title: Disabling musculoskeletal pain and its relation to somatization: a community-based postal survey.
abstract: BACKGROUND
  Somatization (a tendency to report distress from somatic symptoms) is a little studied, but potentially important, confounder and effect modifier in occupational studies of musculoskeletal disease.
  
  
  OBJECTIVE
  To assess the role of somatization as a risk factor for disabling regional pain.
  
  
  METHODS
  A questionnaire was mailed to 4998 subjects of working age. Questions were asked about chronic and disabling pain in the past 12 months affecting the arm, low back, knee or combinations of these sites. Distress from physical symptoms was assessed using elements of the Brief Symptom Inventory and mental well-being was assessed using the short-form 36 (SF-36). Associations were examined by modified Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CI).
  
  
  RESULTS
  Among 2632 responders, 24% reported chronic pain and 25% disabling pain at one or several sites. Risk of chronic or disabling pain increased strongly according to the number of somatic symptoms reported as bothersome. For example, the HR for chronic upper limb pain in those distressed by > or =2 somatic symptoms in the past 7 days versus none was 3.9 (95% CI 2.9-5.3), and that of disabling upper limb pain was 5.8 (95% CI 4.1-8.3). Similar patterns were found for the low back and knee, and there was a gradient of increasing risk according to the number of sites with disabling pain. In comparison, associations with SF-36 mental well-being score were weaker.
  
  
  CONCLUSIONS
  Somatizing tendency should be evaluated as a possible confounder or effect modifier in studies of occupational risk factors for musculoskeletal pain.
authors.affiliation: MRC Environmental Epidemiology Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK. ktp@mrc.soton.ac.uk
authors.forename: Keith T
authors.initials: KT
authors.lastname: Palmer
authors.forename: Michael
authors.initials: M
authors.lastname: Calnan
authors.forename: David
authors.initials: D
authors.lastname: Wainwright
authors.forename: Jason
authors.initials: J
authors.lastname: Poole
authors.forename: Claire
authors.initials: C
authors.lastname: O'Neill
authors.forename: Anna
authors.initials: A
authors.lastname: Winterbottom
authors.forename: Chris
authors.initials: C
authors.lastname: Watkins
authors.forename: David
authors.initials: D
authors.lastname: Coggon
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000523:psychology*; D016272:Occupational Health; D010146:Pain / Q000175:diagnosis / Q000523:psychology*; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013001:Somatoform Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires