🔮Can Chronic Pain Be Predicted Before It Spreads? The Surprising Power of Six Simple Questions

Introduction

Imagine if you could forecast chronic pain before it becomes widespread, disabling, or reliant on opioids.

A ground breaking study published in Nature Medicine suggests we can do exactly that.

By analysing data from nearly half a million people, researchers have developed a simple, science-backed risk score that predicts chronic pain’s development and spreading across the body.

It’s not about tissue damage.

It’s about mood, sleep, bodyweight and stress.

Let’s break it down.

🔥 How Chronic Pain Spreads Like a Wildfire

Pain doesn’t stay still. For many, it starts in one location, for example, the lower back, and over time creeps to the neck, knees, shoulders, or even becomes “pain all over” (known as widespread pain or it develops into a persistent overlapping pain condition like fibromyalgia).

The study analysed over 493,000 participants from the UK Biobank and found:

• 44% of those with chronic pain reported multiple pain sites.

• The number of pain sites correlated strongly with pain intensity, depression, fatigue, and pain interference in daily life.

• Pain tends to spread from proximal (nearby) to distal (farther away) sites—but this pattern becomes unpredictable in high-risk individuals.

❓ The Biopsychosocial Risk Score

Instead of focusing on injury or disease alone, researchers built a biopsychosocial model—integrating psychological, social, and physical health data.

Using machine learning, they identified six key questions that predicted chronic pain spreading 9 years in advance.

These questions were:

1. Sleep quality - Do you have trouble falling asleep at night or do you wake up in the middle of the night?

   - Usually gets 1, rarely or sometimes gets 0

2. Mood - Do you often feel fed up?

3. Tiredness - Over the past 2 weeks, how often have you felt tired or had little energy?

   - More than half the days gets a 1, Several Days or not at all gets 0

4. Mental Health - Have you ever seen a GP or psychiatrist for nerves, anxiety, tension or depression? 

5. Life Stress - Any of the following in the last 2 years?

   - Serious illness, injury, assault or death of a close relative

   - Death of a spouse/partner or marital separation/divorce

   - Financial difficulties

6. Body mass index (BMI) - >30?

They named it the Risk of Pain Spreading (ROPS)—and it performed nearly as well as complex 99-variable models in predicting chronic pain onset, spread, and severity.

💡 From Prediction to Prevention

If you’re a healthcare provider:

• Ask about sleep, mood, life stress and BMI before pain spreads.

• Integrate brief screening tools like ROPS in assessments.

• Treat the person, not the tissue.

If you live with pain:

• Take sleep, stress, and emotional well-being seriously, these aren’t "soft" symptoms, they’re core drivers.

• Movement, stress reduction and understanding your biology can reverse sensitisation.

🎚️ The Brain Can Learn Pain… and Unlearn It

Pain is a process that can escalate or be de-escalated, depending on how much stress your brain and body experience and how you perceive and adapt to that stress.

This study reinforces what many in pain neuroscience have long known: addressing sleep, stress, mood and weight can all impact persistent widespread pain.

References

Tanguay-Sabourin, C., Fillingim, M., Guglietti, G.V. et al. A prognostic risk score for development and spread of chronic pain. Nat Med 29, 1821–1831 (2023). https://doi.org/10.1038/s41591-023-02430-4