Sexual abuse and chronic musculoskeletal pain: prevalence and psychological factors

OBJECTIVE

We investigated the prevalence of a history of sexual abuse among patients with long-term musculoskeletal pain. Psychological factors associated with abuse and pain were also studied.

DESIGN

First, the prevalence of abuse was determined based on self-report on a valid and reliable abuse questionnaire. Subsequently, a cross-sectional method, in which patients were categorized as abused or nonabused, was employed and responses to a battery of questionnaires compared.

PATIENTS

Seventy-five consecutive patients undergoing assessment for chronic musculoskeletal pain participated.

OUTCOME MEASURES

These included Beck's Depression Inventory, the Coping Strategies Questionnaire, the Multidimensional Pain Inventory, the Uppsala Type A Behavior Questionnaire, the Pain and Impairment Rating Scale, as well as ratings of pain intensity.

RESULTS

Thirty-eight percent of the women and 10% of the men reported some form of sexual abuse, usually during adulthood. A majority (77%) had disclosed the abuse to someone, but >85% did not believe that the abuse negatively affected their pain or sex lives. Abused women, relative to nonabused ones, had poorer scores on 27 of the 29 assessment variables. Abused female patients had significantly higher levels of depression, stress from daily hassles, affective distress, and more frequent negative responses from spouses, in addition to having lower levels of social activities, life control and effective coping for pain than did the nonabused female patients.

CONCLUSION

These data extend the relationship between sexual abuse and pain to a Swedish population suffering from musculoskeletal complaints. Our findings suggest that intervention in the pain treatment setting may need to address further the problems of effective coping strategies and depression.

Validity of a brief outpatient functional assessment measure

Aspects of validity are investigated with a brief functional assessment measure among outpatients undergoing rehabilitation for musculoskeletal problems. The Medical Rehabilitation Follow Along measure (MRFA) currently has screening, musculoskeletal, neurologic, and multiple sclerosis forms. In this study, the 31-item musculoskeletal form of the MRFA is compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity are addressed using scale scores before (n = 94) and after (n = 48) outpatient rehabilitation. Scale scores are compared with therapists' ratings of improvement. The results provide support for the validity of inferences made from scale scores of the MRFA for persons with musculoskeletal problems. Applications of the MRFA, including screening, monitoring, and outcome assessment are discussed for clinical management, measuring treatment effectiveness, and program evaluation.

Psychological medicine, pain, and musculoskeletal disorders

There is a two-way relationship between pain and psychological illness. Pain may be produced by psychological states and may cause psychological disturbances. For these reasons, pain and psychiatric problems are often associated. Selection is also highly important in influencing the population of all hospital clinics dealing with chronic nonfatal illness. Patients from this group show increased emotional difficulty, which in the past has been misunderstood as evidence of a psychological etiology.

Influence of previous pain experience on the episode incidence of low back pain: results from the South Manchester Back Pain Study

BACKGROUND

A pathological cause cannot be identified for most new episodes of low back pain (LBP) presenting to the general practitioner. One important potential influence on susceptibility is previous pain experience. To accurately investigate the contribution of this phenomenon to the onset of new episodes of LBP a prospective population study is required.

AIMS

To determine the relationship of prior pain in the back and other musculoskeletal sites to risk of subsequent new episodes of LBP.

METHODS

The population studied included all 2715 adults from the South Manchester Back Pain Study who were free of LBP during the month prior to the baseline survey. At baseline a detailed musculoskeletal pain history was obtained. New episodes of LBP over the subsequent 12 months were ascertained by: (i) prospectively monitoring all primary care consultations in the study cohort (consulting episodes) and (ii) a follow-up survey after 1 year to determine new episodes during that 12-month period not leading to consultation (non-consulting episodes).

RESULTS

The 12-month cumulative incidence of new consulting episodes was 3% in males and 5% in females, and for new non-consulting episodes 31% in males and 32% in females. Those with a history of previous LBP had twice the rate of new episodes, both consulting and non-consulting, compared to those with no LBP in the past. Neck pain or pain in other musculoskeletal sites at baseline also doubled the risk of a subsequent new episode of LBP. Adjusting for psychological distress and the other pain variables had little influence on the findings.

