Associations of multisite pain with healthcare utilization, sickness absence and restrictions at work

Pain, Conflicted Feelings About Work, and Sickness Absence: A Prospective Study of the Effects of Number of Pain Sites and Role Conflicts on Medically Certified Sickness Absence

We investigated associations between the number of pain sites (NPS) and role conflict with medically certified, pain-related sickness absence (SA) in employees of Norwegian enterprises (N = 5,654). Latent profile analyses identified exposure profiles based on 3 types of role conflict (work-role conflict, work-life conflict, and emotional dissonance). Multinomial logistic regressions estimated effects on absence (short-term absence of less than 56 days, long-term absence of more than 56 days) during 1 year after survey. Effects of the NPS on absence were compared across exposure profiles. Results suggested the NPS and all types of role conflict predicted absences separately. Mutually adjusted regressions revealed unique contributions of the NPS to the short-term and long-term absence (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.18, 1.30 and OR 1.51, 95% CI 1.37, 1.66) and of work-role conflict to the short-term absence (OR 1.18, 95% CI 1.03, 1.35). Latent profile analyses identified 4 exposure profiles ("1 unconflicted," "2 dissonant, otherwise medium," "3 conflicted, medium dissonance," "4 conflicted and dissonant"). Profiles 3 and 4 exhibited elevated risk of SA, with the strongest baseline-adjusted effects for profile 4 (short-term absence OR 1.90, 95% CI 1.40, 2.57, long-term absence OR 1.95, 95% CI 1.15, 3.31). Effects of the NPS on short-term absence were stronger for profile 4 versus profile 1 (OR 1.38 vs 1.24, P < .001). Our findings suggest that addressing role conflicts may prevent pain-related absence, possibly also for individuals already experiencing pain. PERSPECTIVE: This article elucidates the connections between role conflicts associated with work roles, the NPS, and SA due to pain. This should help organizations prevent pain-related absences from work and improve working conditions for workers who remain occupationally active in spite of pain problems.

Temporal stability in the prevalence and pattern of co-occurring musculoskeletal pain among people with persistent low back pain: population-based data from the Norwegian HUNT Study, 1995 to 2019

ABSTRACT

People with persistent low back pain (LBP) often report co-occurring persistent musculoskeletal (MSK) pain in other body regions that may influence prognosis as well as treatment approaches and outcomes. This study describes the prevalence and patterns of co-occurring persistent MSK pain among people with persistent LBP based on consecutive cross-sectional studies over 3 decades in the population-based HUNT Study, Norway. The analyses comprised 15,375 participants in HUNT2 (1995-1997), 10,024 in HUNT3 (2006-2008), and 10,647 in HUNT4 (2017-2019) who reported persistent LBP. Overall, ∼90% of participants in each of the HUNT surveys with persistent LBP reported persistent co-occurring MSK pain in other body sites. The age-standardized prevalence of the most common co-occurring MSK pain sites was consistent across the 3 surveys: 64% to 65% report co-occurring neck pain, 62% to 67% report shoulder pain, and 53% to 57% report hip or thigh pain. Using latent class analysis (LCA), we identified 4 distinct patterns of persistent LBP phenotypes that were consistent across the 3 surveys: (1) "LBP only," (2) "LBP with neck or shoulder pain," (3) "LBP with lower extremity or wrist or hand pain," and (4) "LBP with multisite pain," with conditional item response probabilities of 34% to 36%, 30% to 34%, 13% to 17%, and 16% to 20%, respectively. In conclusion, 9 of 10 adults in this Norwegian population with persistent LBP report co-occurring persistent MSK pain, most commonly in the neck, shoulders, and hips or thighs. We identified 4 LCA-derived LBP phenotypes of distinct MSK pain site patterns. In the population, both the prevalence and pattern of co-occurring MSK pain and the distinct phenotypic MSK pain patterns seem stable over decades.

Body awareness and cognitive behavioral therapy for multisite musculoskeletal pain: patients` experiences with group rehabilitation

BACKGROUND

An extended group program called Mind and Body (MB), based on body awareness exercises and cognitive behavioral therapy (CBT), was offered to a subgroup of patients who had completed their traditional outpatient multidisciplinary rehabilitation and were motivated for further treatment.

PURPOSE

To explore how patients with multisite musculoskeletal pain experienced participation in the MB program with respect to usefulness, meaningfulness, behavioral changes, and transferability to daily life and work.

METHOD

The study is rooted in the phenomenological tradition. Individual, semi-structured interviews were performed with eight patients aged 29-56 years. The data were analyzed using systematic text condensation.

RESULTS

Two main themes emerged: 1) New knowledge provided increased body awareness, new ways of thinking, and acceptance of one's own situation. This theme reflected how new knowledge and MB coping strategies were useful in the process of changing problematic thoughts, increasing body awareness, and facilitating acceptance; and 2) Implementing new habits and strategies in daily life revealed how demanding it was to alter behavior, a process that unfolded over time.

CONCLUSION

A combination of body awareness exercises and cognitive coping strategies was described as helpful in further improving function and coping with pain and stress in daily life and work.

Perceived Injustice as a Determinant of the Severity of Post-traumatic Stress Symptoms Following Occupational Injury

BACKGROUND

The present study assessed the role of perceived injustice in the experience and persistence of post-traumatic stress symptoms (PTSS) following work-related musculoskeletal injury.

