MUSCULOSKELETAL MATTERS
Bulletin 11
A NEW LOOK AT PAIN
‘HOW MANY PAINS HAVE YOU GOT?’:
A MORE IMPORTANT QUESTION THAN ‘WHERE IS THE PAIN?’
Musculoskeletal pain which occurs concurrently in
multiple body sites is the most common form of
long-term or chronic pain in adults aged 50+ years.
Despite this, the clinical presentation, assessment
and treatment of pain has tended to focus on single-
site pain.
We studied multi-site pain among people in the
general population, and in people consulting
general practice.
Patterns of self-reported multi-site
pain in the general population
We mailed a survey to a sample of the general
population aged 50+ years in
North Staffordshire, UK
Results
There were four clusters determined more by the
number of pain sites (low, medium, high), than
where the pains were located.
12
Average number of pain sites in the four clusters
10.1
8
3.6
4
0.2
0
None/Low
Medium (no
back pain
present)
Medium
(back pain
present)
High
Proportion of 12,408 participants in each pain cluster
None/low number of pain sites
14%
People were
asked if, in the
past 4 weeks,
they had had
pain, regardless
of whether they
had seen a doctor
about it, and to
shade all such
pain sites on an
outline drawing of
the body
4.8
37%
18%
31%
Medium number of pain sites
(no back pain present)
Medium number of pain sites
(back pain present)
High number of pain sites
People in the cluster with a high number of
pain sites were more likely to have other health
problems, e.g. diabetes, raised blood pressure,
anxiety, depression, cognitive complaints, and
sleep problems.
Key messages – general population
Shading on drawings was used to identify
people’s pain in 16 sites:
Head
Neck
Chest
Abdomen
Spine
Elbow
Hand
Buttock
Knee
Thigh
Foot
Shoulder
Calf & shin
Forearm
Upper back
Lower back
Pain sites were analysed to see if they ‘clustered’
together to form common patterns
Adults aged 50+ in the general population
separate into four clusters determined by
number of pain sites
Number of pain sites is a more useful
classification of people’s pain than one based
on location alone
A classification based on these clusters could
help the treatment of musculoskeletal pain
because one of the reasons for lack of success
in treating single-site pain may be that multi-
site pain is ignored
These bulletins are designed to provide information for general practitioners, the primary care team, teachers, trainers and policy makers about musculoskeletal problems in practice.