CONCLUSION

In those currently free of LBP a previous history of the symptom substantially increases the risk of a further episode, with pain in other sites an equally strong independent predictor of subsequent LBP.

Musculoskeletal pain syndromes that affect adolescents

Musculoskeletal pain is one of the most common pains of adolescence, along with headache and abdominal pain, and arthralgia is the single most common reason for referral to the pediatric rheumatologist. Not surprisingly, the pediatric rheumatologist is frequently called to distinguish organic from functional symptoms. During the past decade, the pediatric rheumatology community has been evaluating increasing numbers of adolescents and preadolescents who experience musculoskeletal symptoms presumably as a defense against emotional stress from achievement either in academic work or in sports. To complicate the challenge further, coexistent organic and psychologic disturbance is not rare. Clearly, organic illness does not protect a patient from emotional plan, and it may be most difficult to differentiate nonorganic pain in a patient with a known organic illness. Conversely, adolescents with organic illness may use their disease for secondary gain. Fear of misdiagnosis of physical illness as psychiatric and the notion that all of the patient's complaints should be explained by a unifying diagnosis cause diagnostic error in both psychogenic illness with physical manifestations and physical illness with psychogenic symptoms.

Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople

OBJECTIVES

To analyse the association between symptoms from the musculoskeletal system and many psychosocial and other physical stressors in the job demand-control-support model. Also to analyse the influence of personality characteristics.

METHODS

1306 salespeople answered a self administered questionnaire on job characteristics, exposures, personality characteristics, social network, smoking and drinking habits, and symptoms of the neck, shoulders, and low back.

RESULTS

In multivariate analyses, high job demands were related to neck and shoulder symptoms (ORs 1.43-1.47 in the highest exposure groups compared with the lowest), and tendency to become overworked and lack of social support from colleagues were related to back pain (OR 1.81-2.04 in the highest exposure groups compared with the lowest). Lack of variation in the job, low control over time, and high competition were related to neck symptoms, but there was an interaction so that both low control over time and high competition had to be present to increase the OR. Also, driving long distances and sedentary work were related to neck and low back pain, and time spent in the car to shoulder pain (ORs 1.64-2.80 in the three highest groups v the lowest exposure groups).

CONCLUSION

Both psychosocial and physical factors were associated with musculoskeletal symptoms. Many dimensions of the demand-control-support model were associated with symptoms. Only one personality characteristic, tendency to feel overworked, significantly influenced the prevalence of musculoskeletal symptoms.

Milking is a high-risk job for young females

The prevalence of and the impact of selected factors on self-reported musculoskeletal complaints in Swedish female milkers with special reference to symptoms in the upper extremities were investigated using data from mail-in surveys. An agricultural study group was formed of three subgroups: 161 active milkers, 108 non-milkers and 62 ex-milkers, women who had been milkers earlier but were no longer doing that kind of work. In the course of the analysis these subgroups were compared with each other and also, separately or in combinations, with a non-agricultural population consisting of 166 nursing assistants. Problems in the upper extremities were significantly more common in the agricultural group than in the non-agricultural group. Milkers ran a higher risk of developing symptoms in the wrists and hands than non-milking women. Symptoms such as numbness, coldness in the wrists and white fingers were more common in all agricultural subgroups than in the non-agricultural group. Numbness and white fingers were related to vibration exposure in the ex-milker and the non-milker groups but not in the milker group. Psychosocial factors such as occupational well-being were not related to the occurrence of symptoms. Milking in a modernized barn gave fewer problems in elbows than milking in a traditional barn. Milkers who had received ergonomic instruction on how to work in order to reduce muscle stress had fewer problems in the elbow region than those who had received no such information.

Are occupational drivers at an increased risk for developing musculoskeletal disorders?

STUDY DESIGN

This study analyzed the role of exposure to driving and other covariates in reports of back, neck, and shoulder pain and resultant disability. Cohorts in Sweden and the United States were compared.

OBJECTIVES

To establish the effect of mechanical and psychosocial factors in reporting back, neck, and shoulder pain and work loss.

SUMMARY OF BACKGROUND DATA

There are numerous reports of a positive relationship between back pain and driving. However, exposure data are minimal. The influence of job satisfaction has not been assessed.