METHODS

The study sample consisted of 187 individuals who were absent from work as a result of a musculoskeletal injury. Participants completed measures of pain severity, perceived injustice, catastrophic thinking, post-traumatic stress symptoms, and disability on three occasions at three-week intervals.

RESULTS

Consistent with previous research, correlational analyses revealed significant cross-sectional relations between pain and PTSS, and between perceived injustice and PTSS. Regression analysis on baseline data revealed that perceived injustice contributed significant variance to the prediction of PTSS, beyond the variance accounted for by pain severity and catastrophic thinking. Sequential analyses provided support for a bi-directional relation between perceived injustice and PTSS. Cross-lagged regression analyses showed that early changes in perceived injustice predicted later changes in PTSS and early changes in PTSS predicted later changes in perceived injustice.

CONCLUSIONS

Possible linkages between perceived injustice and PTSS are discussed. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of PTSS consequent to musculoskeletal injury.

Adults with unilateral lower-limb amputation: greater spatial extent of pain is associated with worse adjustment, greater activity restrictions, and less prosthesis satisfaction

OBJECTIVES

This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation.

METHODS

Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability.

RESULTS

Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC)3,1 = 0.84].

CONCLUSIONS

A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated- and secondary-site pain prevention.

ETHICAL COMMITTEE NUMBER

IRB #1611862.

Sickness absence from work in the footwear industry: A longitudinal study

BACKGROUND: Studies on illness in the footwear industry have prioritized specific work sectors and diseases. OBJECTIVES: To analyze the main factors related to sickness absence and the indicators of illness in terms of recurrence and workdays lost among workers at a footwear company, ranging from storage of raw material to distribution of the final product. METHODS: A total of 9072 cases of absence from work were investigated in shoe production units from 2014 to 2017. Univariate models estimated the risk of bodily dysfunction (physiological and psychological) and the severity of recurrence and work days lost. RESULTS: (1) Most production units and work sectors were related to one or more affected bodily functions; (2) Neuromusculoskeletal and movement-related functions and the work sectors of prefabrication; cutting, assembly and finishing; and quality inspection of the final product required a longer recovery time before return to work and had a greater recurrence of leave; and (3) Women seemed to be more affected than men in terms of the reappearance of symptoms. CONCLUSIONS: Illness differs according to occupational sectors. The production sectors present more serious situations due to physical overload, intense rhythm and concentration, monotony and low autonomy.

Doenças osteomusculares são a principal causa de absenteísmo-doença entre trabalhadores da indústria de petróleo no Brasil: resultados de um estudo de coorte

Resumo Objetivo: descrever indicadores de absenteísmo-doença entre trabalhadores de indústria de petróleo. Métodos: estudo de coorte retrospectiva, realizado de 2012 a 2016, com dados secundários de prontuários médicos e de bases de dados da empresa. Foram calculados indicadores de absenteísmo por morbidade, características sociodemográficas e ocupacionais. Resultados: participaram 2.028 trabalhadores, do sexo masculino (87,6%), com idade maior ou igual a 50 anos (46,9%), nível médio de escolaridade (49,2%) e que trabalhavam em atividade não-operacional (65,1%). A incidência acumulada de afastamento do trabalho foi de 71,5% e a taxa de incidência de 25,8/100 pessoas-ano. Maiores taxas foram observadas entre mulheres (31,6), trabalhadores com 50 ou mais anos (29,9), 30 ou mais anos de serviço (31,9), menor escolaridade (29,2), em atividade operacional (27,9) e horário regular (26,1). Doenças osteomusculares (n=2001), respiratórias (n=1016) e digestivas (n=967) foram responsáveis pelo maior número de licenças. Os maiores números de dias de ausência ao trabalho foram por doenças osteomusculares (n=11640), lesões por causas externas (n=6267) e transtornos mentais (n=5042). Dor lombar foi o diagnóstico com maior número de dias de absenteísmo (n=3632). Conclusão: mulheres, trabalhadores com mais tempo de serviço e de menor escolaridade devem ser alvo de programas de saúde que visem o controle das morbidades identificadas.

Musculoskeletal diseases are the main cause of sick leave among oil industry workers in Brazil: results of a cohort study

Abstract Objective: to describe the incidence of sickness absence among workers of an oil industry in Brazil. Methods: retrospective cohort study conducted with 2,028 workers. Study data were obtained from workers’ medical records from 2012 to 2016. Indicators of absenteeism were calculated by sociodemographic characteristics, occupational characteristics, and morbidity. Results: of the participants, 87.6% were men, 49.2% with high school educational level, 46.9% aged 50 years or older, 65.1% worked in non-operational activities. The cumulative incidence of sick leave was 71.5% and its incidence rate, 25.8 per 100 person-years. We found the highest incidence rates amongst women (31.6), workers aged 50 years or older (29.9), lower educational attainment (29.2), work experience spanned 30 years or more (31.9), working in operational activities (27.9), and regular work schedule (26.1). Musculoskeletal (n=2,001), respiratory (n=1,016), and digestive diseases (n=967) were responsible for the largest number of sick leaves. The highest number of absence days was due to musculoskeletal diseases (n=11,640), followed by injuries (n=6,267) and mental disorders (n=5,042). Low back pain diagnostic was responsible for the greatest number of absence days (n=3,632). Conclusions: health programs aimed at controlling the identified morbidities should target women, those with longer work experiences, and those with lower educational attainment.

