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Risk factors for new onset and persistence of multi-site musculoskeletal pain in a longitudinal study of workers in Crete
  1. Eleni Solidaki1,
  2. Leda Chatzi1,
  3. Panos Bitsios2,
  4. David Coggon3,
  5. Keith T Palmer3,
  6. Manolis Kogevinas4,5,6,7
  1. 1Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece
  2. 2Department of Psychiatry, Medical School, University of Crete, Heraklion, Greece
  3. 3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  4. 4Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  5. 5IMIM (Hospital del Mar Research Institute), Barcelona, Spain
  6. 6CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
  7. 7National School of Public Health, Athens, Greece
  1. Correspondence to Professor Manolis Kogevinas, Centre for Research in Environmental Epidemiology (CREAL), 88 Dr Aiguader Road, Barcelona 08003, Spain; kogevinas{at}


Objectives To explore occupational and psychological risk factors for the incidence and persistence of multi-site musculoskeletal pain.

Methods We conducted a longitudinal investigation of three occupational groups in Crete, Greece. Baseline information was obtained at interview about pain in the past year at each of six anatomical sites, and about possible risk factors for subsequent symptoms. Twelve months later, subjects were re-interviewed about pain at the same anatomical sites in the past month. Pain at two or more sites was classed as multi-site. Associations with new development and persistence of multi-site pain at follow-up were assessed by logistic regression.

Results Analysis was based on 518 subjects (87% of those originally selected for study). At follow-up, multi-site pain persisted in 217 (62%) of those who had experienced it in the year before baseline, and was newly developed in 27 (17%) of those who had not. Persistence of multi-site pain was significantly related to physical loading at work, somatising tendency and beliefs about work as a cause of musculoskeletal pain, with OR (95% CI) for the highest relative to the lowest exposure categories of 2.3 (1.0 to 5.6), 2.6 (1.5 to 4.6) and 1.9 (1.1 to 3.3) respectively. Development of new multi-site pain was most strongly associated with working for ≥40 h per week (OR 5.0, 95% CI 1.1 to 24.0).

Conclusions Our findings confirm the importance of both physical loading at work and somatising tendency as risk factors for multi-site pain, and suggest that persistence of pain is also influenced by adverse beliefs about work causation.

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