Presentation: What Characterises Persons Who Never Report Musculoskeletal Pain? A 4-year Population-Based Cohort Study (2007)

1530 What Characterises Persons Who Never Report Musculoskeletal Pain? A 4-year Population-Based Cohort Study

Risk factors for musculoskeletal pain are well documented. However, little is known about persons who never report such symptoms. The aim of the current study was to identify factors that predict persistent musculoskeletal health.
At baseline, 6259 individuals participated in a postal survey in which they were asked: "During the past month have you had any ache or pain which has lasted for one day or longer?" Information was also collected on sleep problems (Sleep Problem Scale), psychological distress (General Health Questionnaire) and illness behaviour (Illness Attitudes Scale). These scales were divided into tertiles for analysis. The questionnaire also collected data on recent life events (List of Threatening Experiences) and common somatic symptoms (Somatic Symptom Checklist). Participants were then followed up by questionnaire at 1yr and 4yrs when information on pain was collected in the same way. Markers of persons who never reported pain were examined using Poisson regression with results expressed as risk ratios (RR) with 95% confidence intervals.
3706 and 2575 persons were followed up at 1yr and 4yrs, respectively. 2435 persons provided full data on all three occasions of whom 423 (17%) never reported musculoskeletal pain. These persons were younger (RR (25-35yrs vs >55yrs): 1.3; 95%CI: 1.02-1.8) and were more likely to be male (1.3; 1.1-1.5). Pain-free persons were characterised by a low illness behaviour score (lowest v. highest tertile 5.9; 4.1-8.5), high quality sleep (3.4; 2.7-4.5), low levels of psychological distress (2.3; 1.8-2.9), an absence of prior somatic symptoms (3.2; 1.6-6.3) and no recent adverse events (2.3; 1.6-3.5). On multivariable analysis, all of these factors remained statistically independent predictors of musculoskeletal health. In total, 46% of persons who had all five of these characteristics consistently reported being pain free, compared to only 4% of those who had none.
We have shown that in a general population sample, over a 4yr period, approximately 1 in 6 persons never report musculoskeletal pain. Further, we have demonstrated that it is possible - at a single point in time - to identify these individuals in terms of specific behavioural and psychological factors and aspects of general health. In terms of potentially modifiable factors, this study emphasises the importance of psychological health, illness attitudes and high quality sleep as important targets for future management studies to prevent chronicity in persons with musculoskeletal pain syndromes.

 G.T. Jones, None; J. McBeth, None; E.A. Jones, None; R.K. Morriss, None; C. Dickens, None; G.J. Macfarlane, None.