Systematic Review
Musculoskeletal Health
Key Takeaways
- There is no universally agreed definition of “multisite musculoskeletal pain” — different studies use different criteria, making it difficult to compare findings across research and establish reliable prevalence estimates.
- Reported prevalence of multisite pain varies dramatically depending on the definition used — from as low as 4% to as high as 80% in working populations — because stricter definitions capture fewer people while broader definitions capture many more.
- The definition used also affects which risk factors appear significant, which has direct consequences for workplace interventions and clinical management.
- For patients, this matters because the lack of a standard definition can affect diagnosis, treatment decisions, workplace accommodations, and insurance or disability claims.
Why This Seemingly Technical Question Matters to You
If you have ever experienced pain in multiple parts of your body at the same time — perhaps your lower back and your neck, or your shoulders and your knees — you have experienced what researchers call multisite musculoskeletal pain. It is an extremely common experience, particularly among working adults, and it is a leading cause of work disability, reduced quality of life, and healthcare utilisation worldwide.
You might wonder why the definition of this condition matters. After all, pain is pain — you either have it or you don’t. But the way researchers and clinicians define multisite pain has real consequences for how the condition is understood, how common it is believed to be, what risk factors are identified, and ultimately what treatments and workplace policies are developed to address it.
This review, published in the Malaysian Journal of Public Health Medicine, examined how different definitions of multisite musculoskeletal pain used across published research affected the reported prevalence and identified risk factors — and found that the definition used mattered enormously.
The Definition Problem
When a researcher sets out to study multisite musculoskeletal pain, they must first decide what counts as “multisite.” This seemingly simple question turns out to be surprisingly complicated, and different researchers have answered it in very different ways.
| Definition Approach | Example | Effect on Prevalence |
|---|---|---|
| Number of pain sites | “Pain in 2 or more body regions” vs “pain in 4 or more body regions” | Lower threshold = higher prevalence; higher threshold = lower prevalence |
| Which body regions count | Some studies use 4 regions (neck, upper back, lower back, limbs); others use 9 or more specific sites | More regions measured = more opportunities to report pain = higher prevalence |
| Time frame | “Pain in the last 7 days” vs “pain in the last 12 months” | Longer time frames capture more people |
| Pain duration | “Any pain” vs “pain lasting more than 3 months” | Chronic pain criteria dramatically reduce prevalence |
| Spatial distribution | “Widespread pain” (e.g., ACR criteria requiring pain above and below the waist, on both sides of the body, plus axial pain) vs “any multisite pain” | Widespread pain criteria are the most restrictive |
The review found that when studies used a broad definition — such as pain in two or more body regions at any point in the past year — prevalence estimates were very high, sometimes exceeding 60 to 80% in working populations. When stricter definitions were used — such as the American College of Rheumatology criteria for widespread pain, which requires pain above and below the waist, on both sides of the body, plus axial skeletal pain, lasting at least three months — prevalence dropped to 10 to 15% or lower.
This enormous range means that when someone tells you “X% of workers have multisite pain,” the number is meaningless unless you also know how multisite pain was defined. Two studies of identical populations could report prevalences of 15% and 70% for what they both call “multisite musculoskeletal pain,” simply because they defined it differently.
Why This Affects Treatment and Policy
The definition problem is not merely academic. It has tangible consequences for clinical practice, workplace policy, and individual patients.
From a clinical perspective, if a doctor uses a broad definition of multisite pain, they may diagnose the condition in a large number of patients, some of whom have mild, transient aches that would resolve on their own. If they use a strict definition, they may miss patients with genuinely debilitating pain that does not precisely meet the criteria. Neither approach is wrong in an absolute sense, but the choice of definition shapes who receives treatment, what kind of treatment they receive, and how their condition is monitored over time.
From a workplace health perspective, the definition determines how many workers are identified as having multisite pain, which in turn affects decisions about ergonomic interventions, job modifications, and return-to-work programmes. A factory that surveys its workers using a broad definition may conclude that 60% of its workforce has musculoskeletal problems and invest heavily in ergonomic improvements. The same factory using a strict definition might find only 10% affected and decide the problem is not significant enough to justify investment.
For individual patients, the definition can affect whether their condition is taken seriously by clinicians, employers, and insurance providers. A patient with pain in three body regions lasting two months may be told they have “multisite pain” under one definition but not another — and this label (or lack thereof) can influence their access to treatment, workplace accommodations, and disability benefits.
What This Means If You Live with Pain in Multiple Areas
If you experience persistent pain in multiple parts of your body, the most important thing is not which definition you meet but whether the pain is affecting your daily life, your work, your sleep, or your mental health. Pain that interferes with function deserves assessment and management regardless of whether it precisely fits a research definition.
When seeking medical help, describe your pain as specifically as possible — where it is, how long you have had it, what makes it better or worse, and how it affects your daily activities. This information helps your healthcare provider understand your situation without being constrained by arbitrary definitional boundaries.
Be aware that musculoskeletal pain in multiple areas is often associated with other factors including poor sleep, stress, physical deconditioning, and mood disorders. A comprehensive approach that addresses these contributing factors alongside the pain itself tends to produce better outcomes than treatments targeting pain alone.
Implications for Research and Practice
The review highlights an urgent need for the research community to work toward standardised definitions of multisite musculoskeletal pain. Without standardisation, it is impossible to meaningfully compare findings across studies, track trends over time, or develop evidence-based clinical guidelines. In the meantime, researchers should clearly report the definitions they use and discuss how their choice of definition may have affected their findings. Clinicians should be aware that prevalence figures and risk factor profiles for multisite pain are highly dependent on the definition used and should interpret published research accordingly. Workplace health professionals should use consistent, clearly defined criteria when assessing musculoskeletal health in their workforce to enable meaningful comparisons over time.