Advertisement

Combined musculoskeletal pain in the upper and lower body: associations with occupational mechanical and psychosocial exposures

  • Tine Gjedde Sommer
  • Poul Frost
  • Susanne Wulff SvendsenEmail author
Original Article

Abstract

Purpose

Pain in more than one site is common in working populations. We aimed to characterise combined pain (pain in the upper and lower body) and to evaluate whether the prevalence of combined pain is positively related to combined occupational mechanical exposures to the upper and lower body and to high psychosocial job strain.

Methods

This cross-sectional study was based on questionnaire data from the Musculoskeletal Research Database at the Danish Ramazzini Centre. The study included 14,081 men and 20,173 women. Occupational exposures were assessed by job exposure matrices. We analysed the prevalence of pain limited to the upper body, pain limited to the lower body, and combined pain in relation to occupational exposures using Poisson regression.

Results

During the last year, 23.2 % of the men and 33.9 % of the women reported combined pain, which was characterised by somatisation, illness worrying, and low SF-36 scores. For men, the adjusted prevalence ratio for combined pain was 1.51 [95 % confidence interval (95 % CI) 1.40–1.64] in relation to exposures limited to the upper body and 2.24 (95 % CI 2.11–2.39) in relation to combined exposures. For women, the corresponding adjusted prevalence ratios were 1.56 (95 % CI 1.50–1.63) and 1.55 (95 % CI 1.50–1.61). High job strain was related to pain among men, only.

Conclusion

Combined pain may in part be explained by local effects of occupational mechanical exposures acting at more than one site.

Keywords

Lifting Multi-site pain Posture Psychosocial exposure Repetitive work 

Notes

Acknowledgments

The Danish Working Environment Research Fund funded the establishment of the Musculoskeletal Research Database at the Danish Ramazzini Centre (Grant No. 31-2009-09). We would like to thank Annett Dalbøge and Tine Steen Rubak, who made their job exposure matrices available for the study.

Conflict of interest

None declared.

