Global financial crisis and musculoskeletal pain: systematic review

Nascimento, Michele Gomes; Costa, Nataly Pereira; Kosminsky, Ellen; Borba, Cecília Nascimento; Kosminsky, Maurício

doi:10.5935/2595-0118.20230047-en

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REVIEW ARTICLE • BrJP 6 (2) • Apr-Jun 2023 • https://doi.org/10.5935/2595-0118.20230047-en copy

Global financial crisis and musculoskeletal pain: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

It appears that, through several different mechanisms, financial crisis impacts the prevalence of musculoskeletal pain, increasing the demand for symptom control.
Due to the global crisis, some patients may lose their financial ability to access the various treatment modalities. As a result, their symptoms may worsen or become chronic.
Public health systems must prepare for an increase in demand, due to the inability of many patients with musculoskeletal pain to remain in private care.

ABSTRACT

BACKGROUND AND OBJECTIVES:

In recent history, major catastrophes are followed by economic crisis, which are commonly succeeded by high levels of psychological stress related to financial hardships. The relationship between this financial stress (FS) and musculoskeletal pain (MP) is not elucidated. The aim of this systematic review was to critically evaluate the evidence of the relationship between these financial difficulties and MP.

METHODS:

A comprehensive search was conducted on the following databases: Medline, LILACS, Scielo and PsycINFO. Studies included were observational, among adults, measuring FS and its association with MP worsening or development, recruiting participants or data from any setting, and providing outcome data for at least one pain outcome measure.

RESULTS:

445 potentially relevant citations was identified, which included 438 unique citations, 419 of which did not meet inclusion criteria. Final search included nine studies. The most frequent pain types reported were low back pain and neck pain. Descriptions of financial stress varied. Overall, exposure to financial stress was determined according to some difficulty in relation to afford necessities. All studies, except one, found significant associations between some type of MP and FS.

CONCLUSION:

This systematic review brought the available data on the relationship between FS and MP. It is possible to state that there is reasonable evidence of FS as a strong predictor for the onset of MP. It is necessary to be aware of this issue when dealing with pain patients during the current humanitarian crisis.

Keywords:
Economy; Financial stress; Man-made disasters; Musculoskeletal pain; War

