Eveningness is Associated With Persistent Multisite Musculoskeletal Pain: A 15-Year Follow-up Study of Northern Finns

  • Eveliina Heikkala
    Address reprint requests to Eveliina Heikkala Research Unit of Population Health, University of Oulu, 90014 Oulu, Finland.
    Research Unit of Population Health, University of Oulu, Oulu, Finland

    Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

    Rovaniemi Health Center, Rovaniemi, Finland
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  • Ilona Merikanto
    Research Unit of Population Health, University of Oulu, Oulu, Finland

    SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland

    Orton Orthopaedics Hospital, Helsinki, Finland
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  • Christophe Tanguay-Sabourin
    Alan Edwards Pain Centre for Research on Pain, McGill University, Montreal, Quebec, Canada

    Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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  • Jaro Karppinen
    Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

    Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland

    Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
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  • Petteri Oura
    Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

    Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
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Published:December 10, 2022DOI:


      • A 15-year follow-up study on 3,294 participants between ages 31 and 46 years.
      • Evening types, compared to morning types, were more likely to have persistent multisite MSK pain.
      • Sex, mental distress, or poor sleep did not change the strength of this association.
      • Chronotype should be recognized as a predictor of multisite MSK pain.


      Chronotype, a phenotype representing a person's 24-hour circadian rhythm, has been increasingly acknowledged as playing a role in musculoskeletal (MSK) pain. Most prior research on chronotype and MSK pain have been based on cross-sectional data, and no study has explored multisite MSK pain (2 or more pain locations) as the outcome. We drew the study sample from the 31- and 46-year data collections (baseline and follow-up, respectively) of the Northern Finland Birth Cohort 1966 and collected self-reported data on chronotype at follow-up (morning [M]-type, intermediate [I]-type, and evening [E]-type) and longitudinal multisite MSK pain trajectories (n = 3,294). Multinomial logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) in multisite MSK pain trajectories between the chronotypes. We conducted additional sensitivity analyses that 1) accounted for several confounders, and 2) examined the potential moderating role of sex, mental distress, and sleep disturbance status in the chronotype–multisite MSK pain associations. The E-types had two-and-a-half-times higher odds of multisite MSK pain at baseline and follow-up (OR 2.47, 95% CI 1.84–3.32) than the M-types. Having severe mental distress or poor sleep at baseline and follow-up, or sex did not change the strength of this association. Our examination of this longitudinal birth cohort study suggested that evening types, in comparison to morning types, are more likely to experience multisite MSK pain between ages 31 and 46 years. Chronotype should be recognized as a predictor of multisite pain and thus taken into account in the evaluation of a patient's risk for multisite pain.


      This longitudinal study shows that evening types, compared to morning types, have higher odds of experiencing multisite MSK pain between ages 31 and 46 years. Chronotype should be considered while evaluating MSK patient's risk for persistent multisite pain symptoms.

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