Widespread body pain and mortality: prospective population based study.
Macfarlane GJ., McBeth J., Silman AJ.
OBJECTIVE: To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess. DESIGN: Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location. SETTING: North west England. PARTICIPANTS: 6569 people who took part in two pain surveys during 1991-2. MAIN OUTCOME MEASURES: Pain status at baseline and subsequent mortality. RESULTS: 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78). CONCLUSION: There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.