The Comorbidity Factor: Why Some People May Be More Likely to Experience Pain-And Have Multiple Conditions

Any health condition that causes chronic pain is difficult to handle, but research increasingly shows that certain individuals are physiologically more prone to developing chronic pain conditions of any kind, and that the interconnectedness between some of these conditions may be greater than yet understood. Over the last two decades, “not one study but hundreds of studies” have shown that people with chronic pain have physiological differences in the way their brain processes sensory information, explains Christin Veasley. Veasley is the cofounder and director of the Chronic Pain Research Alliance and advocates for improved care through more research and educational initiatives. She has served on many federal committees and collaborative alliances, has been a presenter at over 30 medical, research, and policy conferences, and is frequently interviewed for print, television, and radio media. 

“To me, that’s been one of the most transformative things that has happened over the last couple decades,” says Veasley. “We finally have something definitive to say, ‘I’m not crazy,’ it’s not a weakness or psychological issue—neurologically, people who develop these conditions are not the same as those who don’t.” Therefore, while it may originate in the brain, it’s certainly not “all in their head,” like many patients, especially those assigned female at birth, may have been told at some point. 

This research has identified and begun to investigate the interrelationship between pain conditions in different areas of the body as well as other non-pain comorbidities. Overlap is the norm rather than the exception: for example, according to the U.S. Pain Foundation’s 2021 Pediatric Pain Survey, 80% of surveyed children live with three or more confirmed medical diagnoses, including mental health and other non-pain comorbidities. Similarly, 95% of respondents in the U.S. Pain Foundation’s 2022 survey for adults living with pain reported having at least one comorbidity.

Veasley knows that interrelationship well: she first experienced chronic pain following a near-fatal car accident, and developed multiple other pain conditions over the decades. She learned that pain usually involves a trigger, like an illness or an accident, but that someone with a family health background may be more “genetically primed” to develop chronic pain conditions than the average individual.  

There have been multiple terms coined to describe this, like “central sensitization syndrome,” but the common denominator is the central nervous system. Just as cancer may present in different ways based on location, these chronic pain conditions may have the same basic mechanism but manifest differently. 

In fact, certain conditions—chronic fatigue syndrome, chronic low back pain, chronic tension headache, endometriosis, fibromyalgia, migraine, interstitial cystitis/painful bladder syndrome, irritable bowel syndrome, temporomandibular disorder and vulvodynia—occur so frequently together that the term “chronic overlapping pain conditions” (COPCs) was coined to identify them.