Differences between patients with chronic widespread pain and local chronic low back pain in primary care - a comparative cross-sectional analysis

Background: Chronic pain is a common reason for consultation in
general practice. Current research distinguishes between chronic
localized pain (CLP) and chronic widespread pain (CWP). The aim of
this study was to identify differences between CWP and chronic low
back pain (CLBP), a common type of CLP, in primary care settings.
Methods: Fifty-eight German general practitioners (GPs)
consecutively recruited all eligible patients who consulted for
chronic low back pain during a 5 month period. All patients
received a questionnaire on sociodemographic data, pain
characteristics, comorbidities, psychosomatic symptoms, and
previous therapies. Results: GPs recruited 647 eligible patients
where of a quarter (n = 163, 25.2\%) met the CWP criteria according
to the American College of Rheumatology. CWP patients had
significantly more comorbidities and psychosomatic symptoms, showed
longer pain duration, and suffered predominantly from permanent
pain instead of distinguishable pain attacks. CWP patients were
more often females, are less working and reported a current pension
application or a state-approved grade of disability more
frequently. We found no other differences in demographic parameters
such as age, nationality, marital status, number of persons in
household, education, health insurance status, or in health care
utilization data. Conclusions: This project is the largest study
performed to date which analyzes differences between CLBP and CWP
in primary care settings. Our results showed that CWP is a frequent
and particularly severe pain syndrome.