References

  1. Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ (2006) The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol 35(2):468–476CrossRefGoogle Scholar
  2. Bergman S (2005) Psychosocial aspects of chronic widespread pain and fibromyalgia. Disabil Rehabil 27(12):675–683CrossRefGoogle Scholar
  3. Bergman S, Herrström P, Högström K, Petersson IF, Svensson B, Jacobsson LT (2001) Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study. J Rheumatol 28(6):1369–1377Google Scholar
  4. Bjørner JB, Damsgaard MT, Watt T, Bech P, Rasmussen NK, Kristensen TS, Modvig J, Thunedborg K (1997) Dansk manual til SF-36 [Danish manual on SF-36]. Lif Lægemiddelindustriforeningen, KøbenhavnGoogle Scholar
  5. Carnes D, Parsons S, Ashby D, Breen A, Foster NE, Pincus T, Vogel S, Underwood M (2007) Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study. Rheumatology (Oxford) 46(7):1168–1170CrossRefGoogle Scholar
  6. Coggon D, Ntani G, Palmer K, Felli V, Harari R, Barrero L, Felknor S, Gimeno D, Cattrell A, Vargas-Prada S et al (2013) Patterns of multisite pain and associations with risk factors. Pain 154(9):1769–1777CrossRefGoogle Scholar
  7. Croft P, Rigby AS, Boswell R, Schollum J, Silman A (1993) The prevalence of chronic widespread pain in the general population. J Rheumatol 20(4):710–713Google Scholar
  8. Croft P, Dunn KM, Von Korff M (2007) Chronic pain syndromes: you can’t have one without another. Pain 131(3):237–238CrossRefGoogle Scholar
  9. Dalbøge A, Frost P, Andersen JH, Svendsen SW (2014) Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study. Occup Environ Med 71(11):750–756CrossRefGoogle Scholar
  10. Derogatis LR, Melisaratos N (1983) The brief symptom inventory: an introductory report. Psychol Med 13(3):595–605CrossRefGoogle Scholar
  11. Fink P, Ewald H, Jensen J, Sørensen L, Engberg M, Holm M, Munk-Jørgensen P (1999) Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization. J Psychosom Res 46(3):261–273CrossRefGoogle Scholar
  12. Gran JT (2003) The epidemiology of chronic generalized musculoskeletal pain. Best Prac Res Clin Rheumatol 17(4):547–561CrossRefGoogle Scholar
  13. Grotle M, Croft P (2010) More pain, less gain. Occup Environ Med 67(7):434–435CrossRefGoogle Scholar
  14. Harkness EF, Macfarlane GJ, Nahit E, Silman AJ, McBeth J (2004) Mechanical injury and psychosocial factors in the work place predict the onset of widespread body pain: a two-year prospective study among cohorts of newly employed workers. Arthritis Rheum 50(5):1655–1664CrossRefGoogle Scholar
  15. Haukka E, Leino-Arjas P, Ojajarvi A, Takala E-, Viikari-Juntura E, Riihimaki H (2011) Mental stress and psychosocial factors at work in relation to multiple-site musculoskeletal pain: a longitudinal study of kitchen workers. Eur J Pain 15(4):432–438CrossRefGoogle Scholar
  16. Haukka E, Ojajärvi A, Takala EP, Viikari-Juntura E, Leino-Arjas P (2012) Physical workload, leisure-time physical activity, obesity and smoking as predictors of multisite musculoskeletal pain. A 2-year prospective study of kitchen workers. Occup Environ Med 69(7):485–492CrossRefGoogle Scholar
  17. Herin F, Vézina M, Thaon I, Soulat JM, Paris C, ESTEV group (2014) Predictive risk factors for chronic regional and multisite musculoskeletal pain: a 5-year prospective study in a working population. Pain 155(5):937–943CrossRefGoogle Scholar
  18. Hjøllund NH, Larsen FB, Andersen JH (2007) Register-based follow-up of social benefits and other transfer payments: accuracy and degree of completeness in a Danish interdepartmental administrative database compared with a population-based survey. Scand J Public Health 35(5):497–502CrossRefGoogle Scholar
  19. Kamaleri Y, Natvig B, Ihlebaek CM, Benth JS, Bruusgaard D (2009) Change in the number of musculoskeletal pain sites: a 14-year prospective study. Pain 141(1–2):25–30CrossRefGoogle Scholar
  20. Karasek R, Theorell T (1990) Healthy work: stress, productivity, and the reconstruction of working life. Basic Books, New YorkGoogle Scholar
  21. Kivimäki M, Leino-Arjas P, Virtanen M, Elovainio M, Keltikangas-Järvinen L, Puttonen S, Vartia M, Brunner E, Vahtera J (2004) Work stress and incidence of newly diagnosed fibromyalgia: prospective cohort study. J Psychosom Res 57(5):417–422Google Scholar
  22. Kristensen TS (1996) Job stress and cardiovascular disease: a theoretic critical review. J Occup Health Psychol 1(3):246–260CrossRefGoogle Scholar
  23. Kristensen TR (2010) Sickness absence. The importance of socioeconomic status, job strain, iso-strain and effort-reward imbalance. Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of CopenhagenGoogle Scholar
  24. Lee J, Tan C, Chia K (2009) A practical guide for multivariate analysis of dichotomous outcomes. Ann Acad Med Singapore 38(8):714–719Google Scholar
  25. Macfarlane GJ, Croft PR, Schollum J, Silman AJ (1996) Widespread pain: Is an improved classification possible? J Rheumatol 23(9):1628–1632Google Scholar
  26. Macfarlane GJ, McBeth J, Silman AJ (2001) Widespread body pain and mortality: prospective population based study. BMJ 323(7314):662–664CrossRefGoogle Scholar