Physical and psychosocial demand at work: inequities related to race/skin color

This cross-sectional study investigated the association between self-reported race/skin color and two outcomes - psychosocial demand and physical demand at work - in 1,032 workers in an urban cleaning services company and two footwear manufacturers, located in the State of Bahia, Brazil. Psychosocial demand was measured through the Job Content Questionnaire and physical demand was measured through questions about postures and cargo handling. A Cox regression analysis provided prevalence ratios (PR) adjusted by age, gender, and educational level. Among blacks, there is a higher proportion of garbage collectors and a lower proportion of supervisory positions. Black workers are more subject to high psychological demand and low job control and, consequently, to high strain (PR=1.65). Also, they are more exposed to work with arms above shoulder level (PR=1.93), and material handling (PR=1.62), compared to white workers. Brown workers are more exposed to low job control (PR=1.36), work with arms above shoulder level (PR=1.48), and material handling (PR=1.25), also compared with whites. Social support is lower among blacks and brown. The study demonstrated inequities in psychosocial and physical exposures at work that are in line with the structural conception of racism. This evidence can contribute to the adoption of practices that increase equity in the world of work.

Risk factors for absenteeism due to musculoskeletal diseases in workers in the judiciary sector

Introduction

Musculoskeletal diseases represent an important health problem for workers, due to the degree of suffering caused by pain and to the high frequency of absenteeism.

Objectives

To identify risk factors for absenteeism due to musculoskeletal disease in employees at a judiciary court and to describe incidence, frequency, and duration of sick leaves.

Methods

This is a 6-year follow-up study conducted in the state of Bahia, Brazil. The dependent variable was absenteeism, measured by the time of the first sick leave in the period. The Kaplan-Meier method was used to estimate survival functions, whereas risk factors for absenteeism were obtained by Cox regression.

Results

Overall, 594 workers took sick leaves, with an incidence of 23% at the end of the period. The most frequent diagnoses were back pain (38.5%), shoulder lesions (11.7%), and synovitis and tenosynovitis (8.8%). Cases of one episode of sick leave per worker over the 6 years predominated (42.8%). Cox regression multivariate analysis identified the following variables as posing the greatest risk for sick leave: female sex (hazard ratio 1.39), age older than 40 years (hazard ratio 2.57), judicial technician workers (hazard ratio 1.48), and administrative workers (hazard ratio 1.30).

Conclusions

Women, older adults, and individuals who hold technical positions are worthy of attention from health management department of the court, since they presented the highest rates of incapacity to work during the study period. Back pain was the main reason for musculoskeletal disability.

Chronic Plantar Heel Pain Is Principally Associated With Waist Girth (Systemic) and Pain (Central) Factors, Not Foot Factors: A Case-Control Study

OBJECTIVE

To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain.

DESIGN

Case-control.

METHODS

We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, depression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression.

RESULTS

Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR = 0.98; 95% CI: 0.97, 0.99), pain at multiple sites (pain at 1 other site: OR = 2.76; 95% CI: 1.29, 5.91; pain at 4 or more other sites: OR = 10.45; 95% CI: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91; 95% CI: 1.33, 6.37; catastrophizer: OR = 6.79; 95% CI: 1.91, 24.11) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis).

CONCLUSION

Waist girth, ankle plantar flexor strength, multisite pain, and pain catastrophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. J Orthop Sports Phys Ther 2021;51(9):449-458. Epub 7 May 2021. doi:10.2519/jospt.2021.10018.

Shoulder Pain — Where Are We Now?

Purpose of Review

Shoulder pain is common and costly. For the past century, diagnosis and management has been based upon presumed patho-anatomical abnormalities. With the evolution of imaging techniques and new insight about the causes of musculoskeletal pain, this review evaluates the evidence that a patho-anatomical approach remains justified.

Recent Findings

Imaging modalities have developed considerably but, so far, have only proven value in evaluating full thickness rotator cuff tears prior to surgery. Correlation between imaging findings and symptoms is otherwise poor, with limited evidence of the value and impact of imaging for decision-making. Much of shoulder pain is chronic and few people have single-site musculoskeletal pain. Pain studies suggest that chronic shoulder pain is associated with both central and peripheral pain sensitisation. Moreover, functional MRI points to an effect of cognitive affective pain processing rather than nociception. Few of the established therapies, medical or surgical, that treat the presumed patho-anatomical cause have been shown to have lasting benefit.

Summary

Much of the evidence suggests that shoulder pain is more similar than different from mechanical low back pain. For most people with shoulder pain, the best approach might well be de-medicalisation, support to (self)manage pain, emphasis on retaining movement and identifying adverse beliefs and risk factors for disability and chronicity. Approaches like this are currently being evaluated and more research is desperately required.

Risk factors for sick leave in Brazilian oil industry workers

OBJECTIVE

Studies point to a complex and multifactorial aetiology for sickness absence, but there is still insufficient evidence on how occupational and non-occupational risk factors contribute to this phenomenon. This study aimed to identify occupational and non-occupational factors related to sickness absence in oil industry workers, as well as their population attributable fractions (PAF).

METHODS

A retrospective cohort study of 2028 oil industry workers was conducted in the state of Bahia, Brazil, between January 1, 2012 and December 31, 2016. Study data were obtained from workers´ medical register. The dependent variable was the first event of sick leave for five or more days, and the independent variables were gender, age, years of work, type of work activity, level of education, work schedule, awkward working postures, body mass index, smoking, physical activity and alcohol consumption. Cox regression analysis identified risk factors to the outcome and PAF were calculated.

