The Role of Maladaptive Pain Perceptions and Work-Related Factors in Predicting Work Ability in Employees with Musculoskeletal Pain: A Cross- Sectional Study

Background Musculoskeletal pain is a leading cause of reduced work ability and long-term sickness absence in the workforce. While work-related factors are known to influence work ability, maladaptive pain perceptions may also play a significant role. However, the interaction between these factors remains underexplored. Methods In this cross-sectional study, 249 employees experiencing musculoskeletal pain for at least six weeks filled out online questionnaires assessing work ability, work-related factors (physical job demands, workload, job control, and social support), and maladaptive pain perceptions (pain catastrophizing and fear-avoidance beliefs). Multiple linear regression analysis examined the associations and interactions between these variables. Results Multisite pain (B = -0.633, β = -0.113, p = 0.066) and fear-avoidance beliefs regarding work (B = -0.050, β = -0.214, p = 0.001) independently predicted lower work ability. Pain catastrophizing was also associated with lower work ability, though this effect was mitigated by higher social support (B = 0.009, β = 0.138, p = 0.001). However, social support did not improve work ability in employees with strong fear-avoidance beliefs regarding physical activities (B = -0.013, β = -0.122, p = 0.072). High workload negatively impacted work ability only among employees with high fear-avoidance beliefs regarding physical activities (B = -0.015, β = -0.107, p = 0.088). Conclusion Maladaptive pain perceptions are key predictors of work ability, influencing the impact of work-related factors. Future research should validate our findings in various occupational settings and among employees on sick leave for broader applicability. Clinical trial number Not applicable.