Background & Aims

Chronic pain is one of the most debilitating conditions affecting millions of people worldwide.[1] The impact of chronic pain extends beyond physical discomfort, significantly influencing various aspects of individuals’ lives, including their psychological well-being and overall quality of life (QoL).[2] Understanding the predictors that contribute to the variability in QoL among patients with chronic pain is important for developing targeted interventions and improving patient outcomes. While numerous studies have explored the impact of chronic pain on various aspects of individuals’ lives, including psychological well-being and overall QoL, there remains a need for more extensive investigations into the longitudinal factors influencing QoL.[3] Many studies focus on cross-sectional assessments or have small sample sizes. We aimed to examine predictors for QoL in people with chronic pain.

Methods

Participants completed an online screening and self-report questionnaires as part of the Warwick Study of Mental defeat in Chronic pain, assessing sociodemographics, psychological variables, and other variables including QoL at 0, 6 and 12 months. QoL was assessed by the EuroQol-5 Dimension (EQ-5D-5L mapped to EQ-5D-3L value sets according to NICE guidelines and utility score normed to UK values). Linear multiple regression analysis with stepwise selection was conducted to examine which factors at baseline predict QoL at 12 months. In total, 23 factors were taken into consideration as potential predictor. Linear mixed-effects modeling with random intercept was used to investigate which factors are associated with QOL and whether this relation changes over time by examining interaction effects with time.

Results

527 people with chronic pain were enrolled. Pain interference (standardized regression coefficient [b]=-.173; p=.012), insomnia severity (b=-.204; p=<.001), depressive symptoms (b=-.225; p<.001), Body-map index (b=-.089; p=.05), Employment status (b=-.120; p=.004), pain duration (b=-.095; p=.023), pain severity (b=-.128; p=.033), medication use (b=-.086; p=.047) at baseline were predictors for QoL at 12 months. The regression model explained 46.9% of the total variance. The linear mixed model indicated that being employed (B=.060; p<.001), pain severity (B=-.037; p<.001), pain interference (B=-.019; p<.001), medication use (B=-.005; p<.001), insomnia severity (B=-.006; p<.001) and depressive symptoms (B=.0-15; p<.001) predict QoL (fixed effects) independent of time. QoL scores indicated a moderate health state at baseline (Mean[M]: .536; Standard deviation [SD]: .271), at 6 months (M: .537; SD: .264), and at 12 months follow-up (M: .538; SD: .284), indicating minimal change over time.

Conclusions

The strongest predictors for QoL 12 months later in people with chronic pain are pain interference with activities, insomnia severity, and depressive symptoms. Other weaker, but still significant predictors, are the amount of pain body sites, employment status (unemployed), pain duration, pain severity and medication use. Independent of time, pain interference with activities, insomnia severity, depressive symptoms, pain severity, employment status, and medication use are predictors for QoL. However, there is quite some overlap between the predictors (pain interference, pain severity, and depressive symptoms) and the QoL outcome (including the dimensions mobility, self-care, usual activities, pain/discomfort, and anxiety/depression).

References

[1] GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. Oct 17 2020;396(10258):1204-1222. doi:10.1016/s0140-6736(20)30925-9
[2] Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. May 29 2021;397(10289):2082-2097. doi:10.1016/s0140-6736(21)00393-7
[3] Dueñas M, Ojeda B, Salazar A, Mico JA, Failde I. A review of chronic pain impact on patients, their social environment and the health care system. J Pain Res. 2016;9:457-67. doi:10.2147/jpr.s105892

Presenting Author

Thomas Bilterys

Poster Authors

Thomas Bilterys

PhD

University of Warwick

Lead Author

Kristy Themelis

PhD

Nottingham Trent University

Lead Author

Jenna Gillett

PhD

University of Warwick

Lead Author

Paige Karadag

University of Warwick

Lead Author

Shyam Balasubramanian

University Hospitals Coventry and Warwickshire NHS Trust

Lead Author

Swaran Singh

University of Warwick

Lead Author

Jo Nijs

PhD

Vrije Universiteit Brussel

Lead Author

Nicole K. Y. Tang

University of Warwick

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Pain in Chronic/Inflammatory Diseases