ArticlesPatterns of multisite pain and associations with risk factorsCoggon, 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; Vargas-Prada, Sergioh; Bonzini, Matteoi; Solidaki, Elenij; Merisalu, Edak; Habib, Rima R.l; Sadeghian, Faridehm; Masood Kadir, M.n; Warnakulasuriya, Sudath S.P.o; Matsudaira, Kop; Nyantumbu, Busisiweq,r; Sim, Malcolm R.s; Harcombe, Helent; Cox, Kena; Marziale, Maria H.u; Sarquis, Leila M.v; Harari, Florenciac; Freire, Rocioc; Harari, Nataliac; Monroy, Magda V.d; Quintana, Leonardo A.d; Rojas, Marianelaw; Salazar Vega, Eduardo J.e; Harris, Clare E.a; Serra, Consolh,x,y; Martinez, Miguel J.h,x; Delclos, Georgee,h,x; Benavides, Fernando G.h,x; Carugno, Michelez; Ferrario, Marco M.i; Pesatori, Angela C.z,aa; Chatzi, Ledaj; Bitsios, Panosab; Kogevinas, Manolisx,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.s; Hoe, Victor C.Ws,an; Urquhart, Donna M.s; Derrett, Sarahao; McBride, Davidt; Herbison, Petert; Gray, AndrewtAuthor Information aMedical Research Council Lifecourse Epidemiology Unit, University of Southampton, 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, TX, 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 iEpidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy jDepartment of Social Medicine, Medical School, University of Crete, Heraklion, Greece kDepartment of Public Health, University of Tartu, Estonia lDepartment of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon mDepartment of Occupational Health, Faculty of Health, Shahroud University of Medical Sciences, Shahroud, Iran nDepartment of Community Health Sciences, Aga Khan University, Karachi, Pakistan oDepartment of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka pClinical Research Centre for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, Kawasaki, Japan qNational Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa rFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa sDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia tDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand uSchool of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil vFederal University of Paraná, Curitiba-PR, Brazil wInstitute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica xCIBER of Epidemiology and Public Health, Barcelona, Spain yOccupational Health Service, Parc de Salut MAR, Barcelona, Spain 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, Auckland, New Zealand akDepartment of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA alFaculty of Medicine,University of Kalaniya, 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 25 March 2013 Received in revised form 16 May 2013 Accepted 20 May 2013 Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Pain: September 2013 - Volume 154 - Issue 9 - p 1769-1777 doi: 10.1016/j.pain.2013.05.039 Buy Metrics Abstract Summary 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 20–59 years 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. © 2013 Lippincott Williams & Wilkins, Inc.