RESULTS

Being female (HR 1.79), being older (HR 1.44), non-graduated ones (HR 1.44), being of operational staff (HR 1.18), overweight (HR 1.13), obesity (HR 1.39), smoking (HR 1.61) and former smoking (HR 1.30) were risk factors for sickness absence in this cohort. Of all sickness absence in the study population, 6% could be attributed to overweight, 10% to obesity, and 8% to smoking.

CONCLUSION

To prevent sick leave, we recommend programs focused on combating smoking and encouraging healthy habits, aiming at weight control and the prevention of chronic diseases. Population attributable fractions point that a universal approach, aimed at the total population will be more cost-effective than health promotion programmes restricted for high-risk populations.

Metabolomic analysis coupled with extreme phenotype sampling identified that lysophosphatidylcholines are associated with multisite musculoskeletal pain

ABSTRACT

Musculoskeletal pain often occurs simultaneously at multiple anatomical sites. The aim of the study was to identify metabolic biomarkers for multisite musculoskeletal pain (MSMP) by metabolomics with an extreme phenotype sampling strategy. The study participants (n = 610) were derived from the Newfoundland Osteoarthritis Study. Musculoskeletal pain was assessed using a self-reported pain questionnaire where painful sites were circled on a manikin by participants and the total number of painful sites were calculated. Targeted metabolomic profiling on fasting plasma samples was performed using the Biocrates AbsoluteIDQ p180 kit. Plasma cytokine concentrations including tumor necrosis factor-α, interleukin-6, interleukin-1β, and macrophage migration inhibitory factor were assessed by enzyme-linked immunosorbent assay. Data on blood cholesterol profiles were retrieved from participants' medical records. Demographic, anthropological, and clinical information was self-reported. The number of reported painful sites ranged between 0 and 21. Two hundred and five participants were included in the analysis comprising 83 who had ≥7 painful sites and 122 who had ≤1 painful site. Women and younger people were more likely to have MSMP (P ≤ 0.02). Multisite musculoskeletal pain was associated with a higher risk of having incontinence, worse functional status and longer period of pain, and higher levels of low-density lipoprotein and non-high-density lipoprotein cholesterol (all P ≤ 0.03). Among the 186 metabolites measured, 2 lysophosphatidylcholines, 1 with 26 carbons with no double bond and 1 with 28 carbons with 1 double bond, were significantly and positively associated with MSMP after adjusting for multiple testing with the Bonferroni method (P ≤ 0.0001) and could be considered as novel metabolic markers for MSMP.

Pre-placement examinations for newly recruited health care support staff

Objective

While musculoskeletal disorders (MSD) and physical strength have been extensively studied in health care professionals, little attention has been paid to health care support staff, such as patient care assistants and operation patient assistants, whose jobs are physically demanding. The purpose of this paper was to examine the musculoskeletal symptoms and physical strength of newly recruited health care support staff.

Method

Convenience sampling was conducted on 111 newly employed health care support staff in a public hospital. A custom-made pre-placement examination was performed. Data were analysed using descriptive, correlation, and regression analyses.

Results

Nearly one-third (32%) of the newly recruited health care support staff had experienced musculoskeletal symptoms in at least one body part during the preceding 12 months. Two-thirds (68%) of subjects were physically inactive, and sixty percent was overweight or obese. Handgrip strength was weaker than the local norm. The subjects’ dominant handgrip strength, bilateral lifting, pushing, and pulling force were significantly correlated. Only bilateral lifting was significantly associated with MSD among the newly recruited health care workers.

Conclusions

This study reports the baseline prevalence of MSD symptoms in the newly recruited health care support staff. Their sedentary lifestyle and suboptimal physical strength may render them susceptible to occupational injuries and disease. An effective occupational health programme that provides periodic health surveillance should be considered for high-risk health care workers to allow proper interventions in a timely manner.

Prevalence of multisite pain and association with work ability - Cross-sectional study

BACKGROUND

Multisite pain (MSP) has been studied among the working population because it is associated with reduced work ability. In Brazil, studies have investigated pain without addressing MSP and its interference with work ability.

OBJECTIVE

To evaluate the prevalence of MSP among Brazilian workers from different occupations and to associate MSP with work ability.

METHODS

Participants in the BRAzilian eValuation of Occupational health (BRAVO) database were analysed. The BRAVO database contains information about personal data, musculoskeletal symptoms (Nordic Musculoskeletal Questionnaire), occupational stress (Job Content Questionnaire) and work ability (Work Ability Index). The studies were approved by the Ethics Committee and all participants signed an informed consent form. Data were analysed using logistic and linear regression. Sex, age, comorbidities (hypertension, mild emotional disorder and gastritis), type of work (blue and white-collar) and occupational stress were included as covariates of the regression models.

RESULTS

The prevalence of MSP was 58% (95% CI = 53-62%) among the total sample, 57% (95% CI = 52-62%) in white-collar and 53% (95% CI = 40-66%) among blue-collar workers. The presence of MSP increases the chance of low work ability between 1.8 and 5.1 times. A dose-response relationship was found, with the increase in each pain site causing a reduction of 0.9-1.2 points in the work ability index.

CONCLUSIONS

MSP is highly prevalent among Brazilian workers and should be addressed due to its impact on reducing work ability.

