BMJ 2001;323:662 ( 22 September )

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Widespread body pain and mortality: prospective population based study

Gary J Macfarlane, professor of epidemiology, ^a John McBeth, lecturer in rheumatic disease epidemiology, ^b Alan J Silman, professor of rheumatic disease epidemiology. ^b

^a Unit of Chronic Disease Epidemiology, Medical School, University of Manchester, Manchester M13 9PT, ^b Arthritis Research Campaign Epidemiology Unit, Medical School, University of Manchester

Correspondence to: G J Macfarlane G.Macfarlane{at}man.ac.uk

Objective: To determine whether there is excess mortality in groups of people who report widespread body pain, and if so to establish the nature and extent of any excess.
Design: Prospective follow up study over eight years. Mortality rate ratios were adjusted for age group, sex, and study location.
Setting: North west England.
Participants: 6569 people who took part in two pain surveys during 1991-2.
Main outcome measures: Pain status at baseline and subsequent mortality.
Results: 1005 (15%) participants had widespread pain, 3176 (48%) had regional pain, and 2388 (36%) had no pain. During follow up mortality was higher in people with regional pain (mortality rate ratio 1.21, 95% confidence interval 1.01 to 1.44) and widespread pain (1.31, 1.05 to 1.65) than in those who reported no pain. The excess mortality among people with regional and widespread pain was almost entirely related to deaths from cancer (1.55 (1.09 to 2.19) for regional pain and 2.07 (1.37 to 3.13) for widespread pain). The excess cancer mortality remained after exclusion of people in whom cancer had been diagnosed before the original survey and after adjustment for potential confounding factors. There were also more deaths from causes other than disease (for example, accidents, suicide, violence) among people with widespread pain (5.21, 0.94 to 28.78).
Conclusion: There is an intriguing association between the report of widespread pain and subsequent death from cancer in the medium and long term. This may have implications for the long term follow up of patients with "unexplained" widespread pain symptoms, such as those with fibromyalgia.

What is already known on this topic Widespread body pain, the cardinal symptom of fibromyalgia, is common An organic basis for symptoms is found in only a small proportion of people Treatment is difficult, and studies with short term follow up have shown that symptoms commonly persist What this study adds This was the first study with long term follow up of people with widespread pain in the community These people experience an increased mortality and the excess is principally related to deaths from cancer

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