University of Oulu

Heikkala, E., Oura, P., Korpela, T., Karppinen, J., & Paananen, M. (2022). Chronotypes and disabling musculoskeletal pain: A Finnish birth cohort study. European Journal of Pain, 26, 1069– 1078.

Chronotypes and disabling musculoskeletal pain : a Finnish birth cohort study

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Author: Heikkala, Eveliina1,2,3; Oura, Petteri1,2; Korpela, Tuukka1,2;
Organizations: 1Center for Life Course Health Research, University of Oulu, Oulu, Finland
2Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
3Rovaniemi Health Center, Rovaniemi, Finland
4Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
5Primary Health Care Services, City of Espoo, Espoo, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-11-30


Background: It has been suggested that chronotype, the individual preference for 24-h circadian rhythms, influences health. Sleep problems and mental distress are amongst the greatest risk factors for musculoskeletal (MS) pain. The aims of this study were first, to explore the associations between chronotypes and MS pain, with special reference to disabling MS pain and second, to test whether mental distress and insomnia have a modifying role in the associations between chronotypes and MS pain.

Methods: The dataset of 4961 individuals was composed of Northern Finns surveyed on MS pain, chronotypes and confounding factors (sex, insomnia, sleep duration, smoking, mental distress, occupational status, education level and number of coexisting diseases) at 46 years. The relationships between chronotypes (evening [E], intermediate [I] and morning [M]) and MS pain were evaluated using multinomial logistic regression. To address the second aim, we included an interaction term (chronotype*mental distress, chronotype*insomnia) in the logistic model.

Results: Compared to the M-types, both the E- and I-types had increased odds of suffering ‘disabling pain’ in the unadjusted model (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.37–2.33; OR 1.54, 95% CI 1.29–1.84, respectively). However, the association remained statistically significant only after adjusting for all covariates amongst the I-types (OR 1.39, 95% CI 1.15–1.67). Neither mental distress nor insomnia was found to modify the chronotype–MS pain association.

Conclusions: The results highlight the importance of chronotypes for individuals’ MS health but suggest the presence of confounding factors in the interplay between these factors.

Significance: This study shows that evening and intermediate chronotypes are associated with disabling MS pain, but that mental distress, insomnia and coexisting diseases also play a role in these associations.

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Series: European journal of pain
ISSN: 1090-3801
ISSN-E: 1532-2149
ISSN-L: 1090-3801
Volume: 26
Issue: 5
Pages: 1069 - 1078
DOI: 10.1002/ejp.1931
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
Funding: The NFBC1966 received financial support from the University of Oulu (Grant no. 24000692); Oulu University Hospital (Grant no. 24301140) and ERDF, the European Regional Development Fund (Grant no. 539/2010 A31592).
Copyright information: © 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.