RESEARCH SUBMISSIONS

Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study

Meredith J. Barad MD

Corresponding Author

Meredith J. Barad MD

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

Correspondence

Meredith J. Barad, Stanford University Hospital and Clinics, Stanford, CA, USA.

Email: [email protected]

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John A. Sturgeon PhD

John A. Sturgeon PhD

Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA

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Juliette Hong MS, MEd

Juliette Hong MS, MEd

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

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Anuj K. Aggarwal MD

Anuj K. Aggarwal MD

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

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Sean C. Mackey MD, PhD

Sean C. Mackey MD, PhD

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA

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First published: 29 June 2021
Citations: 9

Funding information

This work was funded by a donation from Helen and Richard Elkus, the Redlich Pain Endowment, and NIH K24DA029262 (S.M.)

Abstract

Objective

Chronic overlapping pain conditions (COPCs) represent a co-aggregation of widespread pain disorders. We characterized differences in physical and psychosocial functioning in patients with chronic migraine (CM) and those with CM and COPCs.

Background

Patients with CM and COPCs have been identified as a distinct subgroup of patients with CM, and these patients may be vulnerable to greater symptom severity and burden.

Methods

Data were extracted from Collaborative Health Outcomes Information Registry (an open-source learning health-care system), completed at the patients' first visit at a large tertiary care pain management center and electronic medical records. In 1601 patients with CM, the number of non-cephalic areas of pain endorsed on a body map was used to examine the differences in pain, physical and psychosocial function, adverse life experience, and health-care utilization.

Results

Patients endorsing more body map regions reported significantly worse symptoms and function across all domains. Scored on a t-score metric (mean = 50, SD = 10), endorsement of one additional body map region corresponded with a 0.69-point increase in pain interference (95% CI = 0.55, 0.82; p < 0.001; Cohen's f = 0.328), 1.15-point increase in fatigue (95% CI = 0.97, 1.32; p < 0.001; Cohen's f = 0.432), and 1.21-point decrease in physical function (95% CI = −1.39, −1.03; p < 0.001; Cohen's f = 0.560). Patients with more widespread pain reported approximately 5% more physician visits (95% CI = 0.03, 0.07; p < 0.001), and patients reporting adverse life events prior to age 17 endorsed 22% more body map regions (95% CI = 0.11, 0.32; p < 0.001).

Conclusions

Patients with CM and other overlapping pain conditions as noted on the body map report significantly worse pain-related physical function, psychosocial functioning, increased health-care utilization, and greater association with adverse life experiences, compared with those with localized CM. This study provides further evidence that patients with CM and co-occurring pain conditions are a distinct subgroup of CM and can be easily identified through patient-reported outcome measures.

CONFLICT OF INTEREST

Dr. Barad reports participation in clinical trials for Allergan, Teva, ATI, and Lilly. She has also consulted for Lilly. Dr. Sturgeon reports a scientific advisory board membership with TribeRx. Dr. Aggarwal and Dr. Mackey report no conflict of interest.