Distribution and prevalence of musculoskeletal pain co-occurring with persistent low back pain: a systematic review

Cecilie K. Øverås*, Melker S. Johansson, Tarcisio F. de Campos, Manuela L. Ferreira, Bård Natvig, Paul J. Mork, Jan Hartvigsen

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    24 Citations (Scopus)
    29 Downloads (Pure)


    Background: Co-occurring musculoskeletal pain is common among people with persistent low back pain (LBP) and associated with more negative consequences than LBP alone. The distribution and prevalence of musculoskeletal pain co-occurring with persistent LBP has not been systematically described, which hence was the aim of this review. Methods: Literature searches were performed in MEDLINE, Embase, CINAHL and Scopus. We considered observational studies from clinical settings or based on cohorts of the general or working populations involving adults 18 years or older with persistent LBP (≥4 wks) and co-occurring musculoskeletal pain for eligibility. Study selection, data extraction and risk of bias assessment were carried out by independent reviewers. Results are presented according to study population, distribution and location(s) of co-occurring pain. Results: Nineteen studies out of 5744 unique records met the inclusion criteria. Studies were from high-income countries in Europe, USA and Japan. A total of 34,492 people with persistent LBP were included in our evidence synthesis. Methods for assessing and categorizing co-occurring pain varied considerably between studies, but based on the available data from observational studies, we identified three main categories of co-occurring pain – these were axial pain (18 to 58%), extremity pain (6 to 50%), and multi-site musculoskeletal pain (10 to 89%). Persistent LBP with co-occurring pain was reported more often by females than males, and co-occurring pain was reported more often in patients with more disability. Conclusions: People with persistent LBP often report co-occurring neck pain, extremity pain or multi-site pain. Assessment of co-occurring pain alongside persistent LBP vary considerable between studies and there is a need for harmonisation of measurement methods to advance our understanding of how pain in different body regions occur alongside persistent LBP. Systematic review registration: PROSPERO CRD42017068807.

    Original languageEnglish
    Article number91
    Pages (from-to)1-14
    Number of pages14
    JournalBMC Musculoskeletal Disorders
    Issue number1
    Publication statusPublished - 18 Jan 2021

    Bibliographical note

    Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • Comorbidity
    • Low back pain
    • Musculoskeletal pain
    • Prevalence
    • Systematic review


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