# The pain-comorbidity links: a cross-sectional analysis of musculoskeletal burden in Saudi older adults

## TL;DR

This study examines how musculoskeletal pain and health conditions like hypertension and diabetes are linked in older Saudi adults, finding that women and obese individuals are at higher risk.

## Contribution

The study provides new insights into the coexistence of musculoskeletal pain and cardiometabolic conditions in Saudi older adults, identifying key predictors and effect modifications.

## Key findings

- Musculoskeletal pain was reported by 73.2% of participants, most commonly in the lower back, knee, neck, and shoulder.
- Female sex was a consistent predictor of pain at multiple sites, including low back, shoulder, and neck.
- Obesity was more strongly associated with hypertension, and smoking had a stronger link to hypertension at normal BMI.

## Abstract

Musculoskeletal pain and noncommunicable diseases are major contributors to disability among adults aged ≥50 years, yet their coexistence and modifying factors are not well characterized in Saudi Arabia. This study aimed to estimate age-group–specific prevalence of musculoskeletal pain, identify independent predictors of site-specific and multisite pain and of major morbidities, and evaluate effect modification among adults ≥50 years.

A community-based cross-sectional survey was administered to participants aged ≥50 years. Data on sociodemographic characteristics, smoking status, body mass index (BMI), morbidities, and musculoskeletal pain sites were collected.

Among 298 participants (mean age 58.2 ± 6.3 years; 47.0% overweight; 32.9% obese), musculoskeletal pain was reported by 73.2%, most commonly at the lower back (30.9%), knee (26.2%), neck (23.8%), and shoulder (21.8%). Hypertension (29.5%) and diabetes (28.2%) were the most prevalent morbidities; multimorbidity was present in 24.5% of participants. Female sex was the most consistent predictor across pain sites, with higher odds for low back pain (OR 2.83, 95% CI 1.60–5.00; p < 0.001), shoulder pain (OR 2.99, 95% CI 1.64–5.44; p < 0.001), and neck pain (OR 2.58, 95% CI 1.44–4.63; p = 0.002). A significant smoking × BMI interaction was observed for hypertension (OR 0.22, 95% CI 0.06–0.86; p = 0.029), indicating that the positive association of smoking with hypertension was strongest at normal BMI and attenuated at higher BMI. For diabetes, the age-related increase in risk was greater among participants with hypertension (OR 1.02 per year, 95% CI 1.01–1.03; p < 0.001) and was further increased at higher BMI (OR 1.59, 95% CI 1.24–2.05; p < 0.001).

Musculoskeletal pain co-occurring with cardiometabolic conditions was common among older adults in Saudi Arabia. Female sex consistently predicted pain, and obesity was more strongly associated with hypertension. Effect-modification patterns identify high-risk strata; therefore, routine cardiometabolic screening should be incorporated into musculoskeletal management, with first-line non-pharmacologic care and targeted counselling for obese women and smokers.