University of Oulu

Ahlholm V-H, Rönkkö V, Ala-Mursula L, Karppinen J and Oura P (2021) Modeling the Multidimensional Predictors of Multisite Musculoskeletal Pain Across Adulthood—A Generalized Estimating Equations Approach. Front. Public Health 9:709778. doi: 10.3389/fpubh.2021.709778

Modeling the multidimensional predictors of multisite musculoskeletal pain across adulthood : a generalized estimating equations approach

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Author: Ahlholm, Ville-Heikki1,2; Rönkkö, Viljami1,2; Ala-Mursula, Leena1;
Organizations: 1Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
2Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Finnish Institute of Occupational Health, Oulu, Finland
4Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: Frontiers Media, 2021
Publish Date: 2021-10-11


Background: Multisite pain is commonly chronic and often lacks its initial role as a potential tissue damage signal. Chronic pain among working-age individuals is a risk for disability and imposes a major burden on health care systems and society. As effective treatments for chronic pain are largely lacking, better identification of the factors associated with pain over working years is needed.

Methods: Members of the Northern Finland Birth Cohort 1966 participated in data collection at the ages of 31 (n = 4,028) and 46 (n = 3,429). Using these two time points, we performed a multivariable analysis of the association of socioeconomic, occupational, psychological and lifestyle factors (i.e., low education, living alone, low household income, unemployment, occupational physical exposures [hard physical labor, leaning forward, back twisting, constant moving, lifting loads of ≥ 1 kg], physical inactivity, regular smoking, regular drinking, overweight, and psychiatric symptoms) with the number of musculoskeletal pain sites (i.e., upper extremity, lower extremity, lower back, and the neck-shoulder region; totalling 0–4 pain sites). The data were analyzed using generalized estimating equations.

Results: At the age of 31, multisite pain was reported by 72.5% of men and 78.6% of women. At the age of 46, the prevalence of multisite pain was 75.7% among men and 82.7% among women. Among men, the number of pain sites was positively associated with age (rate ratio 1.05, 95% confidence interval 1.01–1.08), low household income (1.05, 1.01–1.08), unemployment (1.13, 1.06–1.19), any occupational exposure (1.17, 1.12–1.22), regular smoking (1.06, 1.02–1.11), and psychiatric symptoms (1.21, 1.17–1.26). Among women, the number of pain sites was positively associated with age (1.06, 1.04–1.10), unemployment (1.10, 1.05–1.15), any occupational exposure (1.10, 1.06–1.13), regular smoking (1.06, 1.02–1.10), overweight (1.08, 1.05–1.11), and psychiatric symptoms (1.19, 1.15–1.22); living alone was negatively associated with the number of pain sites (0.95, 0.91–0.99).

Conclusions: Of the studied predictors, psychiatric symptoms, occupational physical exposures and unemployment were most strongly associated with multisite pain among both sexes. The results of this study deepen the understanding of the underlying factors of and comorbidities behind multisite pain, and help develop pain relief and rehabilitation strategies for working-age individuals with multisite pain.

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Series: Frontiers in public health
ISSN: 2296-2565
ISSN-E: 2296-2565
ISSN-L: 2296-2565
Volume: 9
Article number: 709778
DOI: 10.3389/fpubh.2021.709778
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
3141 Health care science
3121 General medicine, internal medicine and other clinical medicine
Funding: The Northern Finland Birth Cohort 1966 study received financial support from: University of Oulu, Oulu, Finland (Grant nos. 65354, 24000692). ; Oulu University Hospital, Oulu, Finland (Grant nos. 2/97, 8/97, 24301140). ; Ministry of Health and Social Affairs, Helsinki, Finland (Grant nos. 23/251/97, 160/97, and 190/97). ; National Institute for Health and Welfare, Helsinki, Finland (Grant no. 54121). ; Regional Institute of Occupational Health, Oulu, Finland (Grant nos. 50621, 54231). ; European Regional Development Fund (Grant nos. 539/2010 A31592).
Copyright information: © 2021 Ahlholm, Rönkkö, Ala-Mursula, Karppinen and Oura. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.