Multidimensional symptom burden across sleep, pain, affect, cognition and energy: cross-sectional associations with chronic pain interference and work disability in UK Biobank
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Background
Sleep, pain, affect, cognition and energy (SPACE) has been described as a latent symptom-severity construct in chronic overlapping pain conditions. Its population-level structure and associations with chronic pain interference and functional disability remain uncertain.
Methods
We conducted a cross-sectional analysis of UK Biobank participants aged ≥40 years. Prespecified standardised symptom domains were examined using correlation analysis, principal component analysis, exploratory factor analysis and k-means clustering. Associations with chronic pain interference, current work disability, poor self-rated health and longstanding illness or disability were assessed using covariate-adjusted logistic regression. A four-domain score excluding pain tested whether associations extended beyond the pain domain. Secondary analyses examined convergence with actigraphy, biomarkers, polygenic risk scores and brain magnetic resonance imaging phenotypes.
Results
Of 501,935 eligible participants, 475,134 had complete domain data. Domains were modestly intercorrelated (r=0.04–0.46). Clustering identified lower- and higher-burden phenotypes comprising 70.5% and 29.5% of participants; current work disability occurred in 1.3% and 10.3%, respectively. Adding the four non-pain domains increased the area under the curve for chronic pain interference from 0.593 to 0.672 and for work disability from 0.748 to 0.850. Inclusion of pain increased the work-disability area under the curve to 0.863. Multimodal measures added smaller increments.
Conclusions
A multidimensional symptom profile was identifiable at population scale and was concurrently associated with chronic pain interference and work disability, with non-pain domains contributing information beyond pain burden alone.
Significance
Chronic pain interference and work disability were associated with a broader multidimensional symptom burden spanning sleep, affect, cognition and energy, rather than pain alone. In a large population cohort, the non-pain domains added substantial concurrent discriminatory information. These findings support multidimensional assessment of functionally impairing pain and justify prospective evaluation of whether symptom-system profiles predict incident disability, healthcare use, recovery trajectories or treatment response.
