Symptoms of Pain, Anxiety, and Disability Predict Changes in Pain Intensity

neck pain
Can pain intensity scores predict psychosocial outcomes longitudinally? This study examines that question.

Psychological distress and disability may be prudent targets for intervention to effectively reduce pain. These findings, from a secondary analysis of data from a cross-sectional study, were published in The Journal of Pain.

Researchers used the PainTracker database from the University of Washington School of Medicine for this analysis. This database is an Internet-based platform that collects patient-reported outcomes of persons treated at a single pain center. It included data from 666 patients who sought care between 2014 and 2017 for pain.

The patient cohort was made up of 67.9% women, with a mean age of 49.6 years and mean average pain intensity score of 6.96 plus or minus 1.7 on a 10-point scale. Patients reported mean average symptoms of depression (11.1±6.64), anxiety (6.94±5.84), posttraumatic stress disorder (PTSD) (1.26±1.54), and pain-related disability (45.24±15.07), as well as difficulty falling asleep (6.19±3.05) and difficulty maintaining sleep (6.48±3.03). All baseline symptoms were positively correlated.

Higher pain intensity at baseline was indicative of greater difficulty falling asleep (b=0.127; P <.001) and maintaining sleep (b=0.072; P =.001) during the follow-up. Baseline difficulty with sleep maintenance predicted greater pain intensity (b=0.053; P =.039) at follow-up, as did the symptom severity of depression (b=0.056; P =.011), anxiety (b=0.049; P =.025), and disability (b=0.104; P <.001).

Symptoms of PTSD were significantly associated with all clinical variables, specifically predicting higher pain intensity (b=0.073; P <.001), increased symptoms of depression (b=0.062; P =.002), anxiety (b=0.113; P <.001), disability (b=0.04; P =.003), and difficulty initiating (b=0.121; P <.001) and maintaining (b=0.102; P <.001) sleep.

Symptoms of anxiety significantly correlated with sex (b=−0.035; P =.018) and age (b=−0.035; P =.03), in which patients who were younger and female were more likely to have increased anxiety at follow-up.

The major limitation of this study was the lack of structured follow-up plans and the high rate of patient attrition from the initial clinical visit to follow-up.

These data indicated that beyond pain intensity, other relevant clinical variables should be candidates for targeted therapies (eg, depression, anxiety, sleep quality), as all these variables correlated at baseline and follow-up, predicting changes to pain intensity over time.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.


Sturgeon JA, Langford D, Tauben D, et al. Pain intensity as a lagging indicator of patient improvement: longitudinal relationships with sleep, psychiatric distress, and function in multidisciplinary care. Published online October 15, 2020. J Pain. doi: 10.1016/j.jpain.2020.10.001