METHODS

The physical factors affecting reports of back, neck, and shoulder pain were investigated in a two-country cohort study of bus and truck drivers and sedentary workers. Vibration exposure was obtained by directly measuring the vibration imposed on the driver during a typical work day. Lifting exposure was attained by questionnaire. Cumulative exposure was computed based on work history. Musculoskeletal health information was based on a modified nordic questionnaire, and other questionnaires recorded the physical and psychosocial aspects of the work environment.

RESULTS

Of the sample, 50% reported low back pain, with no difference between countries. The highest risk factors (odds ratios) for back and neck pain were long-term vibration exposure, heavy lifting, and frequent lifting. A combination of long-term vibration exposure and frequent lifting carried the highest risk of low back pain. Work loss from low back pain was influenced by perceived job stress.

CONCLUSIONS

Vibration (resulting from driving) and lifting cause back, neck, and shoulder pain, whereas inability to work seems affected by stress at work.

Upper extremity musculoskeletal symptoms among female office workers: associations with video display terminal use and occupational psychosocial stressors

The relationships between musculoskeletal symptoms and both video display terminal (VDT) use and occupational psychosocial stress were assessed among women office workers by self-administered questionnaires. Significantly increased odds ratios for neck or shoulder symptoms were observed for subjects who had ever used a VDT, had less job security, and had more stressful work during the 2 weeks prior to completion of the questionnaire. Significantly increased odds ratios for arm and hand symptoms were observed for subjects who had used a VDT for more than 6 years, reported a very crowded workplace, or reported very stressful work during the 2 weeks prior to completion of the questionnaire. Among current non-users, those who previously used VDTs were more likely to report upper extremity musculoskeletal symptoms than those who had never used VDTs. This suggests that individuals with symptoms may be more likely to reduce their VDT usage, distorting results of cross-sectional studies.

Musculoskeletal pain: concepts of disease, illness, and sickness certification in health professionals in Norway

Concepts of disease, illness (being ill), and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories. Questionnaires were filled in by 898 individuals; 194 General Practitioners, 76 medical consultants working for the National Insurance Administration, 307 insurance clerks, and a representative sample (N = 321) of the general public. The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems. Discrepancies between the medical profession representatives and the general public were, in general, attributable to differences in information and knowledge about these somatic conditions. However, for musculoskeletal pain all groups had conceptual problems. In particular, there was a lack of consensus for issuing sickness certificates. For musculoskeletal pain conditions the doctors, as a group, seemed to score at random or 50-50 level for sickness certification. All groups, including medical doctors, were reluctant to accept depression and social problems as diseases, or to accept social problems as reasons for sickness certification. The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints.

Social support, job strain and musculoskeletal pain among female health care personnel

OBJECTIVES

This study explored the relationship between psychosocial work environment and the musculoskeletal pain among health care personnel.

MATERIALS AND METHODS

Ninety registered nurses and nurse's aides working in different hospitals in or just outside Stockholm and working in different kinds of care constituted the study group. Data were collected by means of questionnaires, including questions about symptoms (low-back pain, pain in the neck, and pain in the shoulders), the perception of social support from co-workers and superiors, conflicts, feelings of isolation, poor relations with superiors, psychological demands, authority over decisions, and skill utilization (job-strain factors).

RESULTS

An ordinal univariate logistic regression analysis showed that psychological demands, authority over decisions, skill utilization, and support at work had a statistically significant effect on symptoms from the lower back, while symptoms from the neck and shoulders were related to support a work only. When support at work and job strain were entered into a multivariate logistic regression model, a difference in the patterns of associations between low-back pain and symptoms from the neck and shoulders was found. Symptoms from the back were significantly related to job strain--the higher the strain, the more symptoms in the low back. Symptoms from the neck and shoulders on the other hand were more associated with social support at work--the lower the support score the more severe the symptoms.

CONCLUSIONS

Low-back pain seemed to be related to job strain, while symptoms from the neck and shoulders were to a greater extent related to relational and emotional factors.

The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups

OBJECTIVE

To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States.

METHODS

Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990-1992 National Health Interview Survey.

RESULTS

The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to approximately 2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience approximately 1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions--more than 17 million in all--are limited in their activities.

CONCLUSION

The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.

