To assess if gout is associated with a higher risk of incident chronic pain. This study used the 2006–2012 Medicare claims data. We used multivariable-adjusted Cox regression analyses to examine the association of pre-existing diagnosis of gout with incident (new) diagnosis of chronic pain, adjusting for demographics, medical comorbidity, and use of common medications for cardiovascular disease and gout. Sensitivity analyses substituted Charlson-Romano score with a categorical variable or each Charlson-Romano comorbidity. There were 1,321,521 eligible people, of whom 424,518 developed incident chronic pain. Crude incidence rates of chronic pain were as follows: gout, 158.1 per 1000 person-years and no gout, 64.5 per 1000 person-years. In multivariable-adjusted Cox regression analyses, gout was associated with higher hazard ratio of chronic pain, 2.02 (95% CI, 1.98, 2.05), confirmed in sensitivity analyses 1.96 (95% CI, 1.93, 1.99) (model 2) and 1.77 (95% CI, 1.74, 1.80) (model 3). No meaningful differences were found by gender and race in subgroup analyses; slightly lower hazard of chronic pain with gout was seen in oldest people. Use of allopurinol or febuxostat was associated with lower risk of chronic pain, 0.79 (95% CI, 0.77, 0.82; model 1) and 0.72 (95% CI, 0.56, 0.92; model 1). Gout was associated with a doubling of the risk of chronic pain and gout treatments with reduction in the risk. Efforts must be made to optimize gout control, so that chronic pain can be avoided as a long-term sequalae of gout and when present, treated early and appropriately.
• Gout was associated with twofold higher risk of incident (or new) diagnosis of chronic pain.
• Gout treatments were associated with a lower chronic pain risk.
• Increased risk of chronic pain with gout was similar across age, race, and sex.
• Studies should examine if optimal gout control with treat-to-target approach can reduce the risk of chronic pain in people with gout.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
These data can be obtained from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse. We are ready to share the data with colleagues, after obtaining appropriate permissions from the Centers for Medicare and Medicaid Services (CMS) Chronic Condition Data Warehouse and the University of Alabama at Birmingham (UAB) Ethics Committee, related to HIPAA and Privacy policies.
International Classification of Diseases, ninth revision, common modification
xanthine oxido-reductase system
coronary artery disease
- ACE inhibitor:
angiotensin converting enzyme inhibitor
Centers for Medicare and Medicaid Services
van Hecke O, Torrance N, Smith BH (2013) Chronic pain epidemiology and its clinical relevance. Br J Anaesth 111:13–18
Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH (2010) The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain 11:1230–1239
Tunks ER, Crook J, Weir R (2008) Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Can J Psychiatr 53:224–234
Tracey I, Bushnell MC (2009) How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain 10:1113–1120
Becker N, Bondegaard Thomsen A, Olsen AK, Sjogren P, Bech P, Eriksen J (1997) Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 73:393–400
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D (2006) Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 10:287–333
Zhu Y, Pandya BJ, Choi HK (2011) Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 63:3136–3141
Qaseem A, Harris RP, Forciea MA (2017) Clinical Guidelines Committee of the American College of P. Management of Acute and Recurrent Gout: a clinical practice guideline from the American College of Physicians. Ann Intern Med 166:58–68
Neogi T (2011) Clinical practice. Gout. N Engl J Med 364:443–452
Singh JA (2014) The impact of gout on patient’s lives: a study of African-American and Caucasian men and women with gout. Arthritis Res Ther 16:R132
Singh JA, Hodges JS, Toscano JP, Asch SM (2007) Quality of care for gout in the US needs improvement. Arthritis Rheum 57:822–829
Singh JA (2013) Veterans affairs databases are accurate for gout-related health care utilization: a validation study. Arthritis Res Ther 15:R224
Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:1075–1079 discussion 81-90
Tonelli M, Wiebe N, Fortin M, Guthrie B, Hemmelgarn BR, James MT et al (2015) Methods for identifying 30 chronic conditions: application to administrative data. BMC Med Inform Decis Mak 15:31
Tian TY, Zlateva I, Anderson DR (2013) Using electronic health records data to identify patients with chronic pain in a primary care setting. J Am Med Inform Assoc 20:e275–e280
Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, Pillemer SR, Reveille JD, Stone JH, National Arthritis Data Workgroup (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 58:15–25
Singh JA, Hossain A, Tanjong Ghogomu E, Kotb A, Christensen R, Mudano AS et al (2016) Biologics or tofacitinib for rheumatoid arthritis in incomplete responders to methotrexate or other traditional disease-modifying anti-rheumatic drugs: a systematic review and network meta-analysis. Cochrane Database Syst Rev (5):CD012183
Briesacher BA, Andrade SE, Fouayzi H, Chan KA (2008) Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 28:437–443
Malik A, Dinnella JE, Kwoh CK, Schumacher HR (2009) Poor validation of medical record ICD-9 diagnoses of gout in a veterans affairs database. J Rheumatol 36:1283–1286
We thank Dr. Jeffrey Curtis of the UAB Division of Rheumatology, who permitted us to re-use the 5% Medicare data.
The funding body did not play any role in design, in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.
Conflict of interest
JAS has received consultant fees from Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee, and the co-Chair of the ACR Criteria and Response Criteria subcommittee. DC has no conflicts to declare. There are no non-financial competing interests for any of the authors.
Ethics/IRB approval and consent to participate
The University of Alabama at Birmingham’s Institutional Review Board approved this study and all investigations were conducted in conformity with ethical principles of research. The IRB waived the need for informed consent for this study.
Consent to publish
No individual person’s data were presented in any form in this study and therefore no consent to publish is required.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
About this article
Cite this article
Singh, J.A., Cleveland, J.D. Gout and chronic pain in older adults: a Medicare claims study. Clin Rheumatol 38, 1953–1960 (2019). https://doi.org/10.1007/s10067-019-04526-0
- Chronic pain
- Older adults