ArticleBMC musculoskeletal disorders2026
The impact of anxiety/depression symptoms on return to work in patients with chronic neck or back pain: a longitudinal cohort study from the Norwegian neck and back registry.
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic musculoskeletal pain is among the leading causes of non-fatal health loss, sickness absence and disability. These patients frequently present with co-occurrent symptoms of anxiety and/or depression (A/D). Return to work (RTW) is an important measure of functional recovery, but the longitudinal impact of A/D on RTW in patients with chronic pain is less understood.
methodsThis study investigates the association between A/D symptoms and RTW among sick-listed patients referred to multidisciplinary physical medicine outpatient clinics with chronic neck or back pain (n = 3291), using comprehensive follow-up data from Norwegian national registers. The contribution of A/D symptoms to non-RTW was calculated using population attributable fractions (PAF), with self-reported pain intensity as reference.
resultsThe prevalence of case level A/D symptoms was 56.8%. There was an association between case level A/D symptoms and non-RTW at 12 months both in the unadjusted model (RR 1.32, 95% CI 1.22-1.44) and after adjustment for sociodemographic factors and symptom severity (RR 1.12, 95% CI 1.03-1.23), and PAF was estimated to be 6.6% in the fully adjusted model. In a separate model with adjustment for the same variables, there were no association between pain intensity and non-RTW (RR 1.02, 95% CI 0.93-1.11).
conclusionsThe results suggest that A/D symptoms are more important than pain intensity for RTW at 12 months in sick-listed patients with chronic neck or back pain, irrespective of self-reported severity of musculoskeletal symptoms and sociodemographic factors. Approximately 7% of non-RTW cases could be attributed to case level A/D symptoms. Addressing A/D symptoms as part of assessment and treatment is essential to improve RTW outcomes in patients with chronic neck or back pain.
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