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Objectives: To establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this is related to the methods used., Methods: Reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted., Results: 15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews., Conclusions: The reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplace.

Chronic widespread pain (CWP) is associated with poor health-related quality of life (HRQoL). It is unclear whether pain itself is the cause of poor HRQoL or other factors play a role. We hypothesised that new onset of CWP was associated with poor physical and mental HRQoL but that psychosocial risk markers for CWP onset would explain this relationship. A prospective population-based survey measured pain and psychosocial status at baseline. Subjects free of CWP at baseline were followed up 15 months later, when pain status, threatening life events and HRQoL (SF-12) were assessed. The risk associated with the new onset of CWP and reporting poor SF12-MCS and SF12-PCS was quantified using multinomial logistic regression (relative risk ratios (RRRs) with 95% confidence intervals (95% CI)), adjusted for age and gender. 3000 subjects (77%) free of CWP at baseline participated at follow-up. 2650 subjects (88%) provided full SF-12 and pain data and formed the cohort for this analysis. 9.4% of subjects (n=248) reported new CWP. New CWP was associated with an increased risk of having the poorest SF12-MCS (RRR=2.3; 95% CI 1.6-3.2) and SF12-PCS (RRR=8.0; 95% CI 5.4-11.8) scores. After adjusting for baseline psychosocial status, the relationship between CWP onset and SF12-MCS was attenuated (RRR=1.2; 95% CI 0.8-1.8), although the association with SF12-PCS remained (RRR=4.8% CI 3.1-7.47). New onset of CWP is associated with poor mental and physical HRQoL. However, the relationship with mental HRQoL is explained by psychosocial risk markers.

Background: Musculoskeletal pain symptoms are common in children and adolescents. These symptoms have a negative impact on children's physical and emotional well-being, but their underlying aetiology and risk factors are still poorly understood. Most of the previous cohort studies were conducted among mid and/or late adolescents and were mainly focused on a specific pain location (e.g. low back pain or neck pain). The purpose of this study is to estimate occurrence of new-onset pain symptoms, in all musculoskeletal locations, in preteens and early adolescents and investigate risk factors for development of these symptoms., Methods: 1756 schoolchildren (mean age 10.8) were recruited from schools in southern Finland. Information was extracted as to whether they experienced musculoskeletal pain and a total of 1192 children were identified as free of musculoskeletal pain symptoms. Information was collected on factors which could potentially predict the development of musculoskeletal pain: headache, abdominal pain, sadness/feeling down, day-time tiredness, difficulty in falling asleep, waking up during nights, level of physical activity and hypermobility. These children were followed-up 1-year later and those with new episodes of non-traumatic and traumatic musculoskeletal pain symptoms were identified., Results: A total of 1113 schoolchildren (93% of baseline pain-free children) were found at one-year follow-up. New episodes of musculoskeletal pain were reported by 21.5% of these children. Of them 19.4% reported non-traumatic pain and 4.0% reported traumatic pain. The neck was the most commonly reported site with non-traumatic pain, while the lower limb was the most common site for traumatic pain. The independent risk factors for non-traumatic musculoskeletal pain were headache (OR = 1.68, [95% CI 1.16-2.44]) and day-time tiredness (OR = 1.53, [95% CI 1.03-2.26]). The risk factors for traumatic musculoskeletal pain were vigorous exercise (OR = 3.40 [95% CI 1.39-8.31]) and day-time tiredness (OR = 2.97 [95% CI 1.41-6.26])., Conclusion: This study highlights that there may be two types of pain entities with both distinct and common aspects of aetiology. For primary prevention purposes, school healthcare professionals should pay attention to preteens and early adolescents practicing vigorous exercise (predictor of traumatic pain), reporting headache (predictor of non-traumatic pain) and reporting day-time tiredness (predictor of both types of pain).

Objective: To test the hypothesis that abnormalities in the hypothalamic-pituitary-adrenal (HPA) stress-response system would act as an effect moderator between HPA function and the onset of chronic widespread pain (CWP)., Methods: We conducted a population-based prospective cohort study. Current pain and psychosocial status were ascertained in 11,000 subjects. Of the 768 eligible subjects free of CWP but at future risk based on their psychosocial profile, 463 were randomly selected, and 267 (57.7%) consented to assessment of their HPA axis function. Diurnal function was measured by assessing levels of salivary cortisol in the morning (9:00 AM) and evening (10:00 PM). Serum cortisol levels were measured after an overnight low-dose (0.25 mg) dexamethasone suppression test and a potentially stressful clinical examination. All subjects were followed up 15 months later to identify cases of new-onset CWP., Results: A total of 241 subjects (94.9%) completed the followup study, and 28 (11.6%) reported the new onset of CWP. High levels of cortisol post-dexamethasone (odds ratio [OR] 3.53, 95% confidence interval [95% CI] 1.17-10.65), low levels in morning saliva (OR 1.43, 95% CI 0.52-3.94), and high levels in evening saliva (OR 2.32, 95% CI 0.64-8.42) were all associated with CWP. These 3 factors were found to be independent and additive predictors of CWP (OR for all 3 factors 8.5, 95% CI 1.5-47.9) in analyses controlling for age, sex, depression, sleep disturbance, recent traumatic life events, and pain status. One or more of these 3 HPA factors identified 26 (92.9%) cases of new-onset CWP., Conclusion: Among a group of psychologically at-risk subjects, dysfunction of the HPA axis helps to distinguish those who will and will not develop new-onset CWP.

