The role of psychosocial factors in predicting the onset of chronic widespread pain: results from a prospective population-based study.
OBJECTIVE
Chronic widespread pain (CWP) is strongly associated with psychosocial distress both in a clinical setting and in the community. The aim of this study was to determine the contribution of measures of psychosocial distress, health-seeking behaviour, sleep problems and traumatic life events to the development of new cases of CWP in the community.


METHODS
In a population-based prospective study, 3171 adults aged 25-65 yrs free of CWP were followed-up 15 months later to identify those with new CWP. Baseline data were available on their scores from a number of psychological scales including Illness Attitude Scales (IAS), Somatic Symptom Checklist (SSC), Hospital Anxiety & Depression Scale, Sleep Problems Scale, and Life Events Inventory.


RESULTS
324 subjects [10%, 95% confidence interval (CI) 9.2, 11.3] developed new CWP at follow-up. After adjustment for age and sex, three factors independently predicted the development of CWP: scoring three or more on the SSC [odds ratio (OR) 1.8, 95% CI 1.1, 3.1], scoring eight or more on the Illness Behaviour subscale of the IAS (OR 3.3, 95% CI 2.3, 4.8), and nine or more on the Sleep Problem Scale (OR 2.7, 95% CI 1.6, 3.2). Subjects exposed to all three factors were at 12 times the odds of new CWP than those with low scores on all scales.


CONCLUSIONS
Subjects are at substantial increased odds of developing CWP if they display features of somatization, health-seeking behaviour and poor sleep. Psychosocial distress has a strong aetiological influence on CWP.
Gupta
A
A
Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Stopford Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
Silman
A J
AJ
Ray
D
D
Morriss
R
R
Dickens
C
C
MacFarlane
G J
GJ
Chiu
Y H
YH
Nicholl
B
B
McBeth
J
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005356:Fibromyalgia / Q000209:etiology / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010342:Patient Acceptance of Health Care; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012893:Sleep Wake Disorders / Q000523:psychology