Authors, Countries	Design/ Sample(n)	Study population	FS	Pain	FS assessment	Pain assessment	Pain Outcomes
Jradi, Alanazi and Mohammad²⁰20 Jradi H, Alanazi H, Mohammad Y. Psychosocial and occupational factors associated with low back pain among nurses in Saudi Arabia. J Occup Health. 2020;62(1):e12126. Saudi Arabia	Cross-sectional (410)	Gender: M (n=43); F (n=367) Age: 20 - 30 yr (n=173) 31-40 yr (n=163) >40 yr (n=74) 79.5% of the participants stated that they had low-back pain (LBP). 31.9% had been diagnosed by a health-care professional.	Financial problems	LBP	Multiple domains questionnaire	Multiple domains questionnaire	Financial problems were associated with LBP in univariate analysis (OR = 2.08; 95%CI: 1.26-3.38). while factors that remained significantly associated with LBP in the final multivariate analyses were frequent lifting (OR = 2.04; 95%CI:1.09-3.81), work-related stress (OR = 4.22; 95%CI: 2.34-7.48), and lack of job satisfaction (OR = 1.87; 95%CI: 1.24-3.58).
Jay et al.²¹21 Jay MA, Bendayan R, Cooper R, Muthuri SG. Lifetime socioeconomic circumstances and chronic pain in later adulthood: Findings from a British birth cohort study. BMJ Open. 2019;9(3):1-10. UK	Prospective cohort (2378)	Gender: M (n=1238); F (n=1140). Pain at age 68: CWP (n=164 women); (n= 89 men); CRP (n= 400 women; n= 327 men)	Experience of financial hardship	Chronic widespread (CWP) and regional pain (CRP)	Self-reported of financial hardship	Self-reported frequency of pain	Results from multinomial logistic regression models described that the accumulation of financial hardship across adulthood was associated with an increased risk of CWP (hardship at one point reported vs no hardship RRR 1.93 [95% CI: 1.11 to 3.35]; hardship at both points RRR 3.90 [95% CI: 1.20 to 12.64]).
Hagiwara et al.²²22 Hagiwara Y, Yabe Y, Sugawara Y, Sato M, Watanabe T, Kanazawa K, Sonofuchi K, Koide M, Sekiguchi T, Tsuchiya M, Tsuji I, Itoi E. Influence of living environments and working status on low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2016;21(2):138-42. Japan	Cross-sectional (1809)	Gender: M (n= 825); F (n= 984); Age: <65 yr old (n=985) or > 65 yr old (n=824). Shoulder pain (2 yr after Earthquake) was categorized as Absence (n=1635) and Presence (n=174).	Economic hardship	Shoulder pain	Selfreported economic hardship	Selfreported nonquantified shoulder pain	There were significant differences in the risk of having shoulder pain in those with economic hardship of “hard” (OR= 1.71; 95% CI:1.08-2.7) and “very hard” (OR= 2.51, 95% CI: 1.47-4.29).
Sekiguchi, et al.¹²12 Sekiguchi T, Hagiwara Y, Sugawara Y, Tomata Y, Tanji F, Watanabe T, et al. Influence of subjective economic hardship on new onset of neck pain (so-called: katakori) in the chronic phase of the Great East Japan Earthquake: a prospective cohort study. J Orthop Sci. 2018;23(5):758-64. Japan	Cohort (1.359)	Gender: M (n=650); F (n=709). The mean age: 63.7 yr (SD: 16.3). Participants with new-onset of neck pain (n=175)	Financial difficulty self-perception	Neck pain	Self-reported household economic condition	Self-reported new one-set of neck pain	A significantly higher rate of new-onset neck pain was observed in participants who considered their subjective economic hardship to be “hard” (OR= 2.10, 95% CI: 1.34-3.30) or “very hard” (OR= 3.26, 95% CI: 1.83-5.46; p<0.001) compared with those who considered their hardship to be “normal.”
Yabe et al.⁸8 Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Sato M, Kanazawa K, Koide M, Itaya N, Tsuchiya M, Tsuji I, Itoi E. Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2017;22(1):43-9. Japan	Longitudinal panel study (1292)	Gender: M (n=584); F (n=708) Age: <65 yr old (n=627); > 65 yr old (n=665). Low back pain at 3 years after the earthquake: Absence (n=1094). Presence (n=198)	Subjective economic hardship	LBP	Self-reported household current economic situation	Self-reported LBP	There was significant association between new onset of low back pain and “Very hard” (OR=3.19, 95% CI: 1.84-5.53) in subjective economic hardship.
Hagiwara et al.¹³13 Hagiwara Y, Sekiguchi T, Yabe Y, Sugawara Y, Watanabe T, Kanazawa K, Koide M, Itaya N, Tsuchiya M, Tsuji I, Itoi E. Living status, economic hardship and sleep disturbance were associated with subjective shoulder pain in survivors of the Great East Japan Earthquake: a cross sectional study. J Orthop Sci. 2017;22(3):442-6 Japan	Cross-sectional (986)	Gender: M (n= 431); F (n=555). Age: >65 yr (n= 456) <65 yr (n=530). Low back pain: Absence to Absence (n=653); Presence to Presence (n=117); Presence to Absence (n= 112); and Absence to Presence (n=104).	Decrease in income	LBP	Selfreported decreased income	Selfreported nonquantified LBP	There was significant difference between low back pain and “decrease in income” (OR= 1.93, 95% CI: 1.23-3.03). In the subgroup analyses, there was significant difference between low back pain and “decrease in income” for under 65 years old (OR= 1.84, 95% CI: 1.03-3.29)
Generaal et al.²³23 Generaal E, Vogelzangs N, Macfarlane GJ, Geenen R, Smit JH, de Geus EJ, Penninx BW, Dekker J. Biological stress systems, adverse life events and the onset of chronic multisite musculoskeletal pain: a 6-year cohort study. Ann Rheum Dis. 2016;75(5):847-54. Netherlands	Retrospective cohort	2039 subjects 18-65 yr Gender: F 62.6% free of chronic MP; follow-up assessments 2 years, 4 years and 6 years later	Serious financial problems	Chronic multisite MP	List of Threatening Events Questionnaire	Chronic Pain Grade	Nearly each life event showed a positive association with chronic pain onset, which were significant for financial problems (5.8%; HR (95% CI) 1.54(1.05 to 2.25); p=0.03), independently of biological stress systems function, sociodemographics, lifestyle, chronic diseases, depression, and anxiety.
Rios et al.²⁴24 Rios R, Zautra AJ. Socioeconomic disparities in pain: the role of economic hardship and daily financial worry. Heal Psychol. 2011;30(1):58-66. USA	Prospective cross-sectional (249)	Gender: F (n=249) Age: 37 - 72 yr (M=57.3; SD=8.4) Pain: Osteoarthritis (N=105), fibromyalgia (N=46) or both (N=99).	Ability to afford basic needs	MP pain intensity	Economic hardship scale	Numeric rating scale	The interaction between daily financial worry and economic hardship on pain was significant even after controlling for the influence of level 2 control variables (economic hardship, age, neuroticism, diagnostic group, and working status) (β = .47, SE .23, p .04).
Ochsmann et al.⁶6 Ochsmann EB, Rueger H, Letzel S, Drexler H, Muenster E. Over-indebtedness and its association with the prevalence of back pain. BMC Public Health. 2009;9:451. Germany	Cross-sectional (949)	Gender: M (n=446); F (n=499) Age: 18-79 yr. 80.8% actual back pain A representative sample of the German general population (n = 8318) was used as non-indebted reference group.	Over-indebtedness	LBP	Counselling agencies questions on over-indebtedness	Self-reported low back pain	Being over indebted was identified as an independent effect modifier and was associated with higher odds of suffering from low back pain (aOR:10.92, 95% CI: 8.96 - 13.46).

