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Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries

Sarquis, Leila M.M.; Coggon, David; Ntani, Georgia; Walker-Bone, Karen; Palmer, Keith T.; Felli, Vanda E.; Harari, Raul; Barrero, Lope H.; Felknor, Sarah A.; Gimeno, David; Cattrell, Anna; Vargas-Prada, Sergio; Bonzini, Matteo; Solidaki, Eleni; Merisalu, Eda; Habib, Rima R.; Sadeghian, Farideh; Kadir, M. Masood; Warnakulasuriya, Sudath S.P.; Matsudaira, Ko; Nyantumbu, Busisiwe; Sim, Malcolm R.; Harcombe, Helen; Cox, Ken; Marziale, Maria H.; Harari, Florencia; Freire, Rocio; Harari, Natalia; Monroy, Magda V.; Quintana, Leonardo A.; Rojas, Marianela; Harris, E. Clare; Serra, Consol; Martinez, J. Miguel; Delclos, George; Benavides, Fernando G.; Carugno, Michele; Ferrario, Marco M.; Pesatori, Angela C.; Chatzi, Leda; Bitsios, Panos; Kogevinas, Manolis; Oha, Kristel; Freimann, Tiina; Sadeghian, Ali; Peiris-John, Roshini J.; Sathiakumar, Nalini; Wickremasinghe, A. Rajitha; Yoshimura, Noriko; Kelsall, Helen L.; Hoe, Victor C.W.; Urquhart, Donna M.; Derrett, Sarah; McBride, David; Herbison, Peter; Gray, Andrew; Salazar Vega, Eduardo J.

doi: 10.1097/j.pain.0000000000000477
Research Paper
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To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

Neck/shoulder pain that is associated with pain at other sites is more common and differs epidemiologically from that limited only to the neck or shoulder(s).

aFederal University of Paraná, Curitiba-PR, Brazil

bMedical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom

cArthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom

dSchool of Nursing, University of São Paulo, São Paulo, Brazil

eCorporación para el Desarrollo de la Producción y el Medio Ambiente Laboral—IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador

fDepartment of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia

gSouthwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA

hCenter for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA

iMedical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom

jCenter for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain

kCIBER of Epidemiology and Public Health, Barcelona, Spain

lIMIM (Hospital del Mar Research Institute), Barcelona, Spain

mEpidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy

nDepartment of Social Medicine, Medical School, University of Crete, Heraklion, Greece

oInstitute of Technology, Estonian University of Life Sciences, Tartu, Estonia

pDepartment of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

qDepartment of Occupational Health, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran

rDepartment of Community Health Sciences, Aga Khan University, Karachi, Pakistan

sDepartment of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka

tDepartment for Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan

uNational Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa

vFaculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa

wDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

xDepartment of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

ySchool of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil

zProgram Health, Work and Environment in Central America, Institute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica

aaOccupational Health Service, Parc de Salut MAR, Barcelona, Spain

bbServicio de Investigación y Análisis IT/EP, Departamento de Investigación y Análisis de Prestaciones, MC Mutual, Barcelona, Spain

ccDepartment of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

ddFondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

eeDepartment of Psychiatry, Medical School, University of Crete, Heraklion, Greece

ffCentre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain

ggNorth Estonia Medical Centre, Tallinn, Estonia

hhTartu University Hospital, Tartu, Estonia

iiKlinikum Leverkusen, Leverkusen, Germany

jjDepartment of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka

kkSection of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

llDepartment of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

mmFaculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka

nnDepartment of Joint Disease Research, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan

ooCentre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

ppInjury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand

qqAkzoNobel, Houston, TX, USA

Corresponding author. Address: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. Tel.: +44 2380 777624; fax: +44 2380 704021. E-mail address: dnc@mrc.soton.ac.uk (D. Coggon).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received October 01, 2015

Received in revised form December 17, 2015

Accepted December 22, 2015

© 2016 International Association for the Study of Pain
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