Chronic pain and cardiovascular disease are two of the most common health problems in the world. A growing body of research suggests the two may be linked, and that people with chronic widespread pain (CWP) may carry the highest risk. A new systematic review and meta-analysis, published in PAIN in 2026, has pooled the available evidence to see how strong that link really is.
In a recent systematic review and meta-analysis, researchers aimed to summarise the current evidence on the association between CWP and incident cardiovascular disease.
Key Takeaways:
- The study. Researchers carried out a systematic review and meta-analysis of 18 long-term studies to test whether chronic widespread pain is a risk factor for cardiovascular disease.
- Heart attack and stroke. People with chronic widespread pain had an almost doubled risk of atherosclerotic disease (heart attack and stroke) in the least-adjusted analysis, at a relative risk of 1.94 (95% confidence interval 1.56 to 2.41).
- Cardiovascular death. The same group had about a 1.6-fold risk of dying from cardiovascular disease in the least-adjusted analysis, though this link weakened and was no longer statistically clear once other risk factors were accounted for.
- What it means. The findings point to chronic widespread pain being a consistent risk marker for heart attack and stroke. Whether pain itself causes cardiovascular disease is not yet established, and the certainty of the evidence was rated low to very low.
Why might chronic pain and heart disease be connected?
Several everyday factors are common to both chronic pain and heart disease, which may help explain a link. Long-term stress, physical inactivity, disturbed sleep, obesity, depression and low socioeconomic status are all associated with chronic pain and with a higher risk of cardiovascular disease. Some researchers have also asked whether certain long-term pain medicines, such as non-steroidal anti-inflammatory drugs, could play a part.
Importantly, an association is not the same as cause and effect. The overlap could mean that pain contributes to heart disease, that shared risk factors drive both, or a mixture of the two. Untangling this is exactly what a recent systematic review, published in The Journal of the International Association for the Study of Pain, set out to explore.
What did the study look at?
The researchers searched four major medical databases (Cochrane, EMBASE, MEDLINE via Ovid, and Web of Science) for long-term, peer-reviewed studies. To be included, a study had to follow adults with chronic widespread pain or fibromyalgia over time and compare them with a group who did not have these conditions.
Studies counted if they reported any of the following outcomes:
- Atherosclerotic disease, meaning heart attack (myocardial infarction) or stroke
- Heart failure
- Cardiovascular death
- Any combination of these
The team used a recognised tool called QUIPS (Quality In Prognostic Studies) to judge how much each study might be affected by bias. They also used the GRADE system to rate the overall certainty of the evidence.
What did the researchers find?
Eighteen studies met the criteria. Of these, seven reported on atherosclerotic disease, two on heart failure and 12 on cardiovascular death. The studies followed people for between 4 and 25 years. Most participants were women, reflecting who is most affected by chronic widespread pain and fibromyalgia.
The review reported two kinds of estimates. The minimally adjusted figures account only for basic differences such as age and sex. The maximally adjusted figures also account for established heart-disease risk factors such as smoking, blood pressure and diabetes, which gives a more conservative picture.
| Outcome | Minimally adjusted risk (95% CI) | Fully adjusted risk (95% CI) | Studies | Certainty of evidence |
| Atherosclerotic disease (heart attack and stroke) | 1.94 (1.56–2.41) | 1.53 (1.27–1.86) | 7 | Low |
| Heart failure | Around double the risk (from two studies) | Not separately pooled | 2 | Limited |
| Cardiovascular death | 1.61 (1.24–2.08) | 1.12 (0.93–1.34), not statistically clear | 12 | Very low |
Chronic widespread pain and heart attack or stroke
People with chronic widespread pain had close to double the risk of atherosclerotic disease in the least-adjusted analysis, at a relative risk of 1.94. When the analysis was adjusted for established heart-disease risk factors, the link softened but remained clear, at a relative risk of 1.53. This was the most consistent finding in the review.
Chronic widespread pain and heart failure
Only two studies looked at heart failure, and both came from the same population register. They reported a roughly doubled risk after adjustment. Because so few studies were available, the authors treated this finding with caution.
