• 1 Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK School of Nursing, University of São Paulo, São Paulo, Brazil Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral-IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA Center for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, London, UK Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain Epidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece Department of Public Health, University of Tartu, Estonia Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon Department of Occupational Health, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Department of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka Clinical Research Centre for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, Kawasaki, Japan National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil Federal University of Paraná, Curitiba-PR, Brazil Institute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica CIBER of Epidemiology and Public Health, Barcelona, Spain Occupational Health Service, Parc de Salut MAR, Barcelona, Spain Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Psychiatry, Medical School, University of Crete, Heraklion, Greece Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IMIM (Hospital del Mar Research Institute), Barcelona, Spain National School of Public Health, Athens, Greece North Estonia Medical Centre, Tallinn, Estonia Põlva Hospital, Põlva, Estonia Klinikum Leverkusen, Leverkusen, Germany Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA Faculty of Medicine,University of Kalaniya, Kelaniya, Sri Lanka Department of Joint Disease Research, University of Tokyo, Tokyo, Japan Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
Pain, 2013 Sep;154(9):1769-1777.
PMID: 23727463 DOI: 10.1016/j.pain.2013.05.039


To explore definitions for multisite 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 vs 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 vs 1.1), older age (PRR 2.6 vs 1.1), somatising tendency (PRR 4.6 vs 1.3), and exposure to multiple physically stressing occupational activities (PRR 5.0 vs 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 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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.