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Association between pain catastrophising and musculoskeletal disorders is modified by past injuries in Malaysian military recruits
  1. F H Mohd Din1,2,
  2. Sanjay Rampal3,
  3. M A Muslan1,
  4. Victor C W Hoe2,3
  1. 1Malaysian Armed Forces Health Services, Malaysian Armed Forces, Kuala Lumpur, Malaysia
  2. 2Faculty of Medicine, Department of Social and Preventive Medicine, Centre for Occupational and Environmental Health-UM, University of Malaya, Malaysia
  3. 3Faculty of Medicine, Department of Social and Preventive Medicine, Julius Centre University of Malaya, University of Malaya, Malaysia
  1. Correspondence to Dr FH Mohd Din, Faculty of Medicine, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; faridzal.harrymen{at}


Objectives Pain catastrophising is defined as exaggerated negative thoughts, which can occur during an actual or anticipated painful experience, such as musculoskeletal injuries (MSI) or disorders (MSD). The aims of this study are to examine the association between pain catastrophising and MSI and MSD in Malaysian Army male recruits, and evaluate the effects of past injury.

Methods A cohort of 611 male Malaysian Army recruits were recruited and followed up at 3 and 6 months. Pain catastrophising, MSD, sociodemographic and work factors were measured using a self-administered questionnaire, and MSI incidence was retrieved from the medical records. Multivariable fixed effects regression was used to model the cumulative incidence of MSD and MSI.

Results Approximately 12% of the recruits were diagnosed with incident MSI and 80% reported incident MSD. Higher pain catastrophising at baseline was associated with higher 6 month MSD risk (adjusted OR (aOR) 1.6 per 1 SD increase of Pain Catastrophising Scale (PCS) scores; 95% CI 1.2 to 2.0), and longitudinally associated with MSD incidence (aOR 1.2, 95% CI 1.1 to 1.4). Pain catastrophising was not associated with MSI incidence (aOR 1.0, 95% CI 0.8 to 1.3). The association between pain catastrophising and self-reported MSD was stronger among recruits with self-reported past injury (p for interaction <0.001).

Conclusions Pain catastrophising was able to predict symptomatic MSD, and not physician-diagnosed MSI, and these findings are directly related to individual health beliefs. Pain catastrophising has a greater influence on how military recruits perceived their musculoskeletal conditions during training, and efforts to reduce pain catastrophising may be beneficial.

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