The Context Matters: A Retrospective Analysis of Life Stage at Chronic Pain Onset in Relation to Pain Characteristics and Psychosocial Outcomes

Figures & data

Table 1 Descriptive Overview of Demographic Variables, Pain Characteristics, and Psychosocial Outcomes

	Overall Sample, n=6,225	Early Onset, n=1,200	Intermediate Onset, n=2,620	Late Onset n=2,405)
	n (%)	n (%)	n (%)	n (%)
Sex
Female	4,442 (71.4)	896 (74.7)	1,904 (72.7)	1,642 (68.3)
Male	1,783 (28.6)	304 (25.3)	716 (27.3)	763 (31.7)
Education
Basic	1,145 (18.4)	233 (19.4)	430 (16.4)	482 (20.0)
Gymnasium	3,088 (49.6)	584 (48.7)	1,369 (52.3)	1,135 (47.2)
University	1,597 (25.7)	306 (25.5)	659 (25.2)	632 (26.3)
Other	395 (6.3)	77 (6.4)	162 (6.2)	157 (6.5)
Country of birth
Sweden	5,570 (89.5)	1127 (93.9)	2310 (88.2)	2,133 (88.7)
Other European countries	655 (10.5)	73 (6.1)	310 (11.8)	272 (11.3)
Primary pain location
Back and neck	2,067 (33.2)	372 (31.1)	876 (33.4)	819 (34.0)
Extremities	1,135 (18.3)	114 (9.5)	458 (17.5)	563 (23.4)
Multiple locations	2,248 (36.1)	570 (47.5)	999 (38.1)	679 (28.2)
Other specific pain	775 (12.4)	144 (11.9)	287 (11.0)	344 (14.4)
Primary diagnosis (ICD version 10, 2019)
M00-M99	4,154 (66.7)	828 (69.0)	1,763 (67.3)	1,563 (65.0)
R00-R99	1,338 (21.5)	251 (20.9)	564 (21.5)	523 (21.7)
F00-F99	120 (1.9)	15 (1.3)	60 (2.3)	45 (1.9)
G00-G99	256 (4.1)	44 (3.7)	92 (3.5)	120 (5.0)
S00-T98	259 (4.2)	33 (2.8)	109 (4.2)	117 (4.9)
Other	98 (1.6)	29 (2.4)	32 (1.2)	37 (1.5)
Pain characteristics	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
Intensity	4.46 (0.89)	4.50 (0.84)	4.48 (0.88)	4.41 (0.93)
Number of locations	14.58 (8.47)	17.63 (8.56)	15.46 (8.45)	12.09 (7.75)
Psychosocial outcomes
Poor recovery expectancy	2.91 (1.22)	3.22 (1.06)	2.97 (1.18)	2.70 (1.29)
General emotional distress	44.07 (17.00)	44.32 (16.32)	45.03 (17.15)	42.89 (17.11)
Fear-avoidance beliefs	38.40 (9.03)	37.38 (8.76)	38.51 (8.96)	38.80 (9.19)
Social functioning	46.81 (26.04)	44.77 (25.74)	45.50 (25.97)	49.24 (26.10)
General health functioning	40.29 (19.72)	38.69 (20.33)	38.97 (19.39)	42.51 (19.59)
Pain interference	4.42 (1.04)	4.49 (1.01)	4.49 (1.01)	4.32 (1.08)
Life control	2.76 (1.15)	2.76 (1.15)	2.69 (1.16)	2.82 (1.15)

Notes: Early onset = pain debut ≤30 years old, intermediate onset = pain debut >30–45 years old, late pain onset = pain debut >45 years old. Other specific pain included head/face, chest, abdomen, sexual organs/groin, hip/seat. A gymnasium in Sweden is an upper-secondary school or high school (years 10–12) with regular or vocational programs that are optional. M00–M99, diseases of the musculoskeletal system and connective tissue; R00–R99, symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified; F00–F99, mental and behavioral disorders; G00–G99, diseases of the nervous system; S00–T99, injury, poisoning, and certain other consequences of external causes; other, all other diagnoses with <1% occurrence in the sample combined.

Abbreviation: ICD, International Classification of Diseases.