  27. Macfarlane GJ, Norrie G, Atherton K, Power C, Jones GT (2009) The influence of socioeconomic status on the reporting of regional and widespread musculoskeletal pain: results from the 1958 British birth cohort study. Ann Rheum Dis 68(10):1591–1595CrossRefGoogle Scholar
  28. McBeth J, Macfarlane GJ, Hunt IM, Silman AJ (2001a) Risk factors for persistent chronic widespread pain: a community-based study. Rheumatology (Oxford) 40(1):95–101CrossRefGoogle Scholar
  29. McBeth J, Macfarlane GJ, Benjamin S, Silman AJ (2001b) Features of somatization predict the onset of chronic widespread pain: results of a large population-based study. Arthritis Rheum 44(4):940–946CrossRefGoogle Scholar
  30. McBeth J, Harkness E, Silman A, Macfarlane G (2003) The role of workplace low-level mechanical trauma, posture and environment in the onset of chronic widespread pain. Rheumatology (Oxford) 42(12):1486–1494CrossRefGoogle Scholar
  31. Mikkelsen S, Bonde JP, Andersen JH (2011) Analysis of job strain effects. Occup Environ Med 68(10):786CrossRefGoogle Scholar
  32. Miranda H, Kaila-Kangas L, Heliovaara M, Leino-Arjas P, Haukka E, Liira J, Viikari-Juntura E (2010) Musculoskeletal pain at multiple sites and its effects on work ability in a general working population. Occup Environ Med 67(7):449–455CrossRefGoogle Scholar
  33. Mourao AF, Blyth FM, Branco JC (2010) Generalised musculoskeletal pain syndromes. Best Prac Res Clin Rheumatol 24(6):829–840CrossRefGoogle Scholar
  34. Neupane S, Miranda H, Virtanen P, Siukola A, Nygård C (2013a) Do physical or psychosocial factors at work predict multi-site musculoskeletal pain? A 4-year follow-up study in an industrial population. Int Arch Occup Environ Health 86(5):581–589CrossRefGoogle Scholar
  35. Neupane S, Virtanen P, Leino-Arjas P, Miranda H, Siukola A, Nygård CH (2013b) Multi-site pain and working conditions as predictors of work ability in a 4-year follow-up among food industry employees. Eur J Pain 17(3):444–451CrossRefGoogle Scholar
  36. Nyman T, Grooten WJA, Wiktorin C, Liwing J, Norrman L (2007) Sickness absence and concurrent low back and neck–shoulder pain: results from the MUSIC Norrtälje Study. Eur Spine J 16(5):631–638CrossRefGoogle Scholar
  37. Palmer KT, Calnan M, Wainwright D, Poole J, O’Neill C, Winterbottom A, Watkins C, Coggon D (2005) Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey. Occup Med (Lond) 55(8):612–617CrossRefGoogle Scholar
  38. Parot-Schinkel E, Descatha A, Ha C, Petit A, Leclerc A, Roquelaure Y (2012) Prevalence of multisite musculoskeletal symptoms: a French cross-sectional working population-based study. BMC Musculoskelet Disord 13:122CrossRefGoogle Scholar
  39. Persson R, Kristiansen J (2012) The challenge of assessing the psychosocial working environment: why some self-reports should not be interpreted as environmental exposures. Occup Environ Med 69(12):932–933CrossRefGoogle Scholar
  40. Rubak TS, Svendsen SW, Andersen JH, Haahr JP, Kryger A, Jensen LD, Frost P (2014) An expert-based job exposure matrix for large scale epidemiologic studies of primary hip and knee osteoarthritis: the lower body JEM. BMC Musculoskelet Disord 15:204CrossRefGoogle Scholar
  41. Saastamoinen P, Leino-Arjas P, Laaksonen M, Martikainen P, Lahelma E (2006) Pain and health related functioning among employees. J Epidemiol Community Health 60(9):793–798CrossRefGoogle Scholar
  42. Solidaki E, Chatzi L, Bitsios P, Markatzi I, Plana E, Castro F, Palmer K, Coggon D, Kogevinas M (2010) Work-related and psychological determinants of multisite musculoskeletal pain. Scand J Work Environ Health 36(1):54–61CrossRefGoogle Scholar
  43. Staud R (2009) Chronic widespread pain and fibromyalgia: two sides of the same coin? Curr Rheumatol Rep 11(6):433–436CrossRefGoogle Scholar
  44. Svendsen SW, Frost P, Jensen LD (2012) Time trends in surgery for non-traumatic shoulder disorders and postoperative risk of permanent work disability: a nationwide cohort study. Scand J Rheumatol 41(1):59–65CrossRefGoogle Scholar
  45. Svendsen SW, Dalbøge A, Andersen JH, Thomsen JF, Frost P (2013) Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study. Scand J Work Environ Health 39(6):568–577CrossRefGoogle Scholar
  46. Wilkie R, Tajar A, McBeth J (2013) The onset of widespread musculoskeletal pain is associated with a decrease in healthy ageing in older people: a population-based prospective study. PLoS ONE 8(3):e59858CrossRefGoogle Scholar
  47. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P et al (1990) The American College of Rheumatology 1990. Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33(2):160–172CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tine Gjedde Sommer
    • 1
  • Poul Frost
    • 2
  • Susanne Wulff Svendsen
    • 1
    Email author
  1. 1.Danish Ramazzini Centre, Department of Occupational MedicineRegional Hospital West Jutland – University Research ClinicHerningDenmark
  2. 2.Danish Ramazzini Centre, Department of Occupational MedicineAarhus University HospitalAarhus CDenmark

Personalised recommendations