Musculoskeletal Pain, Insomnia and Health-Related Quality of Life: Associations in the Middle-Aged General Population

Musculoskeletal (MSK) pain and insomnia are interrelated and individually linked to reduced health-related quality of life (HRQoL). This study aimed to enlighten the association of concurrent disabling MSK pain and insomnia with HRQoL among middle-aged individuals.

Members of the Northern Finland Birth Cohort 1966 were surveyed at age 46 years (analytic sample N = 4 130, 56.7% women). Validated Athens insomnia scale was used to determine insomnia status and HRQoL was assessed with the 15D (15-dimensional) questionnaire. Associations between different combinations of disabling MSK pain and insomnia (concurrent, isolated, absent) with HRQoL were analysed using general linear regression, adjusting for sex, smoking, educational level, physical activity and coexisting diseases. Fifteen HRQoL dimensions were also analysed separately.

The prevalence of concurrent disabling MSK pain and insomnia was 14.3%, while 50.8% reported neither condition. Adjusted 15D mean score of participants with concurrent disabling MSK pain and insomnia was significantly lower (beta [β] coefficient: -0.068 [95% CI -0.073 to -0.062]) compared to those without. Concurrent conditions were associated with lower HRQoL than isolated insomnia and isolated disabling MSK pain (β coefficients: -0.032 [95% CI -0.039 to -0.024] and -0.042 [95% CI -0.050 to -0.034], respectively). Fourteen of 15 HRQoL dimensions were the lowest among participants with concurrent conditions.

This study shows that every seventh of the study population has disabling MSK pain and insomnia concurrently and they are more strongly associated with lower HRQoL compared to isolated or absent conditions. The negative effects of comorbid conditions on HRQoL are reflected across multiple dimensions.

Musculoskeletal pain and insomnia together exert a compounded negative effect on health-related quality of life, highlighting the need for integrated management strategies. Treating pain alone may not be enough and routine sleep assessment could be a critical point.