Chronic widespread pain and cardiovascular death
Twelve studies looked at cardiovascular death. People with chronic widespread pain had about a 1.6-fold risk in the least-adjusted analysis. Once established risk factors were taken into account, the link was no longer statistically clear. The association looked stronger when the researchers removed outlier studies or those with a higher risk of bias, but the overall certainty for this outcome was rated very low.
What do the findings mean?
The main message is that chronic widespread pain appears to be a consistent risk marker for heart attack and stroke, and may also be linked to cardiovascular death. In practical terms, people living with chronic widespread pain could benefit from proactive checks of their heart-disease risk and from support to reduce that risk, such as help with blood pressure, activity, sleep and stopping smoking.
The authors are careful not to overstate the case. Because these are observational studies, they cannot prove that pain causes cardiovascular disease. The link may partly reflect shared risk factors. The researchers call for further high-quality studies to confirm the strength of the association and to test whether it is causal.
How does this compare with earlier research?
The results broadly agree with earlier work, while adding something new. A previous meta-analysis of chronic pain (not specifically widespread pain) found a similar pattern, with a slightly smaller increase in heart and blood-vessel disease. The difference may be because the earlier work did not include studies of widespread pain.
Several older reviews, published between 2013 and 2023, did not find a clear link between chronic widespread pain and cardiovascular death. The authors suggest this may be because those reviews used looser definitions of widespread pain, which can dilute a real association.
What are the limitations of this study?
The review was thorough, but the authors are clear about its limits. There were relatively few published studies, especially for atherosclerotic disease and heart failure. The results also varied a lot from study to study, which makes a single combined figure harder to interpret. There were signs of possible publication bias for the cardiovascular-death analysis, meaning some smaller studies with different results may not have been published. Using the GRADE system, the certainty of evidence was rated low for atherosclerotic disease and very low for cardiovascular death.
Frequently Asked Questions
What is chronic widespread pain?
Chronic widespread pain is long-term pain, lasting more than three months, that is felt in several different areas of the body rather than in one place. It is thought to affect around one in ten people and is the core symptom of fibromyalgia, as well as a feature of several other pain conditions. The definition has become more precise over time, with newer criteria describing exactly where and how widely the pain is felt.
What is cardiovascular disease?
Cardiovascular disease is an umbrella term for conditions that affect the heart or blood vessels. It includes coronary heart disease, heart attack and stroke. Cardiovascular disease is the leading cause of disability worldwide, and it is among the top three causes of death from non-communicable diseases.
What are the risk factors for cardiovascular disease?
Well-established risk factors for cardiovascular disease include smoking, an unhealthy diet, physical inactivity, obesity and drinking too much alcohol. Medical conditions such as high blood pressure, high cholesterol and diabetes also raise the risk. Many of these can be improved, which is why regular checks and healthy lifestyle changes matter.
Does chronic pain cause heart disease?
Not necessarily. This review found a consistent link between chronic widespread pain and heart attack and stroke, but a link is not the same as cause and effect. The studies were observational, so they cannot show that pain itself causes cardiovascular disease. Shared factors such as stress, inactivity and disturbed sleep may explain part of the connection. More research is needed to know whether the relationship is causal.
Should I speak to a doctor about my chronic pain and heart health?
If you live with long-term pain and are worried about your heart, it is reasonable to speak to your GP. They can review your personal risk factors, offer checks such as blood pressure and cholesterol, and discuss ways to lower your risk. This article is for general information and does not replace advice from your own healthcare professional.
Can medical cannabis be prescribed for chronic pain?
In the UK, a specialist doctor on the GMC Specialist Register can prescribe an unlicensed cannabis-based medicine when they judge it clinically appropriate and after licensed treatments have been considered. Medical cannabis is not a licensed treatment for chronic pain, the evidence is still developing, and any decision is made individually by a specialist after reviewing a person’s full medical history.
If you’d like to understand whether a consultation with a specialist could be appropriate for you, complete our online eligibility check.
This article is for information only and is not medical advice or a recommendation to use any medicine.
