Decoding the Uric Acid to HDL Cholesterol Ratio (UHR) as a Novel Metabolic Biomarker for Chronic Pain: Insights Into Precision Diagnostics and Management.

BACKGROUND: Chronic pain (CP) constitutes a multidimensional clinical phenomenon with rising prevalence globally, producing substantial societal and healthcare burdens. Metabolic and inflammatory dysregulations are central to its pathophysiology, stimulating interest in identifying biomarkers that reflect these underlying processes. The uric acid to high-density lipoprotein cholesterol ratio (UHR) serves as an integrated index representing systemic inflammatory status and lipid metabolism, offering potential relevance in CP research. METHODS: This cross-sectional study analyzed data from 12,012 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2004 cycles. UHR was calculated as serum uric acid divided by high-density lipoprotein cholesterol. CP was defined as pain lasting ≥ 24 h during the previous month and persisting for ≥ 3 months. Associations between UHR and CP were evaluated using multivariable logistic regression models adjusting for demographic, metabolic, and clinical covariates. Restricted cubic spline and threshold-effect analyses were further performed to assess potential nonlinear relationships. RESULTS: Higher UHR levels were associated with increased CP prevalence. In the fully adjusted model, participants in the highest UHR quartile exhibited significantly greater odds of CP compared with those in the lowest quartile (OR = 1.44, 95% CI: 1.22-1.70). Continuous-variable analysis demonstrated that each unit increase in UHR was associated with an 11% increase in CP odds. Restricted cubic spline analysis revealed an approximately linear positive association between UHR and CP prevalence, whereas threshold-effect analysis did not identify a statistically significant nonlinear relationship. CONCLUSION: The findings indicate that UHR may serve as a biologically informative metabolic correlate of CP. While causality cannot be inferred due to the cross-sectional design, these results highlight a link between metabolic-inflammatory status and CP prevalence. Future longitudinal studies are required to clarify temporal dynamics and assess the predictive value of UHR.