EPIDEMIOLOGY144. IDENTIFICATION OF CHRONIC WIDESPREAD PAIN IN PRIMARY CARE

Abstract

Background: Chronic widespread pain (CWP), defined as long-lasting pain present in multiple body regions, is common in the general population with a reported prevalence of 10%. It is associated with fatigue, concentration problems, and psychological distress and is a fundamental feature of fibromyalgia. There is no specific morbidity code for GPs to record CWP in primary care and it has been suggested that patients regularly consult for different regional pains without being recognized, or managed, as having a generalized condition. The aim of this study was determine prevalence of regular consultation to primary care for multiple regional musculoskeletal pain (recurrent regional pain consultation), assess the extent to which such patients may be under-recognized in primary care, and determine whether they share features characteristic of CWP. Methods: In Phase 1 we used data from 12 general practices in North Staffordshire [Consultations in Primary Care Archive (CiPCA)]. We determined the prevalence of people consulting in primary care for musculoskeletal conditions in different body regions on different occasions (recurrent regional pain consulters) and assessed the extent to which they had diagnosed generalized pain (e.g. fibromyalgia). In Phase 2 we used linked self-reported health and electronic health record (EHR) data from 8,286 people aged 50 plus recruited from six general practices [North Staffordshire Osteoarthritis Project (NorStOP)]. We assessed association of recurrent regional pain consultation with self-reported widespread pain and compared prevalence of somatic symptoms and self-reported general health between recurrent regional pain consulters and two other groups: those self-reporting widespread pain only and patients consulting for a single painful body region. Results: Prevalence of recurrent regional pain consultation in Phase 1 was 10% but three-quarters of these were not recorded with generalized pain conditions related to CWP (e.g. fibromyalgia) and therefore had potentially unrecognized generalized pain. Of the recurrent regional pain consulters identified in Phase 2, 53% selfreported widespread pain, 88% had recorded somatic symptoms, and 23% were frequent consulters for non-musculoskeletal conditions. Self-reported general health was worse in recurrent regional pain consulters than in single-region consulters, but poorest in those who also reported persistent widespread pain. Conclusion: Recurrent regional pain consulters are a heterogeneous group of frequent consulters sharing features with CWP (e.g. somatic symptoms) but including those less severely affected. These patients lie on the spectrum of polysymptomatic distress characteristic of CWP. They are likely to be unrecognized as having generalized pain problems and hence may have unmet needs. Identifying these patients early may help stop progression to CWP and fibromyalgia.