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Preliminary Validation of a General Factor Model of Chronic Overlapping Pain Conditions
Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7(th) Street, Bloomington, IN, 47405, USA.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
Örebro University, School of Behavioural, Social and Legal Sciences. (Center for Health and Medical Psychology (CHAMP))ORCID iD: 0000-0001-9429-9012
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2024 (English)In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 25, no 8, article id 104502Article in journal (Refereed) Published
Abstract [en]

Chronic overlapping pain conditions (COPCs) by definition frequently co-occur, perhaps reflecting their shared etiologies. Their overlapping nature presents a methodological challenge, possibly masking associations between COPCs and health outcomes attributable to either general or specific processes. To address this challenge, we used population-based cohort data to evaluate the predictive validity of a bifactor model of nine self-reported COPCs by assessing its association with incident pain-related clinical diagnoses; pain-relevant pharmacotherapy; and other health outcomes. We obtained data from a 2005-2006 study of Swedish adult twins linked with health data from nationwide registers through 2016 (N = 25,418). We then fit a bifactor model comprising a general COPC factor and two independent specific factors measuring pain-related somatic symptoms and neck and shoulder pain. Accounting for age, biological sex, and cancer, the general factor was associated with increased risk of all pain-related outcomes (e.g., COPC diagnosis aOR, 1.71; 95% CI [1.62, 1.81]), most mental health-related outcomes (e.g., depression aOR, 1.72 [1.60, 1.85]), and overdose and mortality (e.g., all-cause mortality aOR, 1.25 [1.09, 1.43]). The somatic symptoms specific factor was associated with pain-relevant pharmacotherapy (e.g., prescribed opioids aOR, 1.25 [1.15, 1.36]), most mental health-related outcomes (e.g., depression aOR, 1.95 [1.70, 2.23]), and overdose (e.g., nonfatal overdose aOR, 1.66 [1.31, 2.10]). The neck and shoulder pain specific factor was weakly and inconsistently associated with the outcomes. Findings provide initial support for the validity and utility of a general-factor model of COPCs as a tool to strengthen understandings of co-occurrence, etiology, and consequences of chronic pain. PERSPECTIVE: This article presents associations between a novel measurement model of chronic overlapping pain conditions (COPCs) and various health outcomes. Findings provide support for measuring pain across multiple domains rather than only measuring pain specific to one physical location in both research and clinical contexts.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 25, no 8, article id 104502
Keywords [en]
Bifactor model, chronic pain, comorbidity, general factor of pain, mental health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-112026DOI: 10.1016/j.jpain.2024.02.016ISI: 001283683100001PubMedID: 38417595Scopus ID: 2-s2.0-85187980825OAI: oai:DiVA.org:oru-112026DiVA, id: diva2:1841765
Note

Research reported in this publication was supported by Grant number SRG-0-133-19 from the American Foundation for Suicide Prevention Research and by the National Institute on Drug Abuse of the National Institutes of Health under Award number T32-DA-024628. 

Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-08-19Bibliographically approved

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Boersma, Katja

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