Assessment of sickness certification and concepts of musculoskeletal disease and illness in the general population

OBJECTIVE

To investigate how laymen assess the need for sickness certification and how they use the concepts "disease" and "illness" in relation to musculoskeletal disorders.

DESIGN

Mail questionnaire with simulated case histories.

SUBJECTS

A stratified, random sample of 600 Norwegians, aged 16-69 years.

MAIN OUTCOME MEASURES

Scores that measured the respondents' use of the concept "illness", and their view on need for sickness certification were constructed and analysed.

RESULTS

Response rate was 54%. The respondents perceived seven case histories describing musculoskeletal health problems more often as "illness" (61%) than as "disease" (46%). There was a close correlation between the use of "illness" and assessed need for sickness certification. However, sickness certification could be suggested for cases with neck pain, even if the patient was not perceived as ill. Women suggested sickness certification significantly more often than men. Age, length of education, and personal experience with serious musculoskeletal health problems influenced suggestions on certification among men. However, these variables could not explain any difference in use of the concept "illness".

Assessment of depression in chronic musculoskeletal pain patients

OBJECTIVE

To analyze how the cognitive, affective, and somatic-vegetative symptoms of depression included in the modified Zung Self-Rating Depression Scale (ZSDS) relate to pain severity.

SUBJECTS

Three groups of subjects were compared. The "no pain" group (n = 64) reported no musculoskeletal symptoms during the preceding year, the "low pain" group (n = 119) had a pain rating of < or = 4, and the "high pain" group (n = 137) had a rating of > or = 5 on a numerical pain rating scale (0-10).

METHODS

Sum scores of the ZSDS and means of separate items in the three subgroups were compared. Factor analyses were performed to evaluate the structure of the ZSDS, and differences between subgroups on weighted factor scores were analyzed.

RESULTS

The "high pain" group differed statistically significantly from both other groups on the sum score and on most of the items. Comparison of weighted factor scores in a three-factor solution revealed that in Factor I, "Psychic Energy," the "high pain" group differed from both other groups. In Factor II, "Despair," no differences between groups were found, while in Factor III, "Sleep problems," statistically significant differences were found between all subgroups; more severe pain was associated with more sleep problems, fatigue, and restlessness.

CONCLUSION

ZSDS items describing symptoms which could be a consequence of the pain problem (e.g., sleep problems) are clearly related more to pain severity than other indicators of depression--e.g., feelings of hopelessness. A diagnosis of depression based on a sum score of an inventory which contains somatic-vegetative signs of depression may lead to an overestimation of depression in chronic musculoskeletal pain patients. in chronic musculoskeletal pain patients.

Factors associated with pain complaints in a clinical sample of postmenopausal women

The aims of this study were to evaluate the relationships occurring between pain complaints and postmenopausal status, and to look at the correlation between such complaints and other symptoms commonly related to the climacterium. A clinical sample of 99 consecutive postmenopausal patients requiring medical help were studied: 36 complained of muscle-skeletal pains whereas 33 presented with headache limiting daily activity. Climacteric syndrome, level of distress, coping style and bone mineral density were assessed with appropriate questionnaires and instruments. Neither bone mineral density, nor body mass index nor time since menopause were associated with either headaches or muscle-skeletal pains. According to the logistic regression being younger, being without a job, suffering from insomnia and having a lower ability in self-support by the means of comforting ideas predicts suffering from headache. A high level of distress and an avoidance behavior to problem facing predict the presence of pain complaints. In such cases the ineffectiveness of the coping mechanism (i.e. avoid the problem) could be the reason for the increased level of psychological distress. These findings indicate that complaining of pains or headache is not dependent upon postmenopausal status. Individual coping strategies and their effectiveness seem the main reasons for the presence of disabling musculoskeletal pains or headache.

"I have a soul that dances like Tina Turner, but my body can't": physical activity and women with mobility impairments

The purpose of this study was to explore the experiences and meanings of physical activity for women with disabilities and to interpret the implications of physical activities specifically for women with mobility impairments. In-depth qualitative interviews were used to uncover data about how women with mobility impairments experienced physical activity and leisure. Emerging themes addressed the value of physical activity, attitudes toward one's disability and participation in physical activity, and conditions necessary for involvement in physical activity. Four values were associated with physical activities: leisure, therapy, maintenance, or perceived little value. Attitudes toward one's disability and physical activity resulted in conforming, resisting, or adjusting behavior. Energy/stamina/low pain level, transportation, removal of social fears, accessibility, and social support were the individual or combined conditions that influenced values and attitudes regarding physical activities. The results of this study highlighted the need to consider and improve opportunities for physical activity for women with mobility impairments.

