The impact of chronic widespread pain on health status and long-term health predictors: a general population cohort study

Sammanfattning: Background: Previous research states that chronic widespread pain (CWP) has a negative impact on health status and daily life activities. Risk factors for developing CWP are, e.g. female sex, other chronic diseases, smoking, inactivity, sleeping problems and obesity. The average prevalence of CWP is 9.6-15% in the general population. The results vary regarding sex differences in prevalence, pain experience, impact on daily life, work, and health status. Therefore, the overall aim was to investigate CWP’s impact on health status and long-term lifestyle predictors for better health when having CWP. Method: The study is a general population cohort study including 975 participants (442 men, 533 women) at the age of 35-54 years with a 12- and 21-year follow-up. CWP was defined according to the American College of Rheumatology’s (ACR) definition stating pain must be present for at least three months, below and above the waist, on both sides of the body, and the axial skeleton to be classified as widespread. Using a pain mannequin and additional questions the individuals were sorted in three different pain groups: no chronic pain (NCP), chronic regional pain (CRP), and CWP. The questionnaire included questions about lifestyles factors (personal support, friendship circuit, smoking, alcohol intake, physical activity and sleeping habits) and SF-36 measuring health status. Differences in health status were analysed by independent samples t-test and health predictors by logistic regression analysis. The results were further analysed using Tengland’s two-dimensional health theory and the relational gender theory. Results: The prevalence of CWP was higher among women during all time points, but health status was statistically significant reduced for both women and men with CWP (p <0.001) showing no sex differences of clinical relevance. At the 12-year follow-up, 58% of the women and 53% of the men had persistent CWP (p <0.001). At the 21-year follow-up, 59% of the women and 29% of the men had persistent CWP (p <0.001). Health predictors for better health when having persistent CWP were male sex (OR 3.03-6.76), having social support (OR 9.27), no sleeping problems (OR 3.48-4.76), being a former smoker (OR 4.38-7.83) and a weekly intake of alcohol (OR 4.94). Conclusion: More women reported persistent CWP in a 12- and 21-year perspective than men, but when having CWP the health status was equally as bad among women and men. Modifiable health factors such as having no sleeping problems was strongly associated with better mental health, and personal support could be of importance for a better vitality. The higher prevalence reported among women and male sex as a health predictor seems to be influenced by the psychosocial mechanisms of gender. However, health status did not show any association with the relational gender theory. The results suggests, even though men have less prevalence of CWP the condition should be regarded as having the same impact for women and men in health care. Further research should continue studying persistent CWP and possible confounders to establish the sex and gender differences in the long-term perspective.