PAIN Publish Ahead of Print DOI: 10.1097/j.pain.0000000000001065 Trajectories of musculoskeletal pain from adolescence to middle-age: the role of early depressive symptoms. A 27-year follow-up of the Northern Swedish Cohort Päivi Leino-Arjas 1 , Kristiina Rajaleid 2,3 , Gashaw Mekuria 3 , Tapio Nummi4, Pekka Virtanen 5 , Anne Hammarström 6 1 Finnish Institute of Occupational Health, Helsinki, Finland 2 Stress Research Institute, Stockholm University, Sweden 3 Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden 4 School of Information Sciences, University of Tampere, Finland 5 School of Health Sciences, University of Tampere, Finland 6 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden Corresponding author: Päivi Leino-Arjas, paivi.leino-arjas@ttl.fi, Finnish Institute of Occupational Health, Research and Service Centre for Work Organizations, P.O. Box 40, FI-00251 Helsinki, Finland Competing interests: The authors declare that they have no competing interests. Depression and musculoskeletal pain are associated but long-term follow-up studies are rare. We aimed to examine the relationship of early depressive symptoms with developmental patterns of musculoskeletal pain from adolescence to middle age Adolescents ending compulsory school (age 16) in Luleå, Northern Sweden, in 1981 (n=1083) were studied and followed up in 1986, 1995 and 2008 (age 43) for musculoskeletal pain. Attrition was very low. Indicators for any and severe pain were based on pain in the neck- shoulders, low back, and the extremities. Latent class growth analyses were carried out on 563 men and 503 women. Associations of a depressive symptoms score (DSS, range 0.0-2.0) at age 16 with pain trajectory membership were assessed by logistic and ACCEPTED Copyright Ó 2017 by the International Association for the Study of Pain. Unauthorized reproduction of this article is prohibited.