Risk factors predicting the development of widespread pain from chronic back or neck pain

J Pain. 2010 Dec;11(12):1320-8. doi: 10.1016/j.jpain.2010.03.007. Epub 2010 May 21.


Emerging evidence suggests that some individuals with regional pain disorders go on to develop chronic widespread pain (CWP). However, the mechanism behind this transition and the nature of risk factors that predispose a person to develop CWP remain to be elucidated. The purpose of this study was to describe the frequency with which participants with chronic back or neck pain develop CWP and to determine the risk factors associated with this development. In a sample of 512 individuals, we found that nearly a quarter (22.6%) of subjects who presented with regional back or neck pain in 2001/2002 had developed CWP by 2007. Logistic regression indicated that 7 factors were associated with the transition to CWP: moderate or severe pain intensity, female gender, history of abuse, family history of CWP, severe interference with general activity, having 1 or more central sensitivity syndromes, and using more pain management strategies. History of abuse was not significant in multivariate analysis. Notably, number of depressive symptoms endorsed, pain duration, age, body mass index, number of medication classes used, and receipt of disability benefits were not significantly associated with this transition.

Perspective: This study offers insight into risk factors associated with the development of CWP. This information not only offers clues as to the mechanism behind the expansion of pain sensitivity from a regional pain locus to a widespread pain disorder but also provides insight as to how clinicians might mitigate this transition.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Back Pain / complications*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Fibromyalgia / etiology*
  • Humans
  • Male
  • Neck Pain / complications*
  • Retrospective Studies
  • Risk Factors
  • Sex Factors