Background/Purpose: A small number of studies have examined the long-term consequences of having chronic widespread pain (CWP). Most report premature mortality, but the magnitude and type of excess mortality has varied considerably between studies. We report the largest study to examine mortality, and possible lifestyle mediators of premature mortality, amongst person with CWP.

Methods: UK Biobank involves 502,627 persons aged 40-69 years recruited in 2006-10. At recruitment, participants completed touch-screen questionnaires about health and lifestyle, including questions on pain. Those who reported “pain all over the body” that had lasted >3 months were defined as having CWP. Body mass index (BMI) was determined by measuring height and weight. Lifestyle factors measured included days of moderate/vigorous physical activity in a typical week; frequency of alcohol consumption; amount of fruit and vegetables consumed; smoking status. Vital status was determined through record linkage to national registers up to 2015. The relationship between CWP and mortality was analysed by Poisson regression and expressed as Mortality Rate Ratio (MRR) with 95% Confidence Intervals.

Results: The prevalence of CWP was 1.4% (female v. male 1.7%, 1.1%; peak prevalence 50-59 years 1.7%) and at the time of current follow-up 12,799 persons had died after a mean of 46.5 months. Mortality was higher amongst those with CWP compared to those without chronic pain (5.7% v 2.5%; MRR_{adj age/sex} 2.4 95% CI 2.1,2.6). The difference was attenuated after adjustment for markers of lifestyle (1.6 _{adj full} 1.4,1.8) but did not further change excluding deaths occurring in the first two years of follow-up. Specific causes which were in excess included death from cardiovascular disease (2.9  _{age/sex adj} , 1.9 _{full adj} 95% CI (1.5,2.4)), respiratory disease (5.0 _{age/sex adj}, 2.4 _{full adj}  95% CI (1.7, 3.5)) and cancer (1.7 _{age/sex adj} , 1.2 _{full adj} 95% CI (1.01,1.4)).

Conclusion: This study provides the strongest evidence to date that persons with CWP experience long-term excess mortality. An important part of this excess risk is explained by lifestyle factors which should be targets for intervention, alongside current best care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/chronic-widespread-pain-associated-with-premature-mortality-in-a-uk-national-prospective-study/