Table 2 Summary Findings of One-Way MANCOVA Exploring Differences in Pain Characteristics and Psychosocial Outcomes Based on Developmental Life Stage at Chronic Pain Onset While Controlling for Demographic Variables (Sex and Education)

	Mean Square	F2, 6,219	ηp^2	Estimated Marginal Mean (99.9% CI)			Post hoc test
				Early onset, n=1,200 (a)	Intermediate onset, n=2,620 (b)	Late onset, n=2,405 (c)
Pain intensity	2.80	3.65	0.001	4.5 (4.4–4.6)	4.5 (4.4–4.5)	4.4 (4.4–4.5)
Number of pain locations	10,755.20	171.27**	0.052	17.5 (16.7–18.3)	15.4 (14.9–16.0)	12.2 (11.6–12.7)	a > b > c**
Poor recovery expectancy	193.39	137.81**	0.042	3.3 (3.2–3.4)	3.0 (3.0–3.1)	2.6 (2.5–2.7)	a > b > c**
General emotional distress	805.54	2.82	0.001	44.1 (42.4–45.7)	44.7 (43.5–45.8)	43.4 (42.2–44.6)
Fear-avoidance beliefs	495.50	6.66**	0.002	37.6 (36.8–38.4)	38.6 (38.1–39.2)	38.6 (37.9–39.2)	b > a**
Social functioning	4,242.42	6.30	0.002	45.2 (42.7–47.7)	46.1 (44.3–47.8)	48.3 (46.5–50.3)
General health functioning	13,962.40	36.50**	0.012	38.3 (36.4–40.1)	38.4 (37.1–39.8)	43.3 (41.9–44.7)	c > a**, c > b**
Pain interference	8.07	7.55**	0.002	4.5 (4.4–4.6)	4.5 (4.4–4.5)	4.4 (4.3–4.4)	b > c**
Life control	3.05	2.31	0.001	2.8 (2.7–2.9)	2.7 (2.6–2.8)	2.8 (2.7–2.9)

Notes: **α<0.001. Higher scores on all measures indicate higher values, whether positive or negative.Early onset = pain debut ≤30 years old, intermediate onset = pain debut >30–45 years old, late pain onset = pain debut >45 years old. For post hoc testing, only groups with significant differences are shown.

Table 3 Summary Findings of One-Way MANCOVA Exploring Differences in Developmental Life Stages of Chronic Pain Onset on Psychosocial Outcome Variables While Controlling for Sex, Education, Age and Pain Characteristic

	Mean square	F2, 6,217	ηp^2	Estimated marginal means (99.9% CI)			Post hoc test
				Early onset, n=1,200 (a)	Intermediate onset, n=2,620 (b)	Late onset, n=2,405 (c)
Poor recovery expectancy	131.97	99.28**	0.031	3.2 (3.1–3.3)	3.0 (3.0–3.1)	2.6 (2.5–2.7)	a > b > c**
General emotional distress	873.06	3.46	0.001	43.0 (41.4–44.5)	44.3 (43.2–45.3)	44.4 (43.2–45.6)
Fear-avoidance beliefs	729.17	10.97**	0.004	37.4 (36.6–38.2)	38.5 (38.0–39.1)	38.8 (38.2–39.4)	b > a**, c > a**
Social functioning	136.13	0.24	0	46.6 (44.3–49.0)	46.6 (45.0–48.2)	47.1 (45.3–48.9)
General health functioning	3,345.20	10.20**	0.003	40.1 (38.4–41.9)	39.1 (37.9–40.3)	41.7 (40.3–43.0)	c > b**
Pain interference	0.64	0.89	0	4.4 (4.3–4.5)	4.4 (4.4–4.5)	4.4 (4.3–4.5)
Life control	5.77	5.20	0.002	2.8 (2.7–3.0)	2.7 (2.7–2.8)	2.7 (2.7–2.8)

Notes: **α<0.001. Higher scores on all measures indicate higher values, whether positive or negative. Early onset = pain debut ≤30 years, intermediate onset = pain debut >3045 years old, late pain onset = pain debut >45 years old. For post hoc testing, only groups with significant differences are shown.