Background
Multisite musculoskeletal pain is common and disabling. This study aimed to prospectively investigate the distribution of musculoskeletal pain anatomically, and explore risk factors for ...increases/reductions in the number of painful sites.
Methods
Using data from participants working in 45 occupational groups in 18 countries, we explored changes in reporting pain at 10 anatomical sites on two occasions 14 months apart. We used descriptive statistics to explore consistency over time in the number of painful sites, and their anatomical distribution. Baseline risk factors for increases/reductions by ≥3 painful sites were explored by random intercept logistic regression that adjusted for baseline number of painful sites.
Results
Among 8927 workers, only 20% reported no pain at either time point, and 16% reported ≥3 painful sites both times. After 14 months, the anatomical distribution of pain often changed but there was only an average increase of 0.17 painful sites. Some 14% workers reported a change in painful sites by ≥3. Risk factors for an increase of ≥3 painful sites included female sex, lower educational attainment, having a physically demanding job and adverse beliefs about the work‐relatedness of musculoskeletal pain. Also predictives were as follows: older age, somatizing tendency and poorer mental health (each of which was also associated with lower odds of reductions of ≥3 painful sites).
Conclusions
Longitudinally, the number of reported painful sites was relatively stable but the anatomical distribution varied considerably. These findings suggest an important role for central pain sensitization mechanisms, rather than localized risk factors, among working adults.
Significance
Our findings indicate that within individuals, the number of painful sites is fairly constant over time, but the anatomical distribution varies, supporting the theory that among people at work, musculoskeletal pain is driven more by factors that predispose to experiencing or reporting pain rather than by localized stressors specific to only one or two anatomical sites.
Previous research has indicated that wide international variation in the prevalence of disabling low back pain among working populations is largely driven by factors predisposing to musculoskeletal ...pain more generally. This paper explores whether the same applies to disabling wrist/hand pain (WHP).
Using data from the Cultural and Psychosocial Influences on Disability (CUPID) study, we focused on workers from 45 occupational groups (office workers, nurses and other workers) in 18 countries. Among 11,740 participants who completed a baseline questionnaire about musculoskeletal pain and potential risk factors, 9082 (77%) answered a further questionnaire after a mean interval of 14 months, including 1373 (15%) who reported disabling WHP in the month before follow-up. Poisson regression was used to assess associations of this outcome with baseline risk factors, including the number of anatomical sites other than wrist/hand that had been painful in the 12 months before baseline (taken as an index of general propensity to pain).
After allowance for other risk factors, the strongest associations were with general pain propensity (prevalence rate ratio for an index ≥6 vs. 0: 3.6, 95% confidence interval 2.9-4.4), and risk rose progressively as the index increased. The population attributable fraction for a pain propensity index > 0 was 49.4%. The prevalence of disabling WHP by occupational group ranged from 0.3 to 36.2%, and correlated strongly with mean pain propensity index (correlation coefficient 0.86).
Strategies to prevent disability from WHP among working populations should explore ways of reducing general propensity to pain, as well as improving the ergonomics of occupational tasks.
ObjectivesTo explore the association of sickness absence ascribed to pain at specific anatomical sites with wider propensity to musculoskeletal pain.MethodsAs part of the CUPID (Cultural and ...Psychosocial Influences on Disability) study, potential risk factors for sickness absence from musculoskeletal pain were determined for 11 922 participants from 45 occupational groups in 18 countries. After approximately 14 months, 9119 (78%) provided follow-up information about sickness in the past month because of musculoskeletal pain, including 8610 who were still in the same job. Associations with absence for pain at specific anatomical sites were assessed by logistic regression and summarised by ORs with 95% CIs.Results861 participants (10%) reported absence from work because of musculoskeletal pain during the month before follow-up. After allowance for potential confounders, risk of absence ascribed entirely to low back pain (n=235) increased with the number of anatomical sites other than low back that had been reported as painful in the year before baseline (ORs 1.6 to 1.7 for ≥4 vs 0 painful sites). Similarly, associations with wider propensity to pain were observed for absence attributed entirely to pain in the neck (ORs up to 2.0) and shoulders (ORs up to 3.4).ConclusionsSickness absence for pain at specific anatomical sites is importantly associated with wider propensity to pain, the determinants of which extend beyond established risk factors such as somatising tendency and low mood. Better understanding of why some individuals are generally more prone to musculoskeletal pain might point to useful opportunities for prevention.
A cross-sectional survey with a longitudinal follow-up.
The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which ...occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain.
We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries.
Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group.
Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations.
2.
In a large cross-sectional survey, pain affecting 6–10 anatomical sites showed substantially different associations with risk factors from pain limited to 1–3 sites.
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 20–59years 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.
The correct spelling is Sarah Derrett. (2012) Correction: The CUPID (Cultural and Psychosocial Influences on Disability) Study: Methods of Data Collection and Characteristics of Study Sample.
RESUMO: Objetivo: Descrever e analisar o absenteísmo dos trabalhadores do Brasil notificados com distúrbios musculoesqueléticos, do período de 2007 a 2012. Métodos: Estudo quantitativo, transversal e ...descritivo, com dados retrospectivos e secundários. Os registros foram do Sistema de Informação de Agravos de Notificação, que notifica trabalhadores em regime de previdência, bem como os informais. O período do estudo foi de seis anos. As variáveis foram: sociodemográficas, organizacionais do trabalho e específicas do agravo. Resultados: Foram aproximadamente 5 milhões de dias perdidos de trabalho, de 18.611 trabalhadores afastados e notificados com o agravo. Os grupos que mais se destacaram na análise foram os analfabetos, na faixa etária dos 50 aos 59 anos, com carga horária diária de trabalho acima de 6 horas, do grande grupo ocupacional 4, os CID-10 M50 e M51 e os trabalhadores com transtornos mentais. Conclusões: Elevado absenteísmo entre os trabalhadores com distúrbios musculoesqueléticos, analfabetos, idade dos 50 aos 59 anos, trabalhadores de serviços administrativos, CID-10 M51 e trabalhadores com transtornos mentais. Há necessidade de traçar políticas públicas que contemplem o absenteísmo causado pelo agravo, a fim de reduzir a morbidade, bem como os prejuízos socioeconômicos.
Com o objetivo de analisar a multicausalidade dos acidentes de trabalho com exposição biológica em trabalhadores de enfermagem, foi realizada uma pesquisa descritiva e exploratória em um hospital de ...médio porte do Estado do Paraná, no período entre janeiro de 2008 a janeiro de 2009. A população foi de 26 trabalhadores de enfermagem da clínica médica. A coleta de dados foi realizada por entrevistas semiestruturadas com cinco dos oito acidentados no período; os conteúdos foram analisados pelo Diagrama de Causas e Efeitos. As categorias causas materiais, organizacionais, institucionais e comportamentais do trabalhador evidenciaram o descarte inadequado de perfurocortantes, a sobrecarga de trabalho, a não utilização das normas de biossegurança e a deficiente supervisão e capacitação do trabalhador como fatores determinantes para a ocorrência destes acidentes. A adoção da ferramenta do Diagrama de Causas e Efeitos proporcionou a análise dos acidentes na sua multicausalidade, mostrando a interação entre as mesmas.
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