Overlap of Five Chronic Pain Conditions: Temporomandibular Disorders, Headache, Back Pain, Irritable Bowel Syndrome, and Fibromyalgia

J Oral Facial Pain Headache. 2020;34(Suppl):s15-s28. doi: 10.11607/ofph.2581.


Aims: To assess cohort retention in the OPPERA project and to compare the degree of overlap between pairs of chronic overlapping pain conditions (COPCs) using a cross-sectional analysis of data from 655 adults who completed follow-up in the OPPERA study.

Methods: Subjects were classified for the absence or presence of each of the five COPCs. The extent of overlap beyond chance was quantified using odds ratios, which were calculated using binary logistic regression models.

Results: While overlap was the norm, its magnitude varied according to COPC: 51% of people with headache had one or more overlapping COPCs, and this proportion increased to 90% for people with fibromyalgia. The degree of overlap between pairs of COPCs also varied considerably, with odds ratios being greatest for associations between musculoskeletal conditions (fibromyalgia, temporomandibular disorders, and low back pain) and less pronounced for overlap involving headache or IBS. Furthermore, univariate associations between some pairs of COPCs were nullified after adjusting for other COPCs.

Conclusion: There was greater overlap between fibromyalgia and either temporomandibular disorders or low back pain than between other pairs of COPCs. While musculoskeletal conditions exhibited some features that could be explained by a single functional syndrome, headache and irritable bowel syndrome did not.

MeSH terms

  • Adult
  • Back Pain
  • Chronic Pain*
  • Comorbidity
  • Cross-Sectional Studies
  • Fatigue Syndrome, Chronic / epidemiology*
  • Fibromyalgia / epidemiology*
  • Headache / epidemiology
  • Humans
  • Irritable Bowel Syndrome / complications*
  • Irritable Bowel Syndrome / epidemiology*
  • Temporomandibular Joint Disorders / epidemiology*