Chronic Musculoskeletal Pain and Risk of Mortality

Pavankumar Kamat


December 06, 2021


  • Participants with a higher number of musculoskeletal pain sites had an increased risk of all-cause mortality than those without pain.

  • At least half of these associations may be accounted for by 4 mediators (physical activity, smoking status, alcohol consumption and opioid use).

Why this matters

  • Findings suggest that supporting a healthy lifestyle behaviour (keeping adequate levels of physical activity, smoking cessation and controlling alcohol consumption) and opioid deprescription are important strategies for lowering the mortality risk associated with chronic musculoskeletal pain.

Study design

  • The population-based cohort study included 384,367 participants (age, 40-69 years) from the UK Biobank (2006-2010).

  • Primary outcome: all-cause mortality.

  • Funding: Twins Research Australia.

Key results

  • Of the 384,367 included participants, a total of 187,269 participants reported chronic musculoskeletal pain; more than half reported 1 pain site (n=112,227; 59.9%), followed by 2 (n=49,126; 26.2%), 3 (n=19,107; 10.2%) and 4 pain sites (n=6809; 3.6%).

  • The risk of all-cause mortality was higher in participants with (adjusted HR [aHR]; 95% CI):

    • neck or shoulder pain (1.07; 1.02-1.13);

    • back pain (1.17; 1.11-1.22);

    • hip pain (1.15; 1.07-1.24); and

    • knee pain (1.03; 0.99-1.08).

  • The risk of all-cause mortality was higher in participants with multiple pain sites (aHR; 95% CI):

    • 1 (1.09; 1.06-1.12);

    • 2 (1.25; 1.21-1.30);

    • 3 (1.43; 1.36-1.51); and

    • 4 (1.46; 1.35-1.57).

  • The multiple mediator analyses showed that the mediating proportions of all 4 mediators ranged from 53.4% to 122.6%: in participants with ≥2 pain sites, the effect size reduced significantly, for e.g., aHR for 2 pain sites reduced from 1.25 (95% CI, 1.21-1.30) to 1.07 (95% CI, 1.01-1.11).


  • Study did not include data on pain intensity and pain-related symptoms (e.g., numbness and itching).

Chen L, Ferreira ML, Nassar N, Preen DB, Hopper JL, Li S, Bui M, Beckenkamp PR, Shi B, Arden NK, Ferreira PH. Association of chronic musculoskeletal pain with mortality among UK adults: A population-based cohort study with mediation analysis. EClinicalMedicine. 2021;42:101202. doi: 10.1016/j.eclinm.2021.101202. PMID: 34825152 View Full Text.



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