Is chronic widespread pain passed down from parents to children? 

Nearly everyone experiences pain that is felt in the bones, joints, muscles, tendons, or ligaments at some point – commonly termed ‘musculoskeletal pain’. For example, 80-90% of people experience low back pain at some point in their life, with approximately one in three reporting chronic (or long-lasting) symptoms [1].

Chronic musculoskeletal pain is one of the leading causes of disability worldwide [2]. However, approximately one in ten people experience chronic musculoskeletal pain in multiple body areas, often referred to as chronic widespread pain [3], and report more severe, disabling symptoms and poorer quality of life [4, 5]. It is therefore vital to identify populations at risk of developing chronic widespread pain, as this will help clinicians target treatments towards those at risk of developing this disabling condition.

Currently, our understanding of what increases someone’s chance of developing chronic widespread pain is limited. Genetics may be partly to blame for the development of chronic widespread pain [6], but we do not know the extent to which a family history increases the risk of developing chronic widespread pain. It is also unknown whether individuals with a family history of chronic widespread pain can reduce their risk by lifestyle factors like maintaining a healthy weight and engaging in regular physical activity. This information is potentially important as it could guide the content of treatments that target those likely to develop chronic widespread pain.

What we did

We used data from a population-based survey of almost 100,000 people that lived in Nord-Trøndelag County, Norway to determine whether having parents with chronic widespread pain increased the risk of offspring developing chronic widespread pain, and if being physically active or having a normal body mass index (BMI) reduced this risk [7]. Chronic widespread pain was defined as having pain above and below the waist, and in the neck, middle back or lower back.

The survey collected data on participant demographics, lifestyle behaviours and health conditions on three separate occasions (1984-86, 1995-97 and 2006-08), and we used data from 1995-97 and 2006-08 to answer our research question. Participants were included in our study if they did not have chronic widespread pain in 1995-97, but had data on physical activity and BMI, and data on musculoskeletal pain from both parents. We identified 6,580 offspring that fit these criteria; all were adults.

Statistical tests were performed to determine whether offspring that had parents with chronic widespread pain (in 1995-97) were more likely to develop chronic widespread pain in 2006-08 compared to offspring that had parents without chronic widespread pain. We also determined whether the risk of developing chronic widespread pain was greater for offspring who were obese (BMI > 30) or inactive (<3 hours light or non-strenuous physical activity per week).

What we found

Between 1995-97 and 2006-08, 14% of offspring developed chronic widespread pain. Compared to offspring without a family history of chronic widespread pain, offspring that had one parent with chronic widespread pain were 23% (95% Confidence Interval, CI: 5 to 44) more likely to develop chronic widespread pain, and 89% (95% CI: 50 to 138) more likely if both parents had chronic widespread pain. For the subgroup of offspring that were obese, these values increased to 124% (95% CI: 59 to 217) and 235% (95% CI: 94 to 477), respectively. Interestingly, physical inactivity did not seem to influence the risk of developing chronic widespread pain.

What this means

Our study found that people who are overweight or obese, and have a family history of chronic widespread pain, are at risk of developing chronic widespread pain. However, the way our study was designed means we cannot conclude that obesity, a family history of chronic widespread pain, or the combination of these factors causes chronic widespread pain. Nevertheless, our study highlights a population at risk of developing chronic widespread pain and that could benefit from prevention strategies targeting weight loss or weight management.

We did not test the effectiveness of a weight management program for reducing the risk of chronic widespread pain. However, based on the strong interaction between BMI and a family history of chronic widespread pain, I speculate that if we can develop and deliver effective weight management programs, maintaining a healthy body weight could be a valuable strategy for reducing the risk of developing chronic widespread pain.

Our study also demonstrated that chronic widespread pain is often passed down from parents to offspring. This supports the majority of research that has found a link between genetics and the development of chronic widespread pain.

Take away message

A family history of chronic widespread pain increases your risk of developing chronic widespread pain by 23% if you have one parent with chronic widespread pain and by 89% if both parents have chronic widespread pain. This risk drastically increases if you are overweight or obese. Hence, maintaining a normal BMI might be a valuable strategy to reduce the risk of developing chronic widespread pain.

About Joshua Zadro

Joshua is a Physiotherapist and Postdoctoral Research Fellow at the Institute for Musculoskeletal Health, The University of Sydney. He is currently investigating strategies to replace low-value physiotherapy with high-value physiotherapy in partnership with the Australian Physiotherapy Association, Choosing Wisely Australia and Wiser Healthcare. He completed his PhD at the end of 2017, with a research focus on chronic back pain, physical activity and the role of shared familial factors. He is still involved in a number of studies investigating the link between shared familial factors and musculoskeletal pain. He has published his work in high-impact spine and physiotherapy journals and presented at leading conferences in his field (e.g. World Congress on Pain, International Back & Neck Pain Forum, Preventing Overdiagnosis). He continues to work clinically and over the past few years has taught in musculoskeletal physiotherapy units at The University of Sydney.

References

[1] Australian Institute of Health and Welfare 2018. Back problems snapshot. Cat. no: PHE 231.

[2] Vos T, Abajobir A, Abate K. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-59.

[3] Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016;157(1):55-64.

[4] Nicholl BI, Macfarlane GJ, Davies KA, Morriss R, Dickens C, McBeth J. Premorbid psychosocial factors are associated with poor health-related quality of life in subjects with new onset of chronic widespread pain – results from the EPIFUND study. Pain. 2009;141(1-2):119-26.

[5] Viniol A, Jegan N, Leonhardt C, Brugger M, Strauch K, Barth J, et al. Differences between patients with chronic widespread pain and local chronic low back pain in primary care – a comparative cross-sectional analysis. BMC Musculoskelet Disord. 2013;14(1):351.

[6] Kerr JI, Burri A. Genetic and epigenetic epidemiology of chronic widespread pain. J Pain Res. 2017;10:2021-9.

[7] Zadro JR, Nilsen TIL, Shirley D, Amorim AB, Ferreira PH, Mork PJ (2018). Parental chronic widespread pain and the association with chronic widespread pain in adult offspring: Family-linkage data from the Norwegian HUNT Study. Eur J Pain. 2018 Apr 28. doi: 10.1002/ejp.1237.