Onset of Chronic Pain Earlier in Life Associated With Poorer Psychosocial Outcomes

man in pain, headache, migraine
Investigators found that chronic pain onset likely has long-term consequences on patient psychosocial health.

The stage of life in which individuals developed symptoms of chronic pain has significant implications for their clinical trajectory, according to findings published in the Journal of Pain Research.

The Swedish Quality Register for Pain Rehabilitation database, which aggregated information from 40 specialist pain clinics between 2009 and 2016, was used for this retrospective cross-sectional study. Adult patients (N=6225) were assessed for pain characteristics, psychosocial outcomes, and general health function related to the age of the onset of their chronic pain.

Participants were 71.4% women, with a mean pain intensity of 4.46 plus or minus 0.89 and an average of 14.58 plus or minus 8.47 painful locations. The most common specific pain locations were back and neck (33.2%); 36.1% of participants reported pain in no specific location. Patients were stratified by their age at symptom onset: early (before 30 years; 19.3%), intermediate (between ages 30 and 45 years; 42.1%), and late (after 45 years; 38.6%).

Age at onset was significantly associated with number of pain locations (F[2,6219], 171.27; hp2, 0.052), poor recovery expectancy (F[2,6219], 137.81; hp2, 0.042), fear-avoidance beliefs (F[2,6219], 6.66; hp2, 0.002), general health functioning (F[2,6219], 36.50; hp2, 0.012), and pain interference (F[2,6219], 7.55; hp2, 0.002; a <.001 for all).

With a model controlling for demographics, early-onset pain was associated with poorer recovery expectancy (estimated marginal mean, 3.2; 99.9% CI, 3.1-3.3 vs late: estimated marginal mean, 2.6; 99.9% CI, 2.5-2.7) and with decreased fear-avoidance beliefs (estimated marginal mean, 37.4; 99.9% CI, 36.6-38.2 vs late: estimated marginal mean, 38.8; 99.9% CI, 38.2-39.4; a <.001 for both).

Late-onset pain was associated with better general health functioning (estimated marginal mean, 41.7; 99.9% CI, 40.3-43.0 vs early: estimated marginal mean, 40.1; 99.9% CI, 38.4-41.9; a <.001).

This study may have been limited by the self-reported design, and some amount of over and under estimations were likely incorporated.

The study authors concluded the age of chronic pain onset likely had long-term consequences on psychosocial health, in which, the earlier pain symptoms occurred, the poorer psychosocial outcomes were. Future studies are needed to examine the driving factors for these differences among patients.


Owiredue C, Flink I, Vixner L, Äng BO, Tseli E, Boserma K. The context matters: a retrospective analysis of life stage at chronic pain onset in relation to pain characteristics and psychosocial outcomes. J Pain Res. 2020;13:2685-2695.