Objective: To test the hypothesis that the prevalence of specific musculoskeletal pain symptoms has increased over time in the northwest region of England. To meet this objective we have examined the difference in the prevalence of low back, shoulder and widespread pain between the 1950s and today using historical data collected by the Arthritis Research Campaign (arc)., Methods: Two cross-sectional surveys conducted over 40 yr apart in the northwest region of England. The status of two regional pain sites and widespread pain was determined using interview and questionnaire responses, for the earlier and later studies respectively. Subjects were classified positively if they reported low back pain, shoulder pain or widespread pain on the day of the survey. Rates were standardized to the Greater Manchester population., Results: There were large differences in the prevalence of musculoskeletal pain between the two surveys. For all three symptoms examined prevalence increased from 2- to 4-fold between the two surveys. In both surveys low back pain was more common in women. Shoulder and widespread pain was less prevalent in women than in men in the earlier survey but by the time of the later survey women reported more pain at these sites., Conclusions: The prevalence of musculoskeletal pain is much higher than that reported over 40 yr ago. The change in prevalence is unlikely to be entirely due to the study design; other possible explanations such as the increased reporting or awareness of these symptoms is discussed.

Objective: To determine whether adverse psychosocial and individual psychological factors increase the risk of pain across regional sites., Methods: A prospective study was conducted of newly employed workers from 12 diverse occupational groups. Near to the beginning of subjects' employment, details of work related psychosocial factors and individual psychological distress were obtained by means of a self completed questionnaire. Questionnaire follow up after 12 months provided data on these same exposures and ascertained pain at any of four anatomical sites: the low back, shoulder, wrist/forearm, and knee., Results: Of the original 1081 subjects, 829 (77%) provided full details at the one year follow up. Psychosocial work demands and high levels of individual psychological distress were found to have a common effect across sites. Psychological distress was associated with a doubling of the risk of reported pain (odds ratio = 2.1, 95% confidence interval 1.6 to 2.7), while aspects of job demand, poor support from colleagues, and work dissatisfaction were all associated with increased odds of reported pain onset of between 1.4 and 1.7. These effects were almost all common across the four regional pain sites., Conclusions: In cohorts of newly employed workers, certain work related psychosocial factors and individual psychological distress are associated with the subsequent reporting of musculoskeletal pain, and generally this effect is common across anatomical sites.

Objectives: To determine the influence of short term exposure to mechanical factors on regional musculoskeletal pain., Methods: Full time newly employed workers were recruited from 12 occupational groups and information collected by questionnaire. Subjects indicated on a blank body manikin any low back, shoulder, wrist or forearm or both, or knee pain which had occurred during the past month and had lasted more than 1 day. Data were also collected with a previously validated questionnaire on working postures, manual handling activities, and repetitive movements of the upper limb. The relations between mechanical factors and each area of pain were calculated as odds ratios (ORs) with 95% confidence intervals (95% CIs). Adjustment was made for age and sex., Results: 1081 subjects (median age 23; interquartile range 20--27) were recruited to the study (a participation rate of 91%). 261 (24%) reported low back pain, 221 (20%) shoulder pain, 93 (9%) wrist or forearm pain, and 222 (21%) knee pain. Several specific manual handling activities were found to be associated with low back, shoulder, and knee pain. Carrying weights of more than 50 lbs (23 kg) on one shoulder was the factor which was most strongly associated with low back pain (OR 2.4 (95% CI 1.5 to 3.8)), shoulder pain (OR 3.1 (95% CI 1.9 to 4.8)), and knee pain (OR 3.5 (95% CI 2.2 to 5.5)), whereas forearm pain was most strongly associated with repetitive movements of the wrists (OR 1.8 (95% CI 1.04 to 3.1)). By contrast very few postures were associated with regional pain, although bending forwards in an uncomfortable position for at least 15 minutes was associated with shoulder pain (OR 1.6 (95% CI 1.2 to 2.2)) and kneeling for at least 15 minutes was associated with knee pain (OR 1.8 (95% CI 1.2 to 2.6)). Exposure to mechanical factors was most strongly associated with pain at multiple sites rather than with pains in individual regions., Conclusions: Even among workers with only short term exposure to mechanical factors, musculoskeletal pain is increased.