University of Oulu

Eveliina Heikkala, Petteri Oura, Markus Paananen, Emma Ho, Paulo Ferreira, Christophe Tanguay-Sabourin & Jaro Karppinen (2023) Chronic disease clusters are associated with prolonged, bothersome, and multisite musculoskeletal pain: a population-based study on Northern Finns, Annals of Medicine, 55:1, 592-602, DOI:10.1080/07853890.2023.2177723

Chronic disease clusters are associated with prolonged, bothersome, and multisite musculoskeletal pain : a population-based study on Northern Finns

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Author: Heikkala, Eveliina1,2,3; Oura, Petteri1,2; Paananen, Markus1,2,4;
Organizations: 1Research Unit of Population Health, University of Oulu, Oulu, Finland
2Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Rovaniemi Health Center, Rovaniemi, Finland
4Western Uusimaa Wellbeing Services County, Social and Health Care Services, Espoo, Finland
5Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
6Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, Australia
7Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre,University of Sydney, Sydney, Australia
8Alan Edwards Pain Centre for Research on Pain, McGill University, Montreal, Canada
9Faculty of Medicine, Universite de Montreal, Montreal, Canada
10Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: Informa, 2023
Publish Date: 2023-08-14


Background/Objectives: Chronic diseases often accumulate with musculoskeletal (MSK) pain. However, less evidence is available on idiosyncratic patterns of chronic diseases and their relationships with the severity of MSK pain in general MSK pain populations.

Material and methods: Questionnaire-based data on physician-diagnosed chronic diseases, MSK pain and its dimensions (frequency, intensity, bothersomeness, and the number of pain sites), and confounders were collected from the Northern Finland Birth Cohort 1966 at the age of 46. Latent Class Analysis (LCA) was used to identify chronic disease clusters among individuals who reported any MSK pain within the previous year (n = 6105). The associations between chronic disease clusters, pain dimensions, and severe MSK pain, which was defined as prolonged (over 30 d within the preceding year), bothersome (Numerical Rating Scale >5), and multisite (two or more pain sites) pain, were analyzed using logistic regression and general linear regression models, adjusted for sex and educational level (n for the full sample = 4768).

Results: LCA resulted in three clusters: Metabolic (10.8% of the full sample), Psychiatric (2.9%), and Relatively Healthy (86.3%). Compared to the Relatively Healthy cluster, the Metabolic and Psychiatric clusters had higher odds for daily pain and higher mean pain intensity, bothersomeness, and the number of pain sites. Similarly, the odds for severe MSK pain were up to 75% (95% confidence interval: 44%–113%) and 155% (81%–259%) higher in the Metabolic and Psychiatric clusters, respectively, after adjustments for sex and educational level.

Conclusions: Distinct patterns of chronic disease accumulation can be identified in the general MSK pain population. It seems that mental and metabolic health are at interplay with severe MSK pain. These findings suggest a potential need to screen for psychiatric and metabolic entities of health when treating working-aged people with MSK pain.

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Series: Annals of medicine
ISSN: 0785-3890
ISSN-E: 1365-2060
ISSN-L: 0785-3890
Volume: 55
Issue: 1
Pages: 592 - 602
DOI: 10.1080/07853890.2023.2177723
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: NFBC1966 received financial support from University of Oulu [Grant no. 24000692], Oulu University Hospital [Grant no. 24301140], ERDF European Regional Development [Fund Grant no. 539/2010 A31592]. This study was funded by the Medical Research Center Oulu, but the funder had no role in the research, authorship, or publication of this article.
Dataset Reference: NFBC data are available from the University of Oulu, Infrastructure for Population Studies. Permission to use the data can be applied for research purposes via the electronic material request portal. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. The use of personal data is based on the cohort participant’s written informed consent at his/her latest follow-up study, which may cause limitations to its use. Please, contact the NFBC project center (NFBCprojectcenter(at) and visit the cohort website for more information.
Copyright information: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.