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