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Epidemiology of chronic musculoskeletal pain

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Chronic widespread pain (CWP) due to musculoskeletal conditions is a major social burden. The case definition of CWP relies on pain, chronicity (more than 3 months’ duration) and widespread distribution (both sides of the body including the axial skeleton). Health Interview Survey (HIS) and Health Examination Survey (HES) have been used to assess the frequency of CWP in the general population. Unfortunately, both techniques are poorly standardised, which hampers comparison of data pertaining to different populations and countries. A major effort in the European Union (EU) is the development of common strategies to investigate musculoskeletal pain through HIS. Issues to be addressed include: (1) loss of daily life functions due to pain; (2) pain duration and rhythm; (3) affected sites; and (4) type of pain. We know that musculoskeletal pain affects between 13.5% and 47% of the general population, with CWP prevalence varying between 11.4% and 24%. Risk factors for musculoskeletal pain include age, gender, smoking, low education, low physical activity, poor social interaction, low family income, depression, anxiety and sleep disorders, as well as performing manual work, being a recent immigrant, non-Caucasian and widowed, separated or divorced.

Section snippets

Epidemiological definition of chronic widespread pain

Musculoskeletal conditions usually present with pain and loss of function. The patient complains of chronic musculoskeletal pain, which could be due to a number of different illnesses. The real frequency of the original musculoskeletal conditions, as a result, is difficult to assess because it is marred by case-definition uncertainties and differences in the methods adopted in the epidemiological studies [1]. Pain, an important symptom of joint diseases, is also an index of severity and

What to measure?

The goal of descriptive epidemiology is the measure of occurrence of a given disease. In our case, the number of patients affected by musculoskeletal conditions, both in terms of percentage of the general population (prevalence) and of new cases of the disease developing in a given time frame (incidence), is investigated. By convention, the usual time interval for expressing incidence is 1 year and the source population is considered to be 100,000 subjects. However, according to the disease and

Which methods to investigate pain?

To collect data from a population, two main methods are used: Health Interview Survey (HIS) and Health Examination Survey (HES) [7]. HIS is based on face-to-face, phone or postal questionnaires focussed on the main aspects of pain and of the underlying diseases. In a slightly more sophisticated procedure, subjects identified by their answers to the questionnaire as possible patients are subsequently invited to attend the clinic for a complete evaluation. The HES is based on the direct

Which questions?

Diseases associated with pain have a number of characteristics that can be investigated through questionnaires (Table 3). However, none of the questionnaires described in the previous paragraph has been specifically designed to assess musculoskeletal conditions. As a result, the information available for the rheumatologist is scarce. Designing a musculoskeletal conditions-oriented questionnaire could improve the knowledge of these conditions, but which questions should be included?

A first issue

Summary of results of population studies on musculoskeletal pain

Musculoskeletal pain is common to most people at some time of their life. A summary of articles reporting musculoskeletal pain in different geographical areas is described in Table 5. The methods used to ascertain the prevalence of pain are extremely different. Only in few cases was CWP investigated. In the remaining studies, pain located in different areas of the body was studied. In addition, the denominator population at risk could differ as could age range considered and the interview

Risk factors for musculoskeletal pain

Several socio-demographic factors have been associated with CWP in the literature. Knowing these risk factors could be important to understand the mechanisms at play in the associated conditions and to improve chronic pain through preventive measures. Women in most studies complain more often of CWP than men, and this is directly related with age [31], *[32], [33], [34], [35]. The prevalence of musculoskeletal pain increases up to nearly 65 years of age [19], [36], [37], an observation that has

Conclusion

Chronic widespread pain (CWP) is a significant medical and socioeconomic problem in the society. It causes suffering, drug consumption and high frequency of sick leave and disability pensions. To better understand the role of individual risk factors, social and cultural influences and the effect on the health systems, international epidemiological comparative studies are needed. A major effort in the EU will be the development of common strategies to investigate musculoskeletal pain through

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