Disabling musculoskeletal pain in working populations: is it the job the person or the culture?

OBJECTIVES: To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences.METHODS: Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers) in 18 countries. Associations with risk factors were assessed by Poisson regression.RESULTS: The one-month prevalence of DLBP in nurses varied between countries from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the two anatomical sites co-varied (r = 0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, up to eightfold differences in prevalence remained. Systems of compensation for work-related illness, and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms.CONCLUSIONS: There is large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks. This is only partially explained by the personal and socio-economic risk factors that were analysed.