Background & Aims

Pain variability, namely the extent to which pain intensity fluctuates within individuals over time, can have important biopsychosocial consequences for those living with chronic pain (Mun et al, 2019). It has been associated with greater pain severity and opioid consumption (Whitaker et al. 2024; De Koning et al. 2018). However, it is unclear if dispositional factors, such as demographic characteristics, pain duration, and psychological factors are associated with pain variability.

Methods

Individuals living with chronic low back pain were recruited from the Quebec Back Pain Study and through independent advertisements in social media and healthcare clinics. Participants completed baseline online questionnaires (NIH low back pain questionnaire, sociodemographic, perceived stress scale) prior to completing an electronic pain diary 3 x daily for seven days (Numeric Rating Scale of pain intensity 0-10). Multiple linear regression examined whether age, gender, pain duration, baseline pain intensity, current opioid use, stress, depression and anxiety were associated with pain variability (standard deviation of pain scores throughout the diary period).

Results

A total of 179 participants with chronic low back pain completed the baseline questionnaires and more than 80% of diary entries. Participants were on average aged 49.5±12 years, and 59% self-identified as women. Intra-individual pain intensity variability (standard deviation of an individual’s pain scores throughout the diary) ranged from 0.3 to 2.9. Among the examined variables, younger age (B=-0.01, p=0.003), higher baseline pain intensity (B=0.11, p<-.001) and fewer depressive symptoms (B=-0.02, p=0.013) were significantly associated with increased pain variability.

Conclusions

Research has shown that pain variability (e.g., increasing throughout the day or that follows a circadian rhythm), is associated with improved quality of life and reduced need for analgesics compared to stable, unvarying intensity. In the current study, results have identified a modifiable factor, depressive symptoms, associated with pain variability. Further research is needed to examine the temporality of this relationship and explore potential interventional strategies.

References

Mun CJ, Suk HW, Davis MC, Karoly P, FInan P, Tennen H, Jensen MP. (2019). Investigating intraindividual pain variability: methods, applications, issues, and directions. PAIN; 160(11):2415-2429.

Whitaker MM, Odell D, Deboeck PR, Stefanucci JK, Okifuji A. (2024). Increased pain variability in patients with chronic pain: A role for pain catastrophizing. Journal of Pain; Feb 7: S1526-5900(24)00375-4.

De Koning EJ, TImmermans EJ, van Schoor NM, Stubbs B, den Kommer TN, Dennison EM, Limongi F, Castell MV, Edwards MH, Queipo R, Cooper C, Siviero P, van der Pas S, Pederson NL, Sanchez-Martinez M, Deeg DJH, Denkinger MD, EPOSA Group. (2018). Within-person pain variability and mental health in older adults with osteoarthritis: An analysis across 6 European cohorts. Journal of Pain; 19(6): 690-698.

Presenting Author

Karen Ghoussoub

Poster Authors

Gabrielle Pagé

PhD

University of Montreal

Lead Author

E-mail

Karen Ghoussoub

Université de Montréal

Lead Author

E-mail

Mael Gagnon-Mailhot

Université de Montréal

Lead Author

E-mail

Élise Develay

Université de Montréal

Lead Author

E-mail

Sonia Lupien

Université de Montréal

Lead Author

E-mail

Pierre Rainville

Université de Montréal

Lead Author

E-mail

Mathieu Roy

McGill University

Lead Author

E-mail

Étienne Vachon-Presseau

McGill University

Lead Author

E-mail

Topics

  • Mechanisms: Psychosocial and Biopsychosocial