Abstract

Aims Pain is associated with cardiovascular disease; however, its association with incident arrhythmias is unclear. The study aimed to investigate associations between different pain characteristics (pain type, chronic pain, chronic widespread pain, chronic musculoskeletal pain, and number of chronic pain and chronic musculoskeletal pain sites), and risk of incident cardiac arrhythmias, overall and by subtype. Methods and results The study included 422 654 UK Biobank participants. Pain was ascertained via a touchscreen questionnaire. The outcomes were incident arrhythmias: all cardiac arrhythmias, atrial fibrillation (AF), other (non-AF) cardiac arrhythmias, bradyarrhythmias, and ventricular arrhythmias. Multivariable Cox-proportional regression was used to investigate the associations. Over a mean (standard deviation) follow-up of 13.19 (1.96) years, 36 860 (8.72%) participants developed arrhythmia. Compared with those without pain, those with chronic localized pain and chronic widespread pain had increased risk of all cardiac arrhythmias [hazard ratio (HR) 1.13, 95% confidence interval (CI), 1.10-1.17; HR 1.34, 95% CI 1.19-1.51], AF (HR 1.09, 95% CI 1.05-1.14; HR 1.33, 95% CI 1.15-1.55), and other cardiac arrhythmias (HR 1.17, 95% CI 1.12-1.22; HR 1.41, 95% CI 1.20-1.66). There was evidence of a dose relationship between the number of chronic pain sites and risk of all cardiac arrhythmias, AF, and bradyarrhythmias. Effect estimates were significantly larger among participants aged <60 years than those aged >= 60 years, and larger in women than in men. Conclusion Chronic pain was associated with cardiac arrhythmias. Whilst causation cannot be assumed in any observational study, there was evidence of both a temporal relationship and dose relationship. These findings reinforce the need for pain management approaches that include a broad assessment of individuals' risk factors, wider health status, and appropriate vigilance for emerging conditions.