Can we predict who will develop widespread pain?

Our bodies and brains go through radical changes in adolescence, and experiences during this critical time – such as pain – can continue to influence our lives as adults. Having widespread pain in adolescence is a risk factor for future widespread pain conditions (like fibromyalgia) in adulthood.¹ Identifying youth at risk for developing widespread pain could help prevent painful experiences from becoming chronic problems. But how can we predict who is at risk?

To answer this question, we followed 207 adolescents over 3 years, inviting them into our lab for experimental evaluations before and after menarche (their first menstrual period). Before menarche, 25% of participants reported widespread pain on our body map questionnaire - defined as pain in at least 3 out of 7 body sites in the last week. Another 29% of participants reported new widespread pain after menarche, while just under half (46%) did not report any widespread pain. Interestingly, adolescents with widespread pain also reported worse menstrual pain.

We looked at multiple psychological and physical factors and identified which were the strongest predictors of future widespread pain. We found that having more bothersome somatic symptoms (both painful and non-painful; like headache, dizziness, & nausea) was a significant predictor, which has been suggested in previous studies.^2,3 The more painful body sites youth currently reported on the body map questionnaire, the higher risk for having widespread pain in the future.

Somewhat surprisingly, measures of depression, anxiety, and sensitivity to experimental pain weren’t very predictive. Instead, increased sensitivity to unpleasant (but not painful) stimuli delivered in a controlled lab setting – like loud noises and flashing lights - was associated with increased odds of developing widespread pain. Youth who already had widespread pain were even more sensitive to light, sound, and the sensation of their bladder filling after drinking water.

Sensitivity across multiple sensory inputs – like visual, auditory, or internal bodily sensations – has been referred to as “multimodal hypersensitivity”. With hypersensitivity, the threshold where stimuli start to feel bothersome or uncomfortable to the person is lower. Research suggests this cross-modal sensory sensitivity may reflect a change in brain and nervous system function—and could even be an early warning sign for future chronic pain risk.

But what causes multimodal hypersensitivity? The central nervous system must be involved, but exactly how is not clear. When we compared brain activity recorded during the unpleasant sound and light experiments between adolescents with and without widespread pain, we didn’t see any significant differences in how their brains processed the stimuli. The answer may lie deeper in the brain, in regions that process qualities like intensity and unpleasantness. Regardless, treating multimodal hypersensitivity with cognitive or sensory desensitization therapies early in youth could be a promising avenue for preventing widespread chronic pain later in life.

You can read more about this study in the journal PAIN – Osborne et al., Multimodal hypersensitivity and somatic symptoms predict adolescent postmenarchal widespread pain, DOI: 10.1097/j.pain.0000000000003597.

References

1.      Tan AC et al., Chronic widespread pain and fibromyalgia syndrome: life-course risk markers in young people. Pain Research and Management 2019.

2.      Mikkelsson M, et al., Onset, prognosis and risk factors for widespread pain in schoolchildren: a prospective 4-year follow-up study. Pain 2008.

3.      Horst S et al., Predicting Persistence of Functional Abdominal Pain from Childhood into Young Adulthood. Clin Gastroenterol Hepatol 2014.