Prevalence and Impact of Comorbid Widespread Pain in Adults With Chronic Low Back Pain

A Registry-Based Study

John C. Licciardone, DO, MS, MBA; Vishruti Pandya, MBBS, MHA


J Am Board Fam Med. 2020;33(4):541-548. 

In This Article


A total of 358 (91%) of the 394 eligible patients completed the baseline encounter and each quarterly encounter over 12 months (Figure 1). There were 56 (16%) patients who did not have WP, 272 (76%) who had nonpersistent WP, and 30 (8%) who had persistent WP. The mean age of patients was 53.6 years (SD, 12.2 years), 258 (72%) were women, and 230 (64%) had CLBP for more than 5 years (Table 1). There were no significant differences among the 3 WP groups with regard to age, sex, or CLBP duration. However, race and pain catastrophizing remained significant predictors of nonpersistent or persistent WP after adjusting for potential confounders (Table 2). Non-White patients were more likely than White patients to report WP (OR, 4.1; 95% CI, 1.5 to 10.8; P = .01). This finding largely reflects the experience of Black patients, who comprised 97 (88%) of the 110 non-White patients. Patients with moderate (OR, 4.7; 95% CI, 2.1 to 11.0; P < .001) or high (OR, 6.8; 95% CI, 2.1 to 22.1; P = .002) pain catastrophizing were more likely to report WP than patients with low levels of pain catastrophizing.

Figure 1.

Flow of patients through the study.

Patients reported greater low back pain intensity and back-related disability and poorer quality of life over 12 months with increasing levels of WP persistence (P < .001 for each measure) (Figure 2). A significant back-related disability × time interaction effect was also observed (P = .01), wherein Roland-Morris Disability Questionnaire scores declined over time in patients without WP, remained stable in patients with nonpersistent WP, and increased in patients with persistent WP. All findings based on repeated measures analysis of variance remained essentially unchanged after controlling for age, sex, and CLBP duration.

Figure 2.

Clinical measures over 12 months of followup according to widespread pain group. Abbreviations: NRS, numeric rating scale; RMDQ, Roland-Morris Disability Questionnaire; SPADE, sleep disturbance, pain interference with activities, anxiety, depression, and low energy/fatigue; WP, widespread pain. Greater scores represent worse status on each clinical measure. Error bars represent 95% CI. P-values were computed using repeated measures analysis of variance. All WP groups were significantly different from one another in post-hoc comparisons for all clinical measures. A significant back-related disability X time interaction effect was also observed (P = .01).