Criteria	Jradi et al.²⁰20 Jradi H, Alanazi H, Mohammad Y. Psychosocial and occupational factors associated with low back pain among nurses in Saudi Arabia. J Occup Health. 2020;62(1):e12126.	Jay et al.²¹21 Jay MA, Bendayan R, Cooper R, Muthuri SG. Lifetime socioeconomic circumstances and chronic pain in later adulthood: Findings from a British birth cohort study. BMJ Open. 2019;9(3):1-10.	Hagiwara et al.²²22 Hagiwara Y, Yabe Y, Sugawara Y, Sato M, Watanabe T, Kanazawa K, Sonofuchi K, Koide M, Sekiguchi T, Tsuchiya M, Tsuji I, Itoi E. Influence of living environments and working status on low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2016;21(2):138-42.	Sekiguchi et al.¹²12 Sekiguchi T, Hagiwara Y, Sugawara Y, Tomata Y, Tanji F, Watanabe T, et al. Influence of subjective economic hardship on new onset of neck pain (so-called: katakori) in the chronic phase of the Great East Japan Earthquake: a prospective cohort study. J Orthop Sci. 2018;23(5):758-64.	Yabe et al.⁸8 Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Sato M, Kanazawa K, Koide M, Itaya N, Tsuchiya M, Tsuji I, Itoi E. Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2017;22(1):43-9.	Hagiwara et al.¹³13 Hagiwara Y, Sekiguchi T, Yabe Y, Sugawara Y, Watanabe T, Kanazawa K, Koide M, Itaya N, Tsuchiya M, Tsuji I, Itoi E. Living status, economic hardship and sleep disturbance were associated with subjective shoulder pain in survivors of the Great East Japan Earthquake: a cross sectional study. J Orthop Sci. 2017;22(3):442-6	Generaal et al.²³23 Generaal E, Vogelzangs N, Macfarlane GJ, Geenen R, Smit JH, de Geus EJ, Penninx BW, Dekker J. Biological stress systems, adverse life events and the onset of chronic multisite musculoskeletal pain: a 6-year cohort study. Ann Rheum Dis. 2016;75(5):847-54.	Rios et al.²⁴24 Rios R, Zautra AJ. Socioeconomic disparities in pain: the role of economic hardship and daily financial worry. Heal Psychol. 2011;30(1):58-66.	Ochsmann et al.⁶6 Ochsmann EB, Rueger H, Letzel S, Drexler H, Muenster E. Over-indebtedness and its association with the prevalence of back pain. BMC Public Health. 2009;9:451.
1. Was the research question or objective in this paper clearly stated?	Y	Y	Y	Y	Y	Y	Y	Y	Y
2. Was the study population clearly specified and defined?	Y	Y	Y	Y	Y	N	Y	Y	Y
3. Was the participation rate of eligible persons at least 50%?	Y	N	N	N	N	N	Y	Y	N
4.Were all the subjects selected or recruited from the same or similar populations (including the same period)? Were inclusion and exclusion criteria for being in the study prespecified and applied uniformly to all participants?	N	Y	Y	Y	Y	Y	Y	NA	N
5. Was a sample size justification, power description, or variance and effect estimates provided?	N	Y	NR	NR	NR	NR	Y	Y	Y
6. For the analyses in this paper, were the exposure(s) of interest measured prior to the outcome(s) being measured?	N	Y	N	Y	Y	N	Y	NR	N
7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?	N	Y	N	Y	Y	N	Y	Y	NA
8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as continuous variable)?	Y	Y	Y	Y	Y	Y	Y	Y	Y
9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?	Y	Y	NR	Y	Y	Y	Y	Y	NR
10. Was the exposure(s) assessed more than once over time?	NR	Y	N	Y	Y	N	Y	Y	N
11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?	Y	Y	NR	Y	Y	CD	Y	Y	NR
12. Were the outcome assessors blinded to the exposure status of participants?	NR	NR	NR	NR	NR	NR	NR	NR	N
13. Was loss to follow-up after baseline 20% or less?	Y	N	N	N	N	N	Y	Y	N
14.Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?	CD	Y	Y	Y	NR	Y	Y	NR	Y
Quality rating^* * Quality Rating: Poor ≤ 30%; Fair 30% - 50%; Good ≥ 50%.	Good	Good	Fair	Good	Good	Fair	Good	Good	Fair

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[1] Conflict of interests: none