Psychological distress and musculoskeletal pain : results of a population-based prospective study

Background. The prevalence of musculoskeletal pain in the general population is alarming. Studies on musculoskeletal pain in clinical settings and in the community show that there exists a relationship between widespread musculoskeletal pain and psychological symptoms. Objective. The present study was designed to examine the hypothesis that psychological distress precedes the development of widespread musculoskeletal pain. Methods. In late autumn 1990 all inhabitants of the municipality of Ullensaker, Norway, belonging to six birth cohorts (20-22 years, 30-32 years, 40-42 years, 50-52 years, 60-62 years and 70-72 years) were sent a questionnaire from which data on musculoskeletal pain and psychological distress were collected. Demographic characteristics were also gathered in the questionnaire. Of 1144 responders who were free of musculoskeletal pain in 1990, 702 persons returned a second questionnaire with complete data four years later (1994). Results. Twenty-one (3.0%) of the responders at the follow-up, two thirds of which were females, reported to have widespread musculoskeletal pain. At the 95% confidence intervals, a multivariate 10 analysis showed that psychological distress was associated with the development of widespread musculoskeletal pain four years later even after adjustment for gender, age and some demographic and work characteristics. Conclusion. Persons who are free from musculoskeletal pain, are nevertheless at constant increased future risk of its development if they experience psychological distress. Findings from this population-based prospective study supported previous findings of a relationship between musculoskeletal pain and psychological distress and provided evidence that psychological distress precedes widespread musculoskeletal pain. 11 Readers column in Drammens Tidende og Buskeruds Blad, April 29, 2002 ...very few of us were getting an accurate diagnosis of our chronic pain condition... Doctors also have to learn that many of our additional pains influence our quality of life... Nobody needs to suffer from chronic pain without getting an appropriate help and relief. The help is there, but the will and knowledge about the complexity of pain are lacking. Since not everything can be weighed and measured, mutual cooperation is important. Everybody has the right to a good quality of life, and the doctors are not there to judge the reliability of what the patients are saying. When it is about pain, you have to trust what the patients are telling you. There is no other way! [Original text is in Norwegian] One of many patients in Drammen 1.1 Theoretical background Pain is a complex concept, and an accurate definition of this phenomenon should be able to encompass all variations of this concept from the point of view of all the relevant disciplines, e.g. medicine, psychology, sociology, philosophy and anthropology. Unfortunately, such a precise definition does not exist. Furthermore, not only is the phenomenon complex, but the mechanisms underlying pain are also complex, and the more they are investigated, the more complex they appear (1). The most accurate definition for pain to date is that given by the International Association for the Study of Pain (IASP) Committee for Taxonomy, which describes pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage