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Pain. 2016 May;157(5):1028-36. doi: 10.1097/j.pain.0000000000000477.

Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries.

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aFederal University of Paraná, Curitiba-PR, Brazil bMedical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom cArthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, United Kingdom dSchool of Nursing, University of São Paulo, São Paulo, Brazil eCorporación para el Desarrollo de la Producción y el Medio Ambiente Laboral-IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador fDepartment of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia gSouthwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA hCenter for Disease Control and Prevention/National Institute for Occupational Safety and Health, Atlanta, GA, USA iMedical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, United Kingdom jCenter for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain kCIBER of Epidemiology and Public Health, Barcelona, Spain lIMIM (Hospital del Mar Research Institute), Barcelona, Spain mEpidemiology and Preventive Medicine Research Center, University of Insubria, Varese, Italy nDepartment of Social Medicine, Medical School, University of Crete, Heraklion, Greece oInstitute of Technology, Estonian University of Life Sciences, Tartu, Estonia pDepartment of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon qDepartment of Occupational Health, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran rDepartment of Community Health Sciences, Aga Khan University, Karachi, Pakistan sDepartment of Medical Education and Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gango


To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

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