title: Chronic musculoskeletal pain rarely presents in a single body site: results from a UK population study.
abstract: OBJECTIVE
  To investigate the frequency and health impact of chronic multi-site musculoskeletal pain, in a representative UK sample.
  
  
  METHODS
  Population postal questionnaire survey, using 16 general practices in the southeast of England, nationally representative urban/rural, ethnic and socioeconomic mix. A random selection of 4049 registered patients, aged 18 or over, were sent a questionnaire. The main outcome measures were chronic pain location, identified using a pain drawing; distress, pain intensity and disability as measured by the GHQ12 and the Chronic Pain Grade.
  
  
  RESULTS
  A total of 2445 patients (60%) responded to the survey (44% male, mean age 52 yrs); 45% had chronic musculoskeletal pain. Of those with chronic pain, three quarters had pain in multiple sites (two or more sites). Variables significantly predicting this were: age under 55, [odds ratio (OR) 0.5, 95% confidence interval (CI) 0.4, 0.6]; psychological distress (OR 1.8, CI at 95% 1.4, 2.2) and high pain intensity (OR 5.2, CI at 95% 4.1, 6.7). Only 33% of multi-site pain distributions conformed to the American College of Rheumatology definition of chronic widespread pain.
  
  
  CONCLUSIONS
  Multi-site chronic pain is more common than single-site chronic pain and is commonly associated with other problems. Indiscriminate targeting of research and care for chronic musculoskeletal pain on single sites may often be inappropriate.
authors.affiliation: Centre for Health Sciences, Barts and The London, Queen Mary School of Medicine and Dentistry, 2 Newark St, London, E1 2AT, UK. d.carnes@qmul.ac.uk
authors.forename: D
authors.initials: D
authors.lastname: Carnes
authors.forename: S
authors.initials: S
authors.lastname: Parsons
authors.forename: D
authors.initials: D
authors.lastname: Ashby
authors.forename: A
authors.initials: A
authors.lastname: Breen
authors.forename: N E
authors.initials: NE
authors.lastname: Foster
authors.forename: T
authors.initials: T
authors.lastname: Pincus
authors.forename: S
authors.initials: S
authors.lastname: Vogel
authors.forename: M
authors.initials: M
authors.lastname: Underwood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000209:etiology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D006113:United Kingdom