Interoceptive sensibility across different pain site patterns in women with chronic musculoskeletal pain

Aims: This study aimed to investigate interoceptive sensibility according to the distribution of pain sites in women with chronic musculoskeletal pain. Methods: A total of 159 women with chronic musculoskeletal pain were assessed using the Nordic Body Map to identify the painful sites and categorized into three groups: single-site (n=48), multisite (n=89), and generalized pain (n=22). Disability and interoceptive sensibility were assessed using the Pain Disability Index and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2), respectively. Group differences were analyzed using ANCOVA adjusted for demographics. Hierarchical logistic regression analyses were conducted separately for multisite and generalized pain to identify predictors from demographics and interoceptive sensibility dimensions. Additionally, an exploratory multiple linear regression was conducted to identify demographic and interoceptive predictors of disability. Results: Among the eight dimensions of the MAIA-2, only the trusting score differed among pain groups (p=0.041), with posthoc comparisons showing that women with single-site pain had higher trusting scores than those with generalized pain (p=0.04). In the final hierarchical logistic regression model, employment status (p=0.014, Exp(B)=3.49) and the trusting score (p=0.045, Exp(B)=0.68) significantly predicted generalized pain (Nagelkerke R²=0.104, p=0.009), whereas the model for multisite pain was not significant (p>0.05). In the exploratory analysis, lower not-worrying and trusting scores were uniquely associated with higher disability (β=-0.224, p=0.007 and -0.203, p=0.039). Conclusion: Lower trusting toward interoceptive sensations and unemployment were linked to generalized pain, whereas lower trusting and not-worrying toward interoceptive sensations were associated with greater disability. These findings support a multidimensional approach to interoceptive sensibility in chronic pain management.