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J Rheumatol. 2009 May;36(5):1071-7. doi: 10.3899/jrheum.080541. Epub 2009 Apr 15.

What characterizes persons who do not report musculoskeletal pain? Results from a 4-year Population-based longitudinal study (the Epifund study).

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  • 1Section of Population Health, Aberdeen Pain Research Collaboration, School of Medicine and Dentistry, University of Aberdeen, Aberdeen.



To identify and characterize persons in the population who do not report musculoskeletal pain.


This was a population-based 4-year prospective longitudinal study by postal questionnaire. Population sample recruited from general practice registers in North-West England followed up at 15 months and 4 years.


Of respondents, 17.4% [95% confidence interval (CI) 16.1%-19.7%] reported no pain in the previous month at all 3 measurement intervals over 4 years. They were characterized by low levels of psychological distress [relative risk (RR) low vs high levels of psychological distress 2.3; 95% CI 1.7-2.9], low levels of depression (2.7; 95% CI 2.0-3.6), low levels of anxiety (2.1; 95% CI 1.6-2.7), low health anxiety (1.6; 95% CI 1.2-2.1), and low illness behavior scores (5.8; 95% CI 4.0-8.3), good quality sleep (3.4; 95% CI 2.6-4.4), no somatic symptoms (RR 0 vs 3 or more, 3.1; 95% CI 1.6-6.3) and no adverse life events in the 6 months prior to baseline data collection (RR 0 vs 3 or more, 3.2; 95% CI 1.6-6.2). On multivariable analysis, good quality sleep, low illness behavior, low psychological distress, and absence of recent adverse life events remained statistically independent predictors of musculoskeletal health. In total, 46% of persons who had all 4 of these characteristics consistently reported being free of pain, compared to only 5% of those who had none.


In a general population sample, over a period of 4 years, only around 1 in 6 persons do not report musculoskeletal pain. These persons report low levels of psychological distress and high quality sleep, both of which are potentially modifiable risk factors for the targeting of interventional or preventive strategies.

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