CHRONIC MUSCULOSKELETAL PAIN. Population studies of pain-experience with special focus on the Total Body Pain and aspects of adaptation in a cognitive-behavior psychological frame of reference

Musculoskeletal pain-related vocational dysfunction is a major public health problem. The solution is beyond the scope of biomedicine, but the problem could well be analyzed in the complementary, cognitive-behavior psychological frame of reference. In order to better prevent the development of pain-related dysfunction: The sociodemographic milieu of dysfunctional chronic pain patients was examined. The concept of pain, assessed by the Standardized Nordic Questionnaire (SNQ), was validated and the concept of Total Body Pain (TBP) de-fined and its epidemiology studied. In a prospective design, short- and long-term sick leave as resulting from me-chanical exposure, psychosocial- workplace and spare time factors and subject’s pain load was studied. Adaptive and maladaptive behavioral coping strategies, tapped by the newly translated Swedish version of the Chronic Pain Coping Inventory (CPCI), were reported, studying two populations, comparable in terms of Pain Load but work-ing full-time and long-term sick listed respectively. It was concluded that: The concept of pain was well reflected in the SNQ. The concept of TBP equaled pain as-sessed by the SNQ considering relations to scores of Self-Rated Health (SRH) and Mental Distress. Independently of working status, SRH decreased with both increasing TBP-score and increasing pain in the Shoulder-Neck area. Women showed the same SRH levels independently of working status, whereas men scored their SRH better than women did when working full-time and worse, when they were out of full-time gainful work. The TBP should be under control in epidemiological studies of work-related musculoskeletal pain. Mechanical exposure, bad pos-tures, was the only workplace factor that independently predicted incident and recurrent short- and incident long-term sick leave. In addition, previous short-term sick leave was of importance, whereas low Self-Rated Health predicted long-term sick leave only. The overall pain load was of equal importance as other factors assessed, pre-dicting both short- and long-term sick leave and introduced no effect modification when analyzing long-term sick leave. Pain load and previous short-term sick leave confounded self-rated health considering short-tern sick leave. Assessed by the CPCI, adaptive and maladaptive coping-behavior, with high discriminative power, separated vo-cationally active subjects from subjects on long-term sick leave, with no gender difference.