de Cássia Pereira Fernandes Rita, Pataro Silvana Maria Santos, de Carvalho Roberta Brasileiro, Burdorf Alex
Departamento de Medicina Preventiva e Social, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Largo do Terreiro de Jesus, s/n. Centro Histórico, 40.026-010, Salvador, Bahia, Brazil.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
BMC Public Health. 2016 Jul 22;16:628. doi: 10.1186/s12889-016-3306-4.
Several recent studies have described the presence of musculoskeletal complaints, presenting evidence that multisite musculoskeletal pain (MP) is more often present than single-site musculoskeletal pain. However, less is known about determinants of this multimorbidity, particularly, concerning the role of occupational factors and, mainly, what determines single or multisite pain. This study described the associations between pain in different body sites and investigated related factors to MP in workers from Brazil.
A total of 1070 workers (228 women and 842 men), from urban cleaning services and from shoe manufacturers, participated in this cross sectional study (response 97 %). Interviewer-administered questionnaire included sociodemographic factors, physical and psychosocial work demands, leisure-time activities and musculoskeletal pain which was presence of pain in previous seven days, considering eight body sites and MP, the sum score of all painful sites, varying 0-8. A factor analysis was performed that captured the nine variables of physical exposure into two latent factors. Associations of pain between different body sites were assessed. Cox regression analyses, presenting the prevalence ratio (PR), showed the related factors to MP.
In the previous seven days, 30 % of workers had MP. For all body sites, comorbidity ranged from 72 % to 91 %. Having pain in one body site is associated with pain in other site and the associations between proximal sites were stronger than between more distal sites. High exposure to manual material handling and awkward postures (PR = 1.5, 95 % CI 1.1-2.0), job strain (PR = 1.2, 95 % CI 1.0-1.6), and low social support (PR = 1.3, 95 % CI 1.0-1.7) and being woman (PR = 1.7, 95 % CI 1.3-2.3) were associated with MP. Risk factors for single-site pain and for subsequent musculoskeletal comorbidity were very similar, suggesting an additive effect of risk factors.
Most workers reported MP that was associated with several work-related factors. The findings support the idea that multisite pain is a continuum of single-site pain, maintained by exposure to several risk factors, rather than the result of a specific risk factor that initiates the multisite pain but not single-site pain. Workplace interventions are needed to decrease the number of pain sites, in order to improve the worker's health.
最近的几项研究描述了肌肉骨骼疾病的存在，表明多部位肌肉骨骼疼痛（MP）比单部位肌肉骨骼疼痛更为常见。然而，对于这种共病的决定因素知之甚少，特别是职业因素的作用，主要是关于决定单部位或多部位疼痛的因素。本研究描述了不同身体部位疼痛之间的关联，并调查了巴西工人中与MP相关的因素。
共有1070名来自城市清洁服务和鞋厂的工人（228名女性和842名男性）参与了这项横断面研究（应答率97%）。由访谈者实施的问卷包括社会人口学因素、身体和心理社会工作需求、休闲活动以及肌肉骨骼疼痛，即过去七天内是否存在疼痛，考虑八个身体部位和MP，所有疼痛部位的总分，范围为0至8。进行了因子分析，将九个身体暴露变量归纳为两个潜在因子。评估了不同身体部位之间疼痛的关联。Cox回归分析给出患病率比（PR），显示了与MP相关的因素。
在过去七天内，30%的工人患有MP。对于所有身体部位，共病率在72%至91%之间。一个身体部位疼痛与其他部位疼痛相关，近端部位之间的关联比远端部位之间更强。高体力劳动和不良姿势暴露（PR = 1.5，95% CI 1.1 - 2.0）、工作压力（PR = 1.2，95% CI 1.0 - 1.6）、低社会支持（PR = 1.3，95% CI 1.0 - 1.7）以及女性（PR = 1.7，95% CI 1.3 - 2.3）与MP相关。单部位疼痛和随后肌肉骨骼共病的危险因素非常相似，表明危险因素具有累加效应。
大多数工人报告患有与多种工作相关因素有关的MP。研究结果支持这样一种观点，即多部位疼痛是单部位疼痛的连续过程，由多种危险因素的暴露所维持，而不是由引发多部位疼痛而非单部位疼痛的特定危险因素导致。需要采取工作场所干预措施来减少疼痛部位的数量，以改善工人的健康状况。
