title: The effect of pain on sickness absence among middle-aged municipal employees.
abstract: OBJECTIVE
  To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position.
  
  
  METHODS
  Data consisted of City of Helsinki personnel register data on sickness absence and a cross-sectional questionnaire survey which was carried out among employees of the City of Helsinki who reached the age of 40, 45, 50, 55 or 60 years during the years 2000-2002 (n = 8960, response rate 67%). Data sets were combined for those who gave permission for such linkage (78%). The main statistical method was negative binomial regression analysis.
  
  
  RESULTS
  The burden of pain on sickness absence was dependent on the duration of absence: the longer the duration, the higher the burden. Self-certified absence was equally predicted by acute and chronic pain, but medically certified absence was more clearly predicted by chronic pain. Adjustments for a range of work load factors and socio-economic position showed that pain was a relatively independent determinant of subsequent sickness absence, but in particular physical work load and socio-economic position explained a small proportion of the association. Overall, pain accounted for 13% of self-certified absence among women and 8% among men. Corresponding figures were 23% and 25% for medically certified 4-14-day sickness absence and 37% and 30% for absence of over 2 weeks.
  
  
  CONCLUSIONS
  The burden of pain on medically certified sickness absence is considerable. Prevention of pain problems is vital for reducing sickness absence rates.
authors.affiliation: University of Helsinki, Department of Public Health, PO Box 41, 00014 University of Helsinki, Helsinki, Finland. peppiina.saastamoinen@helsinki.fi
authors.forename: P
authors.initials: P
authors.lastname: Saastamoinen
authors.forename: M
authors.initials: M
authors.lastname: Laaksonen
authors.forename: E
authors.initials: E
authors.lastname: Lahelma
authors.forename: P
authors.initials: P
authors.lastname: Leino-Arjas
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000706:statistics & numerical data*; D010146:Pain / Q000453:epidemiology*; D018582:Sick Leave / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data