The impact of occupational and personal factors on musculoskeletal pain - a cohort study of female nurses, sonographers and teachers

Background

Musculoskeletal pain is common in the general population and constitutes a major public health problem. A large proportion of these conditions may be work related. The aim of this study was to explore the relative importance of physical, psychosocial and personal factors, in number of pain sites and in five specific pain sites, among women in common professions with a broad variety of occupational exposures.

Methods

A cohort of 1115 women responded to a questionnaire on ergonomic, psychosocial, personal and life-style factors, and the outcome measure of musculoskeletal pain (based on frequency and intensity of complaints at nine anatomical sites), at baseline and at follow-up. Sum scores of ergonomic and psychosocial factors were created. The importance of exposure at baseline for the number of pain sites at follow-up were estimated using ordinal regression. The importance of exposure at baseline for pain in the neck, shoulders, hands, lower back and feet at follow-up were estimated using multi-exposure Poisson regression models.

Results

High sum scores for ergonomic and psychosocial factors were of importance for a high number of pain sites, although the strongest risk factor was a high number of pain sites already at baseline. On the individual level, there was a large fluctuation in number of pain sites between the two time points. Eighteen percent reported persistent (or recurrent) ≥ four pain sites, while only 11 % did not report any pain at baseline or at follow-up. Among the specific pain sites, a high sum score of ergonomic factors was associated with pain in the neck, hands and feet. A high sum score of psychosocial factors was associated with neck and shoulder pain. The strongest risk factor was, however, pain at that specific anatomical site at baseline. Only a few of the personal and life-style factors were associated with pain.

Conclusions

An overwhelming majority of the women in common occupations were affected by musculoskeletal pain. Both ergonomic and psychosocial factors were predictive of a high number of pain sites and of specific pain sites. These findings indicate the need for preventive measures on the individual, organizational and societal level.

Parental Multisite Chronic Pain and the Risk of Adult Offspring Developing Additional Chronic Pain Sites: Family-Linkage Data From the Norwegian HUNT Study

We investigated if parental multisite chronic pain increases the risk of adult offspring developing additional chronic pain sites, and if offspring body mass index (BMI) and leisure time physical activity modify this association. We used longitudinal data on 7,654 offspring linked with their parents who participated in the population-based HUNT Study (Norway) in 1995 to 1997 and 2006 to 2008. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence interval (CI). One-third of offspring (n = 2,573) developed additional chronic pain sites. Having both parents with 1-2 chronic pain sites increased the risk of developing additional pain sites compared to having parents free of chronic pain (OR = 1.33; 95% CI 1.05-1.68), with larger effects observed when both parents had ≥3 chronic pain sites (OR = 1.46; 95% CI 1.17-1.82). These associations were largely driven by maternal pain, that is, there was no association between paternal chronic pain and risk of additional pain sites in offspring. The parent-offspring transfer of additional pain sites (when both parents had ≥3 pain sites) strengthened when offspring were obese (OR = 2.56; 95% CI 1.75-3.75) or physically inactive (OR = 1.73; 95% CI 1.33-2.27). In conclusion, parental multisite chronic pain increases the risk of offspring developing additional chronic pain sites, particularly those with obesity or inactivity. PERSPECTIVE: This longitudinal analysis investigated the parent-offspring transmission of multisite chronic pain, and whether lifestyle behaviors in offspring modify this association. The findings suggest that having parents with multisite chronic pain increases the risk of offspring developing additional chronic pain sites, particularly if offspring are obese or inactive.

Multiple morbidities and health conditions of waste-loaders in Mumbai: A study of the burden of disease and health expenditure

Study assesses the effects of solid-waste loading on workers, the resultant development of occupational morbidities, and economic burden of these morbidities. A cross-sectional survey was conducted with 360 municipal workers from six of 24 municipal wards in Mumbai. The nearest neighborhood method of Propensity Score Matching (PSM) examined the impact of waste-loading on the development of morbidities and to identify the risk factors - multiple logistic regression analysis was performed. The prevalence of musculoskeletal disorders (MSDs), injury, eye and skin infections found significantly higher for waste-loaders compared to comparison group. The PSM method revealed that the occupation of waste-loading significantly raised the risk of injury (34%), MSDs (23%), eye (19%), skin infection (15%) and disability (15%), compared to comparison group. Significantly higher health expenditure is observed among waste-loaders who have sought treatment in private health facility than public. The study recommends to offer assistance the medical insurance for reducing the financial burden on waste-loaders.

Recurrent pain and work disability: a record linkage study

Purpose

We examined the associations between recurrent single- and multisite pain and incident sickness absence (SA) of different lengths and the risk of disability pension (DP).

Methods

The data were derived from the Finnish Helsinki Health Study. Pain measures were recorded for panel 1 in 2000/2 and 2007, and for panel 2 in 2007 and 2012 (altogether 3191 employees). SA data were obtained from the employer’s personnel register and DP events from the Finnish Centre for Pensions. Negative binomial regression models with generalized estimation equations were used to model the incidence of self-certified short- (1–3 days), and medically certified medium- (4–14 days) and long-term (more than 14 days) SA episodes. Cox regression models were fitted for the associations between pain and all-cause DP and competing risk models for DP by diagnostic groups. Social and health-related covariates were adjusted for.

Results

Recurrent pain was associated with short-, medium- and long-term SA. Additionally, recurrent single- and multisite pain increased the risk of long-term SA. Recurrent single or multisite pain was further associated with an increased risk of DP, while a single instance of pain did not increase the risk.

Conclusions

These results suggest that recurrent pain is a robust determinant of subsequent SA and DP risk. Improved understanding of determinants of recurrent pain is needed to inform the development of targeted measures to reduce SA and premature exit from employment.

Electronic supplementary material

The online version of this article (10.1007/s00420-019-01494-5) contains supplementary material, which is available to authorized users.

Important work demands for reducing sickness absence among workers with neck or upper back pain: a prospective cohort study

BACKGROUND

The aim of this study was to investigate what exposure to work demands, physical and psychosocial, is associated with lower levels of sickness absence among workers with neck or upper back pain in different groups, by age, gender, duration of sickness absence and work ability score.

METHODS

This study was a prospective study of 4567 workers with neck or upper back pain. Data on neck or upper back pain, work demand and work ability were obtained from the Swedish Work Environment survey over a 3-year period (2009-2013). Register data on sickness absence, 1 year after each survey was conducted, were obtained from the Swedish health insurance database. Analyses were performed to estimate the association between self-reported work demands and registered sick days > 14 days. The analyses were stratified for gender, age group and work ability score.

RESULTS

Lower numbers of sick days were found for workers reporting low exposure to lifting ≥15 kg and twisted or forward-leaning work postures. Lower numbers of sick days were found for workers reporting high work control and seated work. The associations were generally stronger in the older age groups for the physical work demands.

CONCLUSIONS

The findings in this study suggest that certain physical work demands and having high control over one's work can result in lower sickness absence, especially among middle-aged and older workers with neck or upper back pain.

Musculoskeletal pain in multiple body sites and work ability in the general working population: cross-sectional study among 10,000 wage earners

Background and aims Musculoskeletal pain may negatively affect work ability, especially when work demands are high and/or physical capacity of the worker is low. This study investigated the association between intensity of musculoskeletal pain in multiple body regions and work ability among young and old workers with sedentary and physical demanding jobs. Methods Currently employed wage earners (n=10,427) replied to questions about pain intensity, work ability, and physical work demands. The odds ratio (OR) for having a lower level of work ability in relation to the physical demands at work were modeled using logistic regression controlled for various confounders. Results The OR for lower work ability increased with higher pain intensity in all regions among workers with sedentary and physical work. The same pattern was observed among workers <50 years and ≥50 years in both work types. The association was quite consistent across age and work activity groups, although it tended to be more pronounced among those with physically demanding work in some of pain regions. Conclusions This study shows that increasing pain intensity in multiple sites of the body is associated with lower work ability. This was seen for both younger and older workers as well as those with sedentary and physical work. Implications Physical workers with multiple-site pain may especially be at increased risk of the consequences of reduced work ability. Therefore, extra attention is needed and this group may benefit from better targeted preventive measures.

Longitudinal Associations between Anatomical Regions of Pain and Work Conditions: A Study from The SwePain Cohort

We investigated the time-based associations between workload (physical and mechanical), psychosocial work stressors (demands, control, and support), and the number of anatomical regions with pain (ARP). This population-based study with a two-year follow-up included 11,386 responders (5125 men, 6261 women; mean age: 48.8 years; SD: 18.5) living in south-eastern Sweden. Predictive associations were assessed through generalised linear models, and changes over time were examined using a generalised estimating equation. The results of both models were reported as parameter estimates (B) with 95% confidence interval (CIs). Mean changes in the number of ARP, workload, and psychosocial work stressors were stable over time. High mechanical workload and job demands were likely associated with the number of ARP at the two-year follow-up. In the reverse prospective model, we found that the number of ARP was also associated with high physical and mechanical workload and low job control and support. In the two time-based models of changes, we found a reciprocal association between number of ARP and mechanical workload. Our results add epidemiological evidence to the associations between work conditions and the extent of pain on the body. Components of work conditions, including job demands and mechanical strain, must be considered when organisations and health policy makers plan and employ ergonomic evaluations to minimise workplace hazards in the general population.

Within-individual analysis of pain and sickness absence among employees from low and high occupational classes: a record linkage study

OBJECTIVES

Pain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics.

METHODS

The Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models.

RESULTS

Acute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19-1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10-1.50] for acute/subacute and 1.43 [1.23-1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08-1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations).

CONCLUSIONS

These results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Multisite joint pain in older Australian women is associated with poorer psychosocial health and greater medication use

Background

Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown.

Methods

Cross-sectional data from 579 women were analyzed. Women were asked "Which of your joints have been troublesome on most days of the past month?" Pain qualities were measured using the McGill Pain Questionnaire (Short Form) and PainDETECT, and health was assessed using the SF-36 and sociodemographic variables. Statistical analysis using generalized ordinal logistic regression included comparison of three joint pain groups: no joint pain, 1-4 sites of joint pain and ≥ 5 sites of joint pain.

Results

Two thirds of respondents had multisite pain (>1 site), and one third had ≥5 joint pain sites. Compared to women with fewer joint pain sites, women with >5 joint pain sites (multisite joint pain) had significantly poorer physical and emotional health-related quality of life, more severe pain, a higher probability of neuropathic pain, and a longer duration of pain. More than half of women in the multisite joint pain group were still employed, statistically significantly more than women with no joint pain. In the final model, pain duration, the number of medications, pain intensity (discomforting and distressing) and the physical component of health-related quality of life were significantly associated with increased number of joint pain sites.

Conclusions

Over one-third of older women in our sample had >5 painful joints in the last month. These women demonstrated significantly poorer psychosocial health, and increased medication use, than women with no or fewer sites of joint pain. Many women with multisite joint pain were still in the workforce, even when nearing retirement age. This study has important implications for future research into musculoskeletal pain, particularly in regards to womens health and wellbeing, and for clinical practice where there should be increased awareness of the implications of concurrent, multisite joint pain.

Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study

BACKGROUND

Patients who consult a physical therapist for low back pain (LBP) may receive initial and subsequent management from different therapists. The impact that physical therapy provider continuity has on health care use in patients with LBP is insufficiently studied.

OBJECTIVE

The objective of this study was to examine the impact of continuity of the physical therapy provider on health care use and costs in patients with LBP referred from primary care.

DESIGN

The study design included a retrospective analysis of claims data.

METHODS

Data from an all-payer claims database were examined. Logistic regression was used to evaluate the association between physical therapy provider continuity and health care use during the 1-year period following a visit with a primary care provider for LBP.

RESULTS

Patients who experienced greater physical therapy provider continuity had a decreased likelihood of receiving lumbar surgery. They also paid less (mean = ${\$}$1737 [95% confidence interval, ${\$}$1602-${\$}$1871]) than those who experienced less physical therapy provider continuity (mean = ${\$}$2577 [95% confidence interval, ${\$}$2008-${\$}$3145]).

LIMITATIONS

The degree of causality between any predictor and outcome variables cannot be determined due to the observational nature of the study.

CONCLUSIONS

Greater continuity of the physical therapy provider appears to be associated with a decreased likelihood of surgical treatment for LBP and lower health care costs related to LBP.

The association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep - a cross-sectional study

Background

The prevention and rehabilitation of multisite musculoskeletal pain would benefit from studies aiming to understand its underlying mechanism. Autonomic imbalance is a suggested mechanism for multisite pain, but hardly been studied during normal daily living. Therefore, the aim of the study is to investigate the association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep.

Methods

This study is based on data from the “Danish Physical activity cohort with objective measurements” among 568 blue-collar workers. Pain intensity scales were dichotomized according to the median of each scale, and the number of pain sites was calculated. No site was regarded as the pain-free, one site was considered as single-site musculoskeletal pain and pain in two or more sites was regarded as multisite musculoskeletal pain. Heart rate variability (HRV) was measured by an electrocardiogram system (ActiHeart) and physical activity using accelerometers (Actigraph). Crude and adjusted linear mixed models were applied to investigate the association between groups and cardiac autonomic regulation during work, leisure and sleep.

Results

There was no significant difference between groups and no significant interaction between groups and domains in the crude or adjusted models for any HRV index. Significant differences between domains were found in the crude and adjusted model for all indices, except SDNN; sleep time showed higher values than leisure and work time, except for LF and LF/HF, which were higher during work.

Conclusion

This cross-sectional study showed that multisite musculoskeletal pain is not associated with imbalanced cardiac autonomic regulation during work, leisure and sleep time.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2312-3) contains supplementary material, which is available to authorized users.

Association between presenteeism and health-related quality of life among Japanese adults with chronic lower back pain: a retrospective observational study

OBJECTIVES

This study investigated the relationship between presenteeism and health-related quality of life (HRQoL) among Japanese adults with chronic lower back pain (CLBP).

DESIGN

This was a retrospective, cross-sectional study.

SETTING

Data were collected via a self-administered online survey of the Japanese adult general population.

PARTICIPANTS

The present study used 2014 Japan National Health and Wellness Survey (NHWS) data (n=30 000). Specifically, data were included from NHWS respondents who self-reported being employed in the past week and having experienced LBP in the past month, with these symptoms lasting for at least 3 months (n=239). 84 (35.1%) participants in this study were female.

PRIMARY AND SECONDARY OUTCOME MEASURES

Presenteeism and HRQoL were measured using the Work Productivity and Activity Impairment Questionnaire-General Health (categorical (none: 0%, low: 10%-20%, high: ≥30%) and continuous) and Medical Outcomes Study 36-Item Short Form Health Survey, respectively. Covariates included patient demographics, health characteristics, pain characteristics and depression severity (Patient Health Questionnaire).

RESULTS

Presenteeism was reported by 77.4% of respondents. High (vs no) presenteeism related to more severe pain in the prior week (4.9±2.2 vs 3.6±2.1, p=0.001) and currently (5.1±2.1 vs 3.9±3.9, p=0.007), more pain sites (1.9±1.6 vs 1.1±1.4, p=0.004) and greater depression severity (7.5±6.5 vs 3.6±3.6, p<0.001). Adjusting for covariates, high (vs no) presenteeism related to lower mental and physical HRQoL. For low versus no presenteeism, significant HRQoL differences were observed in general health (43.0, 95% CI 40.3 to 45.6 vs 46.9, 95% CI 43.9 to 49.8, p=0.015).

CONCLUSIONS

Most respondents experienced presenteeism. Those with high or low presenteeism had poorer HRQoL than respondents with no presenteeism. Monitoring presenteeism rates may help identify workers with an unmet need for better CLBP-related pain management.

The role of pain in chronic pain patients’ perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients

Background and aims

Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics.

Methods

Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects.

Results

There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables.

Conclusions

Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.

Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: a large-scale, observational study

Objective

The objective of this study was to assess the effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS) in a real-world chronic pain sample.

Background

There is a need for nonpharmacological treatment options for chronic pain. FS-TENS improved multisite chronic pain in a previous interventional study. Large observational studies are needed to further characterize its effectiveness.

