Comparison of musculoskeletal health in the general population between 2016/17 and 2022/3: A tapered matching study

OBJECTIVES: To investigate changes in the prevalence of chronic pain (CP), high-impact chronic pain (HICP), and musculoskeletal health (MSK-HQ scores) before and after the COVID-19 pandemic. STUDY DESIGN: Longitudinal cross-sectional study using data from two population-based surveys conducted in 2016/17 (PRELIM) and 2022/23 (MIDAS-POP). METHODS: Adults aged 35 and over registered with general practices in the West Midlands, UK, completed questionnaires including CP, HICP, and MSK-HQ. Entropy balancing was applied to match respondents across survey years on age, sex, deprivation, and ethnicity. Logistic and linear regressions estimated odds ratios (ORs) and mean differences. Subgroup analyses tested for interactions, and E-values were calculated to assess robustness to unmeasured confounding. RESULTS: CP prevalence increased from 35.6% in 2016/17 to 42.9% in 2022/23 (OR 1.36, 95% CI 1.22 to 1.51), and HICP from 15.5% to 22.4% (OR 1.57, 1.38 to 1.80). MSK-HQ scores among people with CP declined from 32.4 to 23.1, exceeding the minimal important change. Increases were more marked among women and people aged 35-54. Differences by deprivation and ethnicity were observed, although subgroup estimates for ethnicity should be interpreted cautiously due to small sample sizes. E-values suggested that the associations were moderately robust to unmeasured confounding. CONCLUSIONS: Chronic pain prevalence and its burden have increased since the COVID-19 pandemic, alongside declines in musculoskeletal health. While some of this may reflect residual confounding, the findings underscore the need for targeted pain prevention and management strategies, particularly for working-age adults and underserved groups.