Factors Associated with Higher Reported Pain Levels

Factors Associated with Higher Reported Pain Levels in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional, Correlational Analysis – PLoS One. 2016

Chronic musculoskeletal pain is highly prevalent, disabling, and costly, and has many negative effects on quality of life.

The aim of this study was to investigate factors associated with higher reported pain levels in patients with chronic musculoskeletal pain among demographic, clinical, and psychological factors, and to evaluate whether insomnia is independently associated with pain intensity in this population.

A total of 357 patients with chronic musculoskeletal pain (pain duration ≥ six months) satisfied the study inclusion criteria and were included in the analyses  


In the present study, we confirmed that poor psychological states are prevalent in chronic musculoskeletal pain patients with severe pain.

We found that

  • older age,
  • high pain catastrophizing, and
  • severe insomnia

were strongly associated with higher reported pain levels in this population.

Many studies have reported high prevalence of anxiety, depression, and pain catastrophizing together with insomnia in patients with chronic pain, and these symptoms, even though they are distinct processes, may share common neurophysiological mechanisms and behavioral manifestations [18,19].

Our results demonstrated that insomnia and pain catastrophizing significantly affects patient reported pain severity and intensity in chronic musculoskeletal pain.

Insomnia is frequently experienced by patients suffering from chronic musculoskeletal pain [15], but is often seen as a secondary symptom of chronic pain and not as an independent symptom. Because pain mediates sleep problems, adequate pain management was thought to lead to improved sleep in patients with chronic pain

pain catastrophizing was strongly associated with higher reported pain levels in patients with chronic musculoskeletal pain.

An interesting finding was that chronological age was significantly associated with patient-reported pain severity and intensity in this study

These age-related changes of pain perception may be intensified by the burden of comorbidities and psychological symptoms including insomnia in older individuals

Worse psychological states were also observed as age increased in this study; therefore, the severity of comorbid psychological symptoms seems to be important when devising treatment strategies for older patients who are likely to be especially vulnerable to the negative impacts of pain and pain-associated events.

Our study has several limitations that suggest directions for future research

First, it was conducted in a single clinical setting and included a study population with a homogeneous racial background, which might limit our ability to detect potentially significant associations

Secondly, our findings are cross-sectional in nature, limiting our ability to identify a causal relationship between psychological factors and current pain or treatments

Here they state they cannot determine causation, but the entire text certainly encourages this misinterpretation.

Third, pain intensity as an outcome variable was only measured by patient-reported pain score using NRS, and this study was based on subjective assessment of insomnia.

Fourth, the ISI does not include parameters that are used to measure the degree of interruption in daytime activities, and insomnia frequency and duration, which would influence insomnia severity

In conclusion, we found that older age, severe insomnia, and high pain catastrophizing were significantly associated with higher reported pain levels in chronic musculoskeletal pain patient

They forget to consider that old age by itself often results in insomnia and physical breakdown as the body deteriorates and approaches closer to death.

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