Chronic Pain and Quality of Life

Migraine warriors face a lot of challenges in their daily lives. From being sensitive to sound to having to abstain from alcohol, migraine is no joke! And unfortunately, for many of us, migraine is not the only condition we suffer from. This is called comorbidity, where one or more diseases are present in the same person. Other common chronic pain conditions that are comorbid with migraine can affect any part of the body, including lower back pain, the digestive system and others.

Our research team landed on a question – do comorbid conditions affect our pain recall, and how do they affect our quality of life? 

Some people with migraine also have one more condition, some even have, 2, 3, 4, or more additional conditions.

The Findings

A total of 1405 people from our community answered a survey through the Migraine Buddy app to find out how they perceived pain over time and how it affected their quality of life. As much as 1052 (75%) responded that they had chronic pain in addition to migraine, with the median age at 44 and the average length of having the chronic pain condition at 12 years. The graph below shows the breakdown of comorbid conditions in our participants. Other conditions included endometriosis (8%) and eczema (6%), with some people (9%) not knowing their comorbid conditions.

Pain Intensity and Average Pain Level

To record pain intensity, participants were asked to rate their pain on a scale from 0 (no pain) to 10 (worst imaginable pain) over different periods of time. The results were very interesting – the longer the recall, the higher the pain intensity. For example, over the last 24 hours, the average pain level was 5.1, while over the last year, it was 6.1. This difference is statistically significant and is a large step in pain intensity. 

To simplify the reading in the graph above, we grouped the pain levels into 5 categories. What we observed is a decrease of the lower pain values (0 to 4) and an increase of higher pain values (7-10) when the duration of recall increases. When asked to recall the last 24 hours, the lower pain values (0-4) are reported by 40% of respondents, while that percentage drops to 20% when asked to recall a longer time period of 12 months.

Similarly, higher pain values are reported by 31% of the respondents when asked to recall the last 24 hours, which increases to 42% when asked to recall the last 12 months. This could mean that we perceive our long-term condition as more painful than a short-term attack.

Age of Respondents

Another interesting observation is that pain intensity reported, varies according to the age of the respondents. On average, the pain level reported over the last 24h, increases with age. The 18-25 years have a pain level of 4.75, while for the people above 65 years old, it is 5.38, with a gradual increase for the age ranges in between.

The graphic below shows the evolution of pain intensity reporting for the last 24 hours, according to age.

The younger respondents (18-25 years) report low pain intensity values (in green) more often than older respondents (46 and above). Similarly, the higher pain intensity values (in orange) increase in percentage, with age, with a plateau from the 46-55 age group.

Quality of Life

Now that we gained information about pain intensity and the perception of pain over time, how could this knowledge be correlated with a person’s quality of life? We asked the participants about their capability to live their lives with their pain.

We asked participants how affected they are for these five categories on a day to day basis, on a scale of 1 to 5 (where 1 was not affected and 5 for most affected):

1. Mobility (the ability to walk)
2. Self-care (showering, feeding, etc)
3. Daily activities
4. Pain or discomfort
5. Anxiety or depression

While the perception of pain was average for 50.1% of respondents, most could still care for themselves (55.4% at 3 out of 5). However, a staggering 91% of respondents say that this pain still affects their usual activities in some manner. Pain is also difficult to cope with mentally, as 63.9% of respondents feel some form of anxiety or depression.

We also examined the influence of age over the five categories. While there seemed to be no effect on self-care and usual activities, pain-related mobility difficulties increased with age. At the same time, anxiety and depression decreases with age. This is similar to findings by a 2019 study, which found that younger adults had a higher level of depression and anxiety as compared to older adults.

Limitations

Pain and quality of life, by their nature, are self-reporting metrics. The pain level is defined by the respondent, and thus, it may not be as consistent as we would like. Furthermore, we did not have a control group of people who only had migraine – instead, our findings concentrated on people with comorbidities and migraine. Thus, the pain and quality of life reported do not imply anything about the individual conditions, merely an aggregation of both (or more) conditions.

Conclusions

Overestimation of pain at recall is frequently reported in scientific literature. Our findings suggest that the reason for this, is that the recall of pain intensity increases over time, then leading to a perceived higher pain intensity the longer the recall period. It is thus important to report pain level daily rather than over time when testing the efficacy of new relief methods for your conditions. On a similar note, having pain does not necessarily mean a poor quality of life. Most people with chronic pain (and comorbid conditions) are able to live their daily lives, but there is a marked effect on their mental health, which only changes with age.