Prevalence of Self Reported Neck, Shoulder, Arm Pain and Concurrent Low Back Pain or Psychological Distress: Time-Trends in a General Population, 1990-2006
From: Spine: 2009 Aug 1;34(17): 1863-8
Nonspecific neck, shoulder, arm pain is a very common symptom in the general population. It causes suffering for individuals as well as high societal costs in form of sick leave, disability pensions, health care utilization, and loss of productivity. Reviews have reported that the 12-month prevalence of neck pain range from 14% up to 78% and that the 12-month prevalence of shoulder pain range from 5% to 47%. It is important to understand whether the magnitude of different pain conditions are changing in order to plan and provide appropriate health care as well as preventive measures. However, differences in case definitions and study methodologies are considerable, making it difficult to establish time trends for neck, shoulder and arm pain. The authors are not aware of any published studies that have attempted to investigate time trends by repeatedly following the prevalence in a given geographical area.
Neck, shoulder, arm pain is more common among females. A summary of data from epidemiological studies in the general population found a median ratio between females and males of 1.4 for neck pain and 1.3 for shoulder pain. Treaster and Burr concluded that females do have higher prevalence than males for many types of upper extremity musculoskeletal disorders, even after controlling for the type of data source self reporting, plant/worker compensation records or physical examinations and confounders such as age. The reasons behind the prevalence differences are poorly understood, and it is still unclear whether this gender gap has been constant over time, or is increasing or decreasing.
Several studies have reported that both comorbid low back pain and comorbid psychological distress are common. Both a national study and a cross national study have shown that about two-third of individuals with musculoskeletal pain reported pain in at least 2 regions. The link between symptoms in different bodily regions may involve shared pathology, common mechanical risk factors, or some aspects of psychological distress. To the authors knowledge, no studies have reported whether the prevalence of neck, shoulder, arm pain with concurrent low back pain or psychological distress has changed over time.
This article presents data on the prevalence of neck, shoulder, arm pain, neck, shoulder, arm pain with concurrent low back pain, and neck, shoulder, arm pain with concurrent psychological distress, from the Stockholm Public Health Surveys that have been carried out every 4 years since 1990.
It has been hypothesized that the prevalence of musculoskeletal pain is increasing, but the evidence has been both sparse and equivocal. In contrast to an earlier study that found a 2 to 4 fold increase of pain in 2 surveys conducted 40 years apart, the results in the present article indicated a slight rise in the prevalence of neck, shoulder, arm pain, which may indicate a similar but weaker time trend.
A possible explanation for the increased rates of neck, shoulder, arm pain could be higher exposures in working life. However, both national and regional work environment surveys indicate that, broadly speaking, physical workload has been quite stable over time. In contrast, there are indications of increased problems with psychosocial factors. At the same time, it is generally acknowledged that mental or psychosocial demands have also increased outside the workplace. Altogether, the relative importance of exposures may to some extent have shifted from strenuous physical work to monotonous sedentary work and psychosocial factors. However, the total magnitude of exposure is still quite extensive and may contribute to maintaining or even increasing the prevalence of neck, shoulder, arm pain. There has also been discussion of whether a higher prevalence of pain is because of random fluctuations in answers to such questions or because general cultural influence has affected awareness and reporting of musculoskeletal symptoms.
Musculoskeletal symptoms in several areas of the body are common. It has been shown to be positively related to outcomes such as health care utilization, impaired work role functioning, and delayed return to work. The increased prevalence of neck, shoulder, arm pain with concurrent low back pain was similar compared to solely neck, shoulder, arm pain. This finding might be explained by shared pathology for the 2 body regions as well as common mechanical and psychological risk factors for pain or disorders.
The prevalence of neck, shoulder, arm pain with concurrent psychological distress was rather low. However, the prevalence increased about 2 fold over the 16 year period, and more for males than for females. It could be argued that the increase in prevalence is only because of an increased prevalence of psychological distress. However, national data from the Swedish Work Environment Authority, obtained by yearly interviews 1998-2008, show that the trends are similar for physical disorders compared with nonphysical disorders. Psychological factors and mental health problems have been described as being intimately associated with musculoskeletal pain. Several different explanations for the association between musculoskeletal pain and mental health have been proposed: first, that mental health problems either may cause pain or are expressed as pain; second, pain causes mental health problems; and third, psychiatric disorders such as depression may share common pathogenic mechanisms with pain. On the other hand, it is rather clear that the experience of pain interacts with psychological factors that influence emotion and behavior, and this in turn shapes the course of pain development. Consequently, the results in the present study are quite worrying.
At the beginning of the 2000s, mental health problems passed musculoskeletal disorders as the most common cause of sickness absence in the County of Stockholm, and in 2006 mental health problems became for the first time the most common cause of early retirement in Sweden. The media attention paid to this development may have contributed to an increased awareness (and acceptance?) of these conditions in the general population, and in turn influenced the willingness to report symptoms of psychological distress.
Finally, the results show that females have a higher prevalence of neck, shoulder, arm pain than males, which is in concordance with previous studies. Generally, the observed increases in prevalence of neck, shoulder, arm pain as well as concurrent conditions were similar among females and males. The gender gap did not seem to have changed over time.