Methods

This retrospective observational cohort study examined changes in chronic pain measures following 60 days of FS-TENS use. The study data were obtained from FS-TENS users who uploaded their device utilization and clinical data to an online database. The primary outcome measures were changes in pain intensity and pain interference with sleep, activity, and mood on an 11-point numerical rating scale. Dose-response associations were evaluated by stratifying subjects into low (≤30 days), intermediate (31-56 days), and high (≥57 days) utilization subgroups. FS-TENS effectiveness was quantified by baseline to follow-up group differences and a responder analysis (≥30% improvement in pain intensity or ≥2-point improvement in pain interference domains).

Results

Utilization and clinical data were collected from 11,900 people using FS-TENS for chronic pain, with 713 device users meeting the inclusion and exclusion criteria. Study subjects were generally older, overweight adults. Subjects reported multisite pain with a mean of 4.8 (standard deviation [SD] 2.5) pain sites. A total of 97.2% of subjects identified low back and/or lower extremity pain, and 72.9% of subjects reported upper body pain. All pain measures exhibited statistically significant group differences from baseline to 60-day follow-up. The largest changes were pain interference with activity (-0.99±2.69 points) and mood (-1.02±2.78 points). A total of 48.7% of subjects exhibited a clinically meaningful reduction in pain interference with activity or mood. This proportion increased to 57.1% for the high utilization subgroup.

Conclusion

FS-TENS is a practical option for treating multisite chronic pain. The greatest impact is on pain interference with activity and mood. FS-TENS utilization and effectiveness exhibit a dose-response association, suggesting that daily use maximizes pain relief.

Multi-site musculoskeletal pain in Swedish police: associations with discomfort from wearing mandatory equipment and prolonged sitting

Purpose

Musculoskeletal disorders are considered as a major issue affecting the health and well-being of active duty police. Discomfort from wearing mandatory equipment and sitting for long periods of time in fleet vehicles are workload factors linked to musculoskeletal disorders in police. This study aims to determine the prevalence of multi-site musculoskeletal pain among Swedish police and to explore the possible association to discomfort experience when wearing mandatory equipment and sitting for long periods in fleet vehicles.

Methods

In this cross-sectional study responses from 4185 police were collected through a self-administered online survey including questions about physical work environment, mandatory equipment and musculoskeletal pain. Multi-site pain was determined through summing pain sites from four body regions. Binomial logistic regression was performed to explore the association between multi-site musculoskeletal pain: (1) discomfort from wearing mandatory equipment and (2) sitting for long periods in fleet vehicles.

Results

The prevalence of multi-site musculoskeletal pain at least 1 day per week within the previous 3 months was 41.3%. A statistically significant association between discomfort from wearing mandatory equipment and multi-site musculoskeletal pain was found; duty belt [OR 5.42 (95% CI 4.56–6.43)] as well as body armour [OR 2.69 (95% CI 2.11–3.42)]. Sitting for long periods in fleet vehicles was not significantly associated to multi-site musculoskeletal pain.

Conclusion

Multi-site musculoskeletal pain is a considerable problem among Swedish police and modifying mandatory equipment to decrease discomfort is suggested as a potential means of decreasing the musculoskeletal pain experienced by many police officers.

A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+ cohort

BACKGROUND

Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population.

OBJECTIVE

This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldest-old ages using a new method (APSs) to assess the location of pain on the body.

MATERIALS AND METHODS

The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed.

RESULTS

Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain.

CONCLUSION

Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

The influence of multisite pain and psychological comorbidity on prognosis of chronic low back pain: longitudinal data from the Norwegian HUNT Study

OBJECTIVES

This study aimed to investigate the prospective influence of multisite pain, depression, anxiety, self-rated health and pain-related disability on recovery from chronic low back pain (LBP).

SETTING

The data is derived from the second (1995-1997) and third (2006-2008) wave of the Nord-Trøndelag Health Study (HUNT) in Norway.

PARTICIPANTS

The study population comprises 4484 women and 3039 men in the Norwegian HUNT Study who reported chronic LBP at baseline in 1995-1997.

PRIMARY OUTCOME MEASURES

The primary outcome was recovery from chronic LBP at the 11-year follow-up. Persons not reporting pain and/or stiffness for at least three consecutive months during the last year were defined as recovered. A Poisson regression model was used to estimate adjusted risk ratios (RRs) with 95% CIs.

RESULTS

At follow-up, 1822 (40.6%) women and 1578 (51.9%) men reported recovery from chronic LBP. The probability of recovery was inversely associated with number of pain sites (P-trend<0.001). Compared with reporting 2-3 pain sites, persons with only LBP had a slightly higher probability of recovery (RR 1.10, 95% CI 0.98 to 1.22 in women and RR 1.10, 95% CI 1.01 to 1.21 in men), whereas people reporting 6-9 pain sites had substantially lower probability of recovery (RR 0.58, 95% CI 0.52 to 0.63 in women and RR 0.70, 95% CI 0.63 to 0.79 in men). Poor/not so good self-rated general health, symptoms of anxiety and depression, and pain-related disability in work and leisure were all associated with reduced probability of recovery, but there was no statistical interaction between multisite pain and these comorbidities.

CONCLUSIONS

Increasing number of pain sites was inversely associated with recovery from chronic LBP. In addition, factors such as poor self-rated health, psychological symptoms and pain-related disability may further reduce the probability of recovery from chronic LBP.