Chronic Pain May Increase Risk for Major Adverse Cardiac and Cerebrovascular Events

In addition to increased medical costs, chronic pain may result in long term consequences, including impaired activities of daily living, cognitive decline and depression.

Individuals with chronic pain may have an increased risk for major adverse cardiac and cerebrovascular events (MACCEs), according to study results published in Pain Medicine.

Investigators conducted a nationwide population-based cohort study using data from the Longitudinal Health Insurance Database 2000. A lack of primary diagnosis of a MACCE prior to the beginning of the study and being younger than 65 years were the inclusion criteria for the study. The first cohort, participants with chronic pain (n=17,614), was identified between 2001 and 2005. The comparison cohort, participants without chronic pain (n=35,228), were selected by matching index year, age, and sex in a 2:1 ratio. Researchers followed up with participants in both cohorts until 2015. The mean age for the participants with and without chronic pain was 50.2 and 50.4 years, respectively. Women comprised 55.5% of both cohorts, and participants aged 50–65 years constituted the largest age subgroup (59.4%). 

Outcomes included all-cause mortality, stroke, a need for coronary angioplasty, and occurrence of acute myocardial infarction. Participants with chronic pain had a higher prevalence of underlying comorbidities such as hypertension, diabetes, renal diseases, and depression. After adjusting for these comorbidities and others, researchers found that participants with chronic pain had a higher risk for MACCE than those without chronic pain (adjusted hazard ratio [AHR], 1.3; 95% CI, 1.3 -1.4)

There was no difference identified in MACCE risk between men and women. However, there was an increased risk of MACCEs in the age subgroup <20 years (AHR, 4.7; 95% CI, 1.9 –11.7). Researchers also found that 5.5% of the participants used opioids, and that nonsteroidal anti-inflammatory drugs were the most common analgesics used among participants with chronic pain (79.7%). Individuals taking opioids had a higher risk for MACCEs than those who did not use opioids (AHR, 1.3; 95% CI, 1.1–1.5)

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Investigators noted that the possible reasons for increased occurrence of MACCE in patients with chronic pain included “reduced activity, disability, sleep disturbance, fatigue, and mood alterations such as anxiety and depression.”

Study limitations included an underestimated prevalence of chronic pain among participants, and a lack of lifestyle and socioeconomic information available for each cohort. Further there is an inability to generalize results due to the study’s focus on the Asian population. Moreover, it was noted that the causal relationship between chronic pain and MACCE cannot be completely established due to the complex interplay between chronic pain and MACCE. Finally, the study did not investigate the relationship between chronic pain and MACCE in participants older than 65 years. 


Chung K-M, MD. Chung-Han H, PhD, Chen Y-C, MS, et al. Chronic pain increases the risk for major adverse cardiac and cerebrovascular events: a nationwide population-based study in Asia. Pain Medicine. doi:10.1093/pm/pnaa107

This article originally appeared on Clinical Pain Advisor