Musculoskeletal pain intensity and risk of long-term sickness absence in the general working population: A prospective cohort study with register follow-up

• Published in: Preventive medicine 2023-09, Vol.174, p.107636, Article 107636
• Main Authors: Skovlund, Sebastian Venge, Bláfoss, Rúni, Calatayud, Joaquín, López Bueno, Rubén, Sundstrup, Emil, Andersen, Lars Louis
• Format: Article
• Language: English
• Subjects: Musculoskeletal diseases; Occupational health; Registry research; Sickness absence; Sustainable employment; Workplace
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2023.107636

Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study aimed to determine the prospective association between musculoskeletal pain intensity and risk of incident register-based long-term sickness absence in the general working population, as well as to determine the population attributable fraction. Drawing on data from a nation-wide questionnaire survey, this prospective cohort study followed a representative sample of the Danish general working population without recent long-term sickness absence (≥6 consecutive weeks) (n = 69,273) for long-term sickness absence up to two years (mean follow-up: 93 weeks) in a national register. The predictor was musculoskeletal pain intensity in the neck/shoulder and low-back during the preceding three months rated on an 11-point numerical rating scale from 0 to 10. The weighted incidence of long-term sickness-absence was 8.9% during two-year follow-up (n = 6165). We observed a clear dose-response association between musculoskeletal pain intensity of the neck/shoulder or low-back and the risk of incident long-term sickness absence, with a lower threshold of increased risk of 4 and 3 (scale 0–10) for neck/shoulder (HR (95% CI): 1.25 (1.09–1.42)) and low-back pain (HR (95% CI): 1.13 (1.00–1.29)), respectively. Prevention of pain intensities at or above 4 out of 10 could potentially prevent 17% (population attributable fraction, PAF (95% CI): 16.8 (13.6–20.1)) of the total long-term sickness absence in the general working population. Large-scale interventions to prevent and manage musculoskeletal pain need to be documented and implemented. •Musculoskeletal pain disorders are highly prevalent and may increase sickness absence.•Determining pain-related prognostic factors for sickness absence could be useful.•Musculoskeletal pain intensity increased risk of long-term sickness absence progressively.•Effective pain prevention could potentially prevent 17% of long-term sickness absence cases.•Documentation and implementation of large-scale preventive measures are needed.