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Introduction: Previous pain episodes is a strong predictor of new pain episodes. The aim was to describe the associations between self-reported symptoms and later surgery for neck spondyloses, subacromial impingement syndrome, carpal tunnel syndrome, lumbar disc herniation, hip and knee arthroplasty in a longitudinal study of male construction workers.

Methods: The study population consisted of a sub-population from a cohort of male construction workers participating in health examinations from the late 1960s to 1993 (N=389 132). The sub-sample consists of male workers who at the time of the health examination filled in a questionnaire during the time period 1989–1993 (baseline, n=69 767). The questionnaire contained questions regarding self-reported musculoskeletal symptoms in the neck, shoulders, hand/wrists, low back, hips and knees. The question for the respective body part asked for the frequency of pain/aches/discomfort during the last 12 months. The response options were rarely, quite rarely, sometimes, fairly often and often. The outcomes of operative treatment were collected from the Swedish in- and outpatient register (depending on the outcome) by ICD-9 and ICD-10 diagnose codes combined with surgical procedures for: cervical spondylosis, subacromial impingement syndrome, carpal tunnel syndrome (CTS), lumbar disc herniation, hip and knee arthroplasty. Person-years were summed from the start of follow-up (1989–1993) until: surgical treatment, censoring for death or emigration, the end of the observation period (December 31, 2019), or until the year the worker exceeded 65 years of age. All risks are adjusted for age, BMI, smoking and calender year.

Results: For all operative treatments there were increased risks for individuals with frequent self-reported symptoms at baseline. Relative risks ranged from 1.9 for frequent hip pain and hip arthroplasty to 4.8 for frequent low back pain and future surgery for lumbar disc herniation. For all outcomes there were clear monotonic associations where more frequent symptoms resulted in higher relative risks for surgery.

Discussion: We have previously observed that subjective symptoms of pain in the neck increases the risk for surgically treated cervical spondylosis [1]. The current study shows that self-reported symptoms from other part of the body is also associated with increased risks for future surgery of subacromial impingement syndrome, lumbar disc herniation and, hip and knee arthroplasty. We propose that addressing self-reported symptoms in an early phase and then in an individualized way combine medical treatment (for example physiotherapy) and to adjust the biomechanical exposure at work to balance the load on the affected structure and preventing disease progression may be a powerful tool for secondary prevention in occupational health.

Conclusion: Reporting frequent symptoms of pain and discomfort increases the risk for having operative treatment in male construction workers.

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