Background The prevalence of disabling regional pain varies widely between countries, even among people with similar jobs. It appears that the factors driving this variation predispose to musculoskeletal pain in general rather than being specific to any one anatomical site. To explore at what age they act, and whether they might be amenable to intervention, we analysed previously collected data from a cross-sectional survey.

Methods Information about musculoskeletal pain and risk factors was elicited at interview from six groups of workers (N=855, response rate 95.4%) defined by the nature of their work (non-manual or manual) and their country of residence and ethnicity (UK white, UK of Indian subcontinental origin and Indian in India). We compared the 12 month prevalence of multisite pain across the six occupational groups with adjustment for potential confounders.

Results Overall, 200 participants (23%) reported pain at ≥3 sites, which was much less frequent in Indian manual and non-manual workers than among white non-manual workers in the UK (adjusted ORs 0.04, 95% CI: 0.01 to 0.2, and 0.2, 95% CI: 0.1 to 0.6). However, rates in UK workers of Indian subcontinental origin were very similar to those in white UK workers. This pattern was maintained when analysis was restricted to participants aged <35 years, and when second and later generation migrants were excluded.

Conclusions Large differences in pain prevalence between the UK and India are attributable to environmentally-determined factors which influence pain at multiple anatomical sites, impact by early in adult life, and act soon after moving from India to the UK.