Content » Vol 45, Issue 10

Original report

Main and combined effects of musculoskeletal pain frequency and avoidant coping on sickness absence: Findings from a prospective cohort study

Ulla Christensen, Lone Schmidt, Charlotte Ørsted Hougaard, Karsten Thielen, Else Nygaard, Rikke Lund
Department of Social Medicine, University of Copenhagen, Institute of Public Health, Copenhagen, Denmark. E-mail:
DOI: 10.2340/16501977-1212


Objective: Musculoskeletal pain and avoidant coping predicts sickness absence, but how these 2 predictors relate to each other is unknown. We examined the main and combined effects of musculoskeletal pain and avoidant, behavioural coping on incidence of sickness absence.
Design and subjects: Prospective cohort study of a sample of middle-aged Danes, economically active in 2006, reporting functional limitations due to musculoskeletal pain, n = 3115.
Methods: Data included surveys from 2000 and 2006 and register data from 2007. Outcome was sickness absence exceeding 2 consecutive weeks in 2007. The main effect of self-reported pain frequency and avoidant coping on sickness absence was analysed by multivariate logistic regression. The combined effect was calculated as departure from multiplicativity and by the inclusion of a product term.
Results: Daily pain and use of avoidant coping were both associated with sickness absence in multiple adjusted analyses, odds ratio (OR)daily pain = 1.83 (95% confidence interval (CI) 1.51–2.21) and ORavoidant coping = 1.52 (95% CI 1.24–1.88) (main effects). A modest combined effect of musculoskeletal pain and avoidant coping on sickness absence was suggested (p = 0.286).
Conclusion: Avoidant coping and daily pain are both associated with sickness absence, but showed no strong signs of interactive effects. Clinicians should be aware of both factors.

Lay Abstract


Do you want to comment on this paper? The comments will show up here and if appropriate the comments will also separately be forwarded to the authors. You need to login/create an account to comment on articles. Click here to login/create an account.