1 3 Int Arch Occup Environ Health DOI 10.1007/s00420-014-0957-2 ORIGINAL ARTICLE Does the association between musculoskeletal pain and sickness absence due to musculoskeletal diagnoses depend on biomechanical working conditions? Subas Neupane · Päivi Leino-Arjas · Clas-Håkan Nygård · Helena Miranda · Anna Siukola · Pekka Virtanen Received: 4 December 2013 / Accepted: 23 June 2014 © Springer-Verlag Berlin Heidelberg 2014 Results Multi-site pain occurred among 59 % in the total cohort and predicted sickness absence with a rate ratio of 1.48 [95 % confidence interval (CI) 1.21–1.80], adjusted for age, gender, biomechanical and psychosocial working conditions, body mass index and physical exercise. Similar associations were seen in the sub-cohorts with a low occur- rence of repetitive movements (RR 2.18, CI 1.69–2.80) and awkward postures (RR 1.78, CI 1.39–2.28), but not in the sub-cohorts with a high occurrence of these exposure. Sin- gle-site pain was not predictive of sickness absence. Conclusions A very high level of sickness absence in bio- mechanically strenuous work was found. Multi-site pain predicted sickness absence due to MSD among the employ- ees with low exposure, but not among those with high exposure. Keywords Multi-site pain · Food industry · Musculoskeletal diagnosis · Sickness absence · Physical working conditions Introduction Musculoskeletal disorders are a major public health prob- lem worldwide (Murray et al. 2012), causing significant suffering and healthcare needs for individuals as well as costs to the society. Among working populations, muscu- loskeletal disorders are the most common reason for work- related consultations in general practice (Weevers et al. 2005; Taimela et al. 2007) and the spells due to musculo- skeletal diagnoses account for a total of 35 % of long-term absence periods in Finland (Finnish Center for pensions [Eläketurvakeskus] 2013). Regarding the nature of musculoskeletal disorders, the leading symptom is pain, and often widespread pain. Either Abstract Aim To investigate single-site and multi-site musculo- skeletal pain as predictors of future sickness absence due to musculoskeletal disorders (MSD) among blue-collar employees in food industry, and to study to what extent this relationship depends on physical loading at work. Methods Survey responses of 901 employees on work- ing conditions and musculoskeletal pain during the past week were linked to their future sickness absence records obtained from the personnel register of a food industry company. Negative binomial regression models were com- puted to determine associations of pain in one and in multi- site with the number of sickness absence days due to MSD during a four-year follow-up. Analyses were made in the whole cohort and stratified by the occurrence of repetitive movements and awkward postures (low/high). S. Neupane (*) · P. Leino-Arjas · C.-H. Nygård · H. Miranda · A. Siukola · P. Virtanen School of Health Sciences, University of Tampere, 33014 Tampere, Finland e-mail: subas.neupane@uta.fi S. Neupane · C.-H. Nygård · A. Siukola Gerontology Research Center, University of Tampere, 33014 Tampere, Finland P. Leino-Arjas Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland C.-H. Nygård · P. Virtanen Institute for Advanced Social Research, University of Tampere, Tampere, Finland H. Miranda Occupational Health Centre, Helsinki City, Helsinki, Finland