Phenotypes of Chronic Overlapping Pain Multimorbidity in Rheumatology: A Population-Based Claims Study.

OBJECTIVE

This study aims to characterize the burden and distinct patterns of chronic overlapping pain conditions (COPCs) multimorbidity in adults with autoimmune rheumatic diseases (ARDs).

METHODS

We analyzed 2008 to 2021 data from the Merative MarketScan Commercial Claims and Encounters Database, identifying 149,742 patients with ARDs (ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren disease, systemic lupus erythematosus, and systemic sclerosis) using International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification codes. We assessed COPC (eg, fibromyalgia, chronic low back pain, migraine, irritable bowel syndrome, chronic fatigue syndrome, temporomandibular disorders, and pelvic pain conditions) prevalence, multimorbidity patterns, and pairwise co-occurrence frequencies, calculating observed/expected ratios and odds ratios (ORs).

RESULTS

Of 149,742 patients with ARDs, 57.5% had one or more COPCs, with 22.7% experiencing multiple conditions. Chronic low back pain (41.4%) and fibromyalgia (21.1%) were most prevalent. Women and individuals aged 31 to 50 years had the highest COPC prevalence. Many COPC pairs co-occurred more frequently than expected by chance (eg, fibromyalgia and chronic low back pain: observed/expected ratio 1.35; migraine and chronic low back pain: observed/expected ratio 1.42). Strongly associated dyads included urologic chronic pelvic pain and vulvodynia (OR 10.46).

CONCLUSION

A substantial burden and distinct multimorbidity patterns of COPCs exist among patients with ARDs, suggesting shared pathophysiologic mechanisms. Routine COPC screening and targeted nonopioid multimodal interventions, especially for common dyads, are crucial for improved pain management and reducing opioid-related risks in this population.