Integrating evidence-based treatment strategies across care settings may help mitigate opioid-related harm by addressing shared central sensitization mechanisms.
More than half of patients with autoimmune rheumatic diseases (ARDs) have at least 1 chronic overlapping pain condition, with nearly one-quarter experiencing multiple pain-related comorbidities, according to study findings published in Arthritis Care & Research
Chronic pain frequently persists among patients with ARDs despite treatment of underlying inflammatory disease. Identifying the most common types of chronic pain, the researchers noted, can flag patients at risk for long-term opioid therapy — a common outcome in patients with chronic overlapping pain conditions. Researchers therefore examined the prevalence and clustering of chronic overlapping pain conditions among adults with ARDs using data from the Merative MarketScan Commercial Claims and Encounters Database collected between 2008 and 2021.
This retrospective claims-based analysis included 149,742 adults aged 18 to 64 years with ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren disease, systemic lupus erythematosus, or systemic sclerosis. Mean patient age was 48.2±10.9 years; 75.7% were women, and rheumatoid arthritis accounted for 54.4% of ARD diagnoses
Overall, 57.5% of patients had at least 1 COPC, while 22.7% had multiple COPCs. Among patients with at least 1 chronic overlapping pain condition, 60.6% had a single condition, 27.1% had 2 conditions, and 12.3% had 3 or more. Women were more likely than men to have chronic overlapping pain conditions, and the highest prevalence was observed among patients aged 31 to 50 years
Integrating…evidence‐based approaches across care settings could mitigate opioid-related harm while addressing the shared central sensitization mechanisms underpinning pain amplification in rheumatology populations
Chronic low back pain and fibromyalgia were the most common chronic overlapping conditions, affecting 41.4% and 21.1%, respectively, of patients overall; migraine was also common, occurring in 10.6% of patients. Chronic low back pain was especially prevalent among patients with ankylosing spondylitis (67.7%), while fibromyalgia affected approximately one-quarter of patients with Sjögren disease (27.7%), systemic lupus erythematosus (27.7%), and ankylosing spondylitis (24.4%). Migraine was most prevalent among patients with Sjögren disease (15.2%) and systemic lupus erythematosus (13.3%).
Researchers also assessed patterns of co-occurrence among pain conditions. Fibromyalgia and chronic low back pain represented the most common pain dyad, occurring in 11.8% of patients. Chronic low back pain and migraine co-occurred in 6.2% of patients, while migraine and fibromyalgia were present together in 3.8%
Several pain condition pairs demonstrated strong associations. Urologic chronic pelvic pain syndrome and vulvodynia showed the strongest relationship (odds ratio [OR], 10.46; 95% CI, 7.88-13.42). Migraine was strongly associated with chronic tension-type headache (OR, 6.37; 95% CI, 5.98-6.78), and irritable bowel syndrome was associated with urologic chronic pelvic pain syndrome (OR, 4.43; 95% CI, 3.83-5.09)
This study was limited by its reliance on administrative claims data, which could lead to misclassification and lacked key pain-related information, and its focus on commercially insured adults younger than 65 may limit the generalizability of its findings
“Integrating…evidence‐based approaches across care settings could mitigate opioid-related harm while addressing the shared central sensitization mechanisms underpinning pain amplification in rheumatology populations,” the study authors concluded
Di Lu, Cunanan K, Cragun J, Vuong L, Baker MC, Falasinnu T.Phenotypes of chronic overlapping pain multimorbidity in rheumatology: a population-based claims study.Arthritis Care Res (Hoboken).Published online May 18, 2026. doi:10.1002/acr.80090
