Patterns of multisite pain and associations with risk factors

Abstract

To explore definitions for multi-site pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants v 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 v 1.1), older age (PRR 2.6 v 1.1), somatising tendency (PRR 4.6 v 1.3) and exposure to multiple physically stressing occupational activities (PRR 5.0 v 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology (ACR) criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.

Long-Term Changes in Musculoskeletal Pain Sites in the General Population: The HUNT Study

“…8 Female sex, anxiety and depression, sleeping problems, smoking, overweight/obesity, and family history of pain are also known risk factors for chronic widespread pain (CWP). 3,32,45 Chronic musculoskeletal pain is complex and determined by multiple causal pathways involving biological, psychological, and social influences that can interact with each other.…”

“…Ordinal variables for anxiety and depression symptom load were computed as reference (0-4), sub-symptom load, (5-7) mild symptom load (8)(9)(10), moderate symptom load (11)(12)(13)(14), and severe symptom load (15)(16)(17)(18)(19)(20)(21). 4, 27 Sleeping problems were identified by two questions: "Have you had difficulty falling asleep in the last month?"…”

“…8 In this study, we examined potential associations between risk factors and change in pain on the basis of three baseline pain categories: no pain, 1-2 pain sites, and 3 or more pain sites. Thus we could include but not limit the study to those with pain consistent with CWP according to the ACR criteria.…”

“…1,23,35,39 Recent research also suggests that there are important differences in the risk factors for single-site pain and widespread pain, and that the overall consequences are highly dependent on number of pain sites. 8,24 Indeed, chronic pain can be classified as regional or widespread, depending on the number of pain sites affected. 2,7,23 Regional pain appears as single pain sites in, e.g., lower back, shoulder, or neck, with lower back and neck pain as the most frequently reported sites, 11,24 whereas widespread pain has commonly been categorized as pain in the trunk, in upper and lower limbs, and on both sides of the body.…”

Psychological and psychosocial determinants of musculoskeletal pain and associated disability

“…Moreover, the relationship extends to widespread pain [56], and there are indications that relative risks are even higher for pain occurring at multiple sites [10,12]. In particular, a large international study which compared associations with risk factors for different patterns of musculoskeletal pain, found that relative to no pain, pain that affected six or more anatomical sites showed a stronger association with tendency to somatise than pain involving fewer than four anatomical sites [57].Importantly, the relationship is not only with awareness and reporting of musculoskeletal symptoms, but also with disability for everyday activities as a consequence of musculoskeletal pain [10,[12][13][14]49].It is possible that the development of a musculoskeletal disorder could sensitise an individual to other symptoms. However, findings from longitudinal studies suggest that causation is in the reverse direction -i.e.…”