title: Multisite musculoskeletal pain predicts medically certified disability retirement among Finns.
abstract: BACKGROUND
  Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement.
  
  
  METHODS
  A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression.
  
  
  RESULTS
  The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2).
  
  
  CONCLUSIONS
  The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability.
authors.affiliation: Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Haukka
authors.affiliation: Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: L
authors.initials: L
authors.lastname: Kaila-Kangas
authors.affiliation: Creating Solutions, Statistics and Health Economics Team, Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Ojajärvi
authors.affiliation: Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.|Department of Public Health, University of Helsinki, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Saastamoinen
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Holtermann
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: M B
authors.initials: MB
authors.lastname: Jørgensen
authors.affiliation: Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.|Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Karppinen
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Heliövaara
authors.affiliation: Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.|School of Health Sciences, University of Tampere, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Leino-Arjas
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000150:complications / Q000453:epidemiology*; D011446:Prospective Studies; D012179:Retirement / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016526:Workload