Objectives We studied the developmental trajectories of multisite musculoskeletal pain (MSP) to learn whether pain in midlife persists to old age, and whether pain trajectories associate with midlife work or lifestyle exposures or retirement from work.
Methods Municipal employees aged 44–58 years were studied in 1981 (n=6257) with follow-ups in 1985, 1992, 1997 and 2009. Pain in the neck, low back, and upper and lower limbs was assessed in each survey. Trajectories of the number (0–4) of pain sites were defined using growth mixture modelling (n=3093). Workload, lifestyle and morbidity were elicited by questionnaire and retirement from registries. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Cumulative hazard curves for retirement by trajectory group were calculated.
Results Three trajectories of pain over 28 years emerged: low (25%), moderate (52%) and high-decreasing (23%). In the latter, the number of pain sites first decreased sharply, stabilising to a moderate level after most subjects had retired. The disability pension rate was highest in this trajectory, which associated with high baseline morbidity, particularly musculoskeletal disorder (OR 8.06; 95% CI 5.97 to 10.87). Also high biomechanical exposure (2.86;95% CI 2.16 to 3.78), high job demands (1.79; 95% CI 1.39 to 2.30), high job control (OR 0.70; 95% CI 0.54 to 0.90), body mass index (BMI) ≥25.0 kg/m2 (1.40; 95% CI 1.09 to 1.80) and low leisure-time physical activity (LTPA) (1.39; 95% CI 1.09 to 1.78) at baseline were associated with this trajectory. However, high LTPA and BMI in repeated surveys also associated with the high-decreasing trajectory.
Conclusion MSP in midlife often persists to old age. However, high widespreadness of pain may decrease with retirement from work.
- multisite pain
- trajectory analysis
- working conditions
- leisure-time physical activity
- cohort study
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Contributors SN developed the idea, analysed the data and wrote the first draft of the manuscript. KCP and PLL-A contributed to interpretation of the results. C-HN, MBvB, MEvB, JS, TR and JI contributed to the design of the study and data collection. PLA reviewed the manuscript and provided direction for the intellectual content, additional analyses and context. All authors reviewed the draft manuscript and approved the final version for publication.
Funding SN was partly funded by the Finnish Cultural Foundation (SKR) with a personal grant (grant number 00150637). MEvB was funded by the Academy of Finland (grant numbers: 294530, 307114 and 303920).
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Ethics Committee of the Finnish Institute of Occupational Health, Helsinki, Finland approved the study and ethical clearance for the register linkages was obtained from the national Data Protection Ombudsman.
Provenance and peer review Not commissioned; externally peer reviewed.
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