title: Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study.
abstract: BACKGROUND
  Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders.
  
  
  METHODS
  3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location and intensity of experienced musculoskeletal pain in seven different body regions in February 2008. Outcome was duration of sickness absence based on register data divided into long-term (>52 weeks during follow-up) and sickness absence of shorter duration (12-52 weeks during follow-up) over a period of 4 years. Data on pain-intensity were analyzed at three different cut-off levels for each body region: i) > 1 (any pain), ii) > 2 (bothersome pain), iii) > 3 (very bothersome pain). Analyses were stratified and compared between participants without GP contact and participants with GP contact due to musculoskeletal disorders.
  
  
  RESULTS
  Musculoskeletal pain in more than two body regions was strongly associated with long-term sickness absence in an exposure-response pattern. Different cut-off levels of pain intensity and adjustment for age, sex, educational level and work environmental factors did not alter the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall alter the odds of later sickness absence.
  
  
  CONCLUSIONS
  Pain intensity and care-seeking due to musculoskeletal disorders did not seem to influence the association between the number of pain sites and later sickness absence. The number of musculoskeletal pain sites seems to be a strong risk factor for later sickness absence.
authors.affiliation: Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark. sorm@via.dk.|VIA Faculty of Health Sciences, Physiotherapist College, Gl. Struervej 1, DK-7500, Holstebro, Denmark. sorm@via.dk.
authors.forename: Søren
authors.initials: S
authors.lastname: Mose
authors.affiliation: Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark.
authors.forename: David Høyrup
authors.initials: DH
authors.lastname: Christiansen
authors.affiliation: Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark.
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Jensen
authors.affiliation: Danish Ramazzini Center, Department of Occupational Medicine, Regional Hospital Herning, Gl. Landevej 61, DK-7400, Herning, Denmark.
authors.forename: Johan Hviid
authors.initials: JH
authors.lastname: Andersen
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods / Q000639:trends; D010342:Patient Acceptance of Health Care; D011159:Population Surveillance; D012307:Risk Factors; D018582:Sick Leave / Q000639:trends; D055815:Young Adult
keywords: Care-seeking; Cohort study; Musculoskeletal pain; Pain intensity; Sickness absence; Widespread pain