Shoulder-Neck Pain and Total Body Pain

Work-related musculoskeletal pain is a huge expense, and recently OSHA has taken some steps in making the workplace easier for workers. This study examined one aspect of worker pain by evaluating the relationship between shoulder-neck (SN) pain and total body pain (TBP). The authors also wanted to evaluate the effect of nonspecific pain on a patient's report of mental distress and self-experienced health. The study looked at 8,116 people in the general population. The authors organized their data according to work status (employed or retired) and age to see if total body pain was related to working status as well.

The analysis was performed mainly through questionnaires. Body aching was assessed by the Standardized Nordic Questionnaire (SNQ), in which 4 regions of the body were illustrated on a body map. The General Health Questionnaire assessed mental health, and a seven-point scale was used to measure self-reported health.

72% of those reporting shoulder-neck pain had more than one painful body area. Total body pain scores were higher as shoulder/neck pain scores increased, and self-experienced health scores were significantly affected. Yet men and women scored quite differently in the remainder of the findings:

• Women had higher TBP scores than men, but the scores decreased in the 60 year old age group—their condition improved when out of work.
• The relationship between TBP and SN pain was more pronounced in the female group than the male group.
• Men who were not working had the lowest reported health scores in relation to their pain status.
• Women showed higher mental stress and distress in relation to their degree of shoulder-neck pain.
• Emotional distress was found in 30.9% of women and 23.3% in men.
• 42.3% of employed women had SN pain, and 55.7% had widespread pain.

 These findings show that the amount of pain experienced in the shoulder/neck area is dependent on the total burden of body pain. "The findings suggest that a majority of a middle aged general population could be sensitized to develop pain when subjected to repeated musculoskeletal strain in a particular part of the body, e.g. work situations demanding repetitive shoulder movements." They also mention that mental stress is often overlooked with chronic musculoskeletal pain patients. The authors make the following recommendations for handling these cases:

"Our results emphasize the need for assessment of the number of pain locations as well as the primary pain location when investigating possible causal relationship between repetitive low force musculoskeletal load and the development of localized pain...In the treatment and rehabilitation of patients reporting chronic musculoskeletal pain, a multidisciplinary approach focusing also on mental distress, is important already before work capacity is lost."

Ektor-Andersen J, Isacsson S, Lindgren A, et al. The experience of pain from the shoulder neck area related to the total body pain, self experienced health and mental distress. Pain 1999;82:289-295.