A Journey full of Pain through the General Population

Chronic musculoskeletal pain is a common disabling condition with a great impact on daily functioning. In the Netherlands, 19% of all individuals aged 21 years and older experience chronic pain and in elderly this is more