ArticleDisabling musculoskeletal pain in working populations: Is it the job, the person, or the culture?Coggon, Davida,*; Ntani, Georgiaa; Palmer, Keith T.a; Felli, Vanda E.b; Harari, Raulc; Barrero, Lope H.d; Felknor, Sarah A.e,f; Gimeno, Davide; Cattrell, Annag; Serra, Consolh,i,j; Bonzini, Matteok; Solidaki, Elenil; Merisalu, Edam; Habib, Rima R.n; Sadeghian, Farideho; Masood Kadir, M.p; Warnakulasuriya, Sudath S.P.q; Matsudaira, Kor; Nyantumbu, Busisiwes,t; Sim, Malcolm R.u; Harcombe, Helenv; Cox, Kena; Marziale, Maria H.w; Sarquis, Leila M.x; Harari, Florenciac; Freire, Rocioc; Harari, Nataliac; Monroy, Magda V.d; Quintana, Leonardo A.d; Rojas, Marianelay; Salazar Vega, Eduardo J.e; Harris, Clare E.a; Vargas-Prada, Sergioh; Martinez, Miguel J.h,i; Delclos, Georgee,h,i; Benavides, Fernando G.h,i; Carugno, Michelez; Ferrario, Marco M.k; Pesatori, Angela C.z,aa; Chatzi, Ledal; Bitsios, Panosab; Kogevinas, Manolisi,ac,ad,ae; Oha, Kristelaf; Sirk, Tuuliag; Sadeghian, Aliah; Peiris-John, Roshini J.ai,aj; Sathiakumar, Naliniak; Wickremasinghe, Rajitha A.al; Yoshimura, Norikoam; Kelsall, Helen L.u; Hoe, Victor C.W.u,an; Urquhart, Donna M.u; Derrett, Sarahao; McBride, Davidv; Herbison, Peterv; Gray, Andrewv Author Information Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. aMedical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK bSchool of Nursing, University of São Paulo, São Paulo, Brazil cCorporación para el Desarrollo de la Producción y el Medio Ambiente Laboral – IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador dDepartment of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia eSouthwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA fCenter for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA gMedical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College, London, UK hCenter for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain iCIBER of Epidemiology and Public Health, Barcelona, Spain jOccupational Health Service, Parc de Salut MAR, Barcelona, Spain kEpidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy lDepartment of Social Medicine, Medical School, University of Crete, Heraklion, Greece mDepartment of Public Health, University of Tartu, Estonia nDepartment of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon oDepartment of Occupational Health, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran pDepartment of Community Health Sciences, Aga Khan University, Karachi, Pakistan qDepartment of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka rClinical Research Centre for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, Kawasaki, Japan sNational Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa tFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa uDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia vDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand wSchool of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil xFederal University of Paraná, Curitiba-PR, Brazil yInstitute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica zDepartment of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy aaFondazione Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy abDepartment of Psychiatry, Medical School, University of Crete, Heraklion, Greece acCentre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain adIMIM (Hospital del Mar Research Institute), Barcelona, Spain aeNational School of Public Health, Athens, Greece afNorth Estonia Medical Centre, Tallinn, Estonia agPõlva Hospital, Põlva, Estonia ahKlinikum Leverkusen, Leverkusen, Germany aiDepartment of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka ajSection of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand akDepartment of Epidemiology, School of Public Health, University of Alabama at Birmingham, USA alFaculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka amDepartment of Joint Disease Research, University of Tokyo, Tokyo, Japan anCentre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia aoInjury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand *Corresponding author. Address: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK. Tel.: +44 2380 777624; fax: +44 2380 704021. E-mail address:[email protected] Article history: Received 14 December 2012; Received in revised form 11 February 2013; Accepted 19 February 2013. Pain 154(6):p 856-863, June 2013. | DOI: 10.1016/j.pain.2013.02.008 Buy Metrics Abstract Large international variation in the prevalence of disabling forearm and low back pain was only partially explained by established personal and socioeconomic risk factors. To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed. © 2013 Lippincott Williams & Wilkins, Inc.