Multimodal Hypersensitivity Predicts the Development of Widespread Body Pain in Adolescents

Widespread body pain can emerge in adolescence and is a risk factor for chronic widespread pain conditions in adulthood, such as fibromyalgia, that negatively impact quality of life. In this longitudinal study we identified predictors for developing widespread body pain (pain in at least 3/7 sites) across menarche in adolescents. Over pre- and post- menarchal study visits spanning an average of 2.6 years, 178 participants completed a bodymap questionnaire as well as psychosocial questionnaires, quantitative sensory testing (including unpleasant visual and auditory stimuli), and a provoked visceral pain task that measures bladder sensitivity. Bodymap analysis revealed that one quarter (n=44) of participants had widespread pain at the baseline pre-menarche visit. Another quarter of participants (n=45) would develop widespread pain by post-menarche follow-up visit, while the other half (n=89) did not develop widespread pain at any time point. Neither baseline pressure pain thresholds, cold pain ratings, nor conditioned pain modulation predicted the development of widespread pain. Menstrual pain was not associated with widespread pain at post-menarche follow up visits. However, greater sensitivity to visceral (bladder) provocation (p<0.001) as well as unpleasant auditory (p<0.01) and visual stimuli (p<0.01) at baseline did predict widespread pain development. Other baseline predictors of widespread pain included higher anxiety, depression, somatization and stress and lower positive affect. These results suggest that - in addition to psychosocial factors - increased sensitivity to unpleasant and painful stimuli across multiple modalities is a risk factor for pain spread in adolescents. Funding: R01HD096332.