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

Abstract and Introduction


Introduction: Widespread pain (WP) is emerging as a key comorbid condition in patients with chronic low back pain (CLBP). This study measured the prevalence of comorbid WP in adults with CLBP, WP predictors, and impact on patients.

Methods: Patients with CLBP were recruited from the Pain Registry for Epidemiologic, Clinical, and Interventional Studies and Innovation from 2016 through 2019. They were followed over 12 months to measure annual WP period prevalence rates using an item from the minimum dataset recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain. Patients were classified as not having WP, having nonpersistent WP, or having persistent WP. Pain intensity, back-related disability, and quality of life were measured using a numerical rating scale, the Roland-Morris Disability Questionnaire, and the PROMIS-29 instrument, respectively.

Results: A total of 358 patients were studied, including 56 (16%) without WP, 272 (76%) with nonpersistent WP, and 30 (8%) with persistent WP. There were no significant differences among the WP groups with regard to age, sex, or CLBP duration. However, being non-White and having moderate or high levels of pain catastrophizing remained significant predictors of nonpersistent or persistent WP after adjusting for potential confounders. Patients reported greater 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).

Conclusion: Greater efforts are needed in primary care to help close these gaps in pain intensity, back-related disability, and quality-of-life outcomes associated with WP.


Low back pain is a pervasive condition that affects over 600 million persons worldwide and is the leading cause of disability.[1] In the United States, about 50 million adults suffer from chronic pain.[2] This includes about 20 million adults with high-impact chronic pain, such as low back pain that interferes with work or life most days or every day. Although primary care physicians often face challenges in treating patients with low back pain that has become chronic and potentially disabling, the extent of this burden has not been well established. The National Pain Strategy called for more precise prevalence estimates of high-impact chronic pain to help develop and implement appropriate pain interventions.[3] The National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain (NIH-RTF) recommended assessing pain impact based on pain intensity, functional status, and quality of life, and considering widespread pain (WP) a key comorbid condition.[4] Chronic low back pain (CLBP) may progress to WP, with fibromyalgia manifesting as an extreme form of the condition. Fibromyalgia was originally associated with 11 or more tender point sites identified by clinical examination.[5] However, updated fibromyalgia criteria and self-report scales have been developed to enable epidemiologic research in the absence of clinical examination.[6,7] The objectives of this study were to: measure annual period prevalence rates of nonpersistent and persistent WP among patients with CLBP using a simple patient self-report item; to identify WP predictors; and to assess the impact of WP on low back pain intensity, functional status, and quality of life.