title: The epidemiology of regional and widespread musculoskeletal pain in rural versus urban settings in those ≥55 years.
abstract: OBJECTIVE
  To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess.
  
  
  METHODS
  Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi(2) test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios.
  
  
  RESULTS
  There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with the reporting of CWP included poor general health, feeling downhearted most of the time and selected measures of social contact. Factors independently associated with CWP included female gender (risk ratio: 1.24; 95% confidence interval (CI): 0.997-1.55), poor self-rated health (risk ratio: 3.50; 95% CI: 1.92-6.39) and low mood (risk ratio: 1.54; 95% CI: 1.07-2.20). Also, having fewer than 10 people to turn to in a crisis was associated with a decrease in the risk of CWP - risk ratio: 0.68 (95% CI: 0.50-0.93) and 0.78 (95% CI: 0.60-1.02) for those with 5-10 and <5 people, respectively.
  
  
  CONCLUSIONS
  This study provides no evidence that the prevalence of regional musculoskeletal pain is increased in rural settings, although there is some evidence of a modest increase in CWP. Risk factors for CWP are similar to those seen in the urban setting, including markers of general health, mental health and also aspects of social contact. It may be, however, that social networks are more difficult to maintain in rural settings, and clinicians should be aware of the negative effect of perceived social isolation on pain in rural areas.
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK ; Faculty of Education and Health, University of Greenwich,London, UK.
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Docking
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Beasley
authors.affiliation: Rural Society Research Team, Scotland's Rural College, Edinburgh, UK.
authors.forename: Artur
authors.initials: A
authors.lastname: Steinerowski
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jones
authors.affiliation: La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Farmer
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.affiliation: Musculoskeletal Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK.
authors.forename: Gareth T
authors.initials: GT
authors.lastname: Jones
keywords: Pain; chronic widespread pain; epidemiology; rural; statistics and numerical data; urban