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Multidimensional Associations of Chronic Pain in a Nationally Representative Sample

P-063 - (Poster #63) Multidimensional Associations of Chronic Pain in a Nationally Representative Sample

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background: Chronic pain, defined as pain persisting beyond three months, affects approximately 30% of the global population. Rather than being merely symptomatic, chronic pain represents a complex syndrome characterized by significant neurobiological and behavioral adaptations. The biopsychosocial model has fundamentally shifted both research and clinical management by emphasizing the active, reciprocal contributions of biological, psychological, and social factors to the pain experience and associated disability. These dimensions dynamically interact through feedback loops among neurobiological changes, psychological distress, behavioral adaptations, and social context, thereby perpetuating or ameliorating symptoms depending on their interplay. Current research increasingly seeks to elucidate mechanisms underlying these interactions, such as psychological factors like catastrophizing or resilience, and social determinants like support networks that modulate neurobiological pain pathways. This knowledge has facilitated the development of integrative, personalized treatments combining pharmacologic, psychological, behavioral, and social interventions tailored to individual biopsychosocial profiles. Multidisciplinary pain management teams are now standard practice, highlighting the necessity for coordinated, multimodal care. A deeper understanding of these interactions is critical for optimizing patient outcomes and quality of life by addressing the full spectrum of factors driving pain chronification and disability.

Purpose/Objectives: We aim to further characterize biopsychosocial associations with chronic pain diagnosis using multiple dimensions of psychometric assessments, somatic and psychiatric conditions, and demographic information. Specifically, we seek to identify unique and interactive effects among these biopsychosocial factors to enhance the precision of diagnostic models. This comprehensive approach will facilitate targeted interventions by elucidating how specific psychological and social factors interact with biological processes. Ultimately, this will support the development of more individualized, effective treatments, thereby improving clinical outcomes and patient quality of life.

Methods: A secondary analysis was conducted of a cross-sectional, quota-controlled survey representative of US census data from August 2024, with 3,022 respondents. Participants with missing data were excluded from respective analyses. Descriptive statistics were calculated for each variable by chronic pain diagnosis. Pearson Chi-Square tests assessed associations between categorical covariates and chronic pain diagnosis, with significance set at p < 0.05. For continuous variables, Levene’s test assessed variance equality, followed by either an unpaired t-test or Welch’s t-test (p < 0.05). Unadjusted logistic regressions were conducted for each variable individually, followed by models adjusted for demographic variables. Subsequently, logistic regression models incorporating medical and psychometric variables, adjusted for demographics, were conducted, reporting odds ratios and 95% confidence intervals. Variance Inflation Factor (VIF) was computed to evaluate multicollinearity. Analyses utilized Google Colab with Python packages: pyreadstat, pandas, numpy, scipy.stats, and statsmodels.api.

Results:

A total of 3,022 respondents participated, with minor missing data across MAIA subsections: Body Listening (n=3,020), Emotional Awareness (n=3,021), Noticing (n=3,021), and Self-Regulation (n=3,021). Chronic pain was most prevalent among those aged 50–64 (OR=3.15, 95% CI: 2.46–4.03). African Americans had lower odds (OR=0.57, 95% CI: 0.42–0.79), while women had higher odds than men (OR=1.34, 95% CI: 1.11–1.63). Full-time employment was protective (OR=0.67, 95% CI: 0.53–0.84); insurance status and poverty were not significant.

Multiple psychiatric and medical conditions were strongly associated with chronic pain, including anxiety (OR=3.24, 95% CI: 2.69–3.91), depression (OR=3.45, 95% CI: 2.87–4.15), panic disorder (OR=3.35, 95% CI: 2.65–4.22), dissociative disorders (OR=4.97, 95% CI: 3.20–7.72), bipolar disorder (OR=2.52, 95% CI: 1.98–3.20), ADHD (OR=2.63, 95% CI: 2.09–3.32), migraines (OR=3.69, 95% CI: 3.02–4.51), chronic kidney disease (OR=3.87, 95% CI: 2.64–5.67), chronic lung disease (OR=3.83, 95% CI: 2.66–5.50), asthma (OR=2.58, 95% CI: 2.10–3.18), stroke (OR=3.03, 95% CI: 2.02–4.53), heart disease (OR=2.71, 95% CI: 2.03–3.63), acute COVID-19 (OR=2.61, 95% CI: 1.90–3.58), and long COVID (OR=4.43, 95% CI: 2.98–6.58).

The top quartile of the Thought Impact Scale showed increased odds (OR=1.99, 95% CI: 1.55–2.55). Significant associations were observed for BFI openness (OR=1.03, 95% CI: 1.01–1.05), neuroticism (OR=1.06, 95% CI: 1.05–1.08), and MAIA subscales: Emotional Awareness (OR=1.03, 95% CI: 1.01–1.04), Non-Distracting (OR=1.06, 95% CI: 1.04–1.07), and Noticing (OR=1.06, 95% CI: 1.04–1.08). Negative associations were seen for the Spiritual Index of Well-being (OR=0.96, 95% CI: 0.95–0.98) and self-efficacy (OR=0.95, 95% CI: 0.93–0.96).

Conclusions/Implications for future research and/or clinical care:

This study identifies a multifactorial profile of chronic pain vulnerability, highlighting the importance of demographic, clinical, and psychometric dimensions. Middle-aged adults (50–64), women, and individuals not employed full-time showed elevated risk, while African American race was associated with reduced odds. A broad spectrum of psychiatric and medical comorbidities—including anxiety, depression, dissociative disorders, migraines, and long COVID—demonstrated strong associations with chronic pain, underscoring its complex biopsychosocial nature.

Psychological dimensions further differentiated risk. Elevated Thought Impact Scale scores and high levels of neuroticism and interoceptive awareness (especially MAIA Noticing and Non-Distracting) were positively associated with chronic pain, suggesting that heightened internal focus may amplify symptom perception or persistence. In contrast, self-efficacy and spiritual well-being appeared protective, pointing to the potential value of interventions that enhance personal agency and existential coherence.

Together, these findings emphasize that chronic pain is not merely a physical condition but one deeply intertwined with affective, cognitive, and social domains. Risk stratification and treatment approaches should incorporate this complexity, targeting not only physiological and psychiatric comorbidities but also individual psychological patterns and beliefs. Future work may benefit from longitudinal designs to examine causality and explore how modifying these factors may alleviate chronic pain burden.