Psychosocial work factors, physical work load and associated musculoskeletal symptoms among home care workers

This study was based on a questionnaire and included a group of home care workers (HCW) (n = 305) and a reference group of municipal employees (n = 694). The relationship between the work environment and musculoskeletal symptoms was analysed. The HCW were less satisfied with their control over their work and stimulus from their work and had a higher physical work load and prevalence of musculoskeletal symptoms, compared with the reference group. The Rate Ratio (RR) of neck and shoulder symptoms among HCW was 83 and 54%, respectively, higher among those reporting a "high" psychological work load compared with those reporting a "low" load. The highest RR for a single risk indicator was 2.5, and this concerned low-back symptoms among HCW who often worked with twisted postures. A combination of "poor" psychosocial work environment and "high" physical work load produced the highest RR for work-related neck (RR = 2.57) and shoulder (RR = 2.13) symptoms.

Musculoskeletal disorders in construction workers

Physical factors that contribute to musculoskeletal disorders in construction workers are described, and the clinical findings associated with muscular, tendon, articular, spinal, and peripheral nerve entrapment disorders are reviewed. Psychosocial factors and individual factors such as the worker's age, smoking habits, and endurance are considered.

Psychosocial factors at work in relation to back and limb disorders

OBJECTIVES

This study was a 10-year follow-up of the associations between work content, work control, social relationships at work, mental overstrain, physical work load, and musculoskeletal morbidity in the neck, shoulder and upper limb region, the low back, and the lower limbs among workers in the metal industry.

METHODS

A sample of 902 blue- and white-collar employees were studied. Measurements were made twice at the a 10-year interval by questionnaire and clinical examination.

RESULTS

At the beginning of the study, mental overstrain showed several associations with both the symptoms and the findings. The other psychosocial factors were the most consistently associated with the symptoms in the region of the neck, shoulder, and upper limbs and also in the lower-limb region among the middle-aged men. Prospectively, the social relations and the work content scores predicted the change in several morbidity scores. The associations were independent of physical work load.

CONCLUSIONS

Work-related psychosocial factors were associated with, and predicted, the change in the occurrence of musculoskeletal disorders when age, gender, social class, and physical work load were controlled for.

Methods and applications of stress research

The major health problems in the industrialized countries have a multifactorial etiology, where stress and other psychosocial factors seem to play an important role. Mental stress is not only induced by high demands, but also by demands that are too low, which happens in many repetitive and monotonous work situations and, e.g., in response to unemployment. For a long time, musculoskeletal disorders were mainly considered to be caused by physical conditions. However, accumulating evidence from several sources now indicate that psychosocial factors are also significantly associated with, e.g., back pain and shoulder problems. Studies of assembly line workers with a high incidence of back pain complaints indicate that the physical load on the spine at work is low, whereas psychophysiological stress levels are high and work satisfaction is low. Female assembly workers were found to have higher physiological arousal than men in traditional assembly line work, whereas their stress levels were lower in a more flexible and autonomous work organisation. In a recent laboratory experiment, both mental and physical stress was found to increase physiological stress levels and muscular tension. It was concluded, that data consistently support the assumption that mental stress is of importance for the development of musculoskeletal symptoms.

[Changes in subjective health in sports participating and sedentary patients after 4-week treatment in a rehabilitation clinic]

Presented are selected findings of a study of 62 patients who had participated in a four-week inpatient treatment programme in a health-resort rehabilitation clinic due to complaints of the locomotor organs. The patients' physical and general complaints showed statistically significant reductions in the course of this programme participation. Similar effects were stated as well for the majority of the scales pertaining to subjective health. A correlation between physical activity and subjective wellbeing, or physical complaints, respectively, has not been stated for all of the subjective health-related scales and complaints items. The improvements achieved can be considered proof of the effectiveness of the clinic's overall therapeutic concept as well as of the social relief afforded by the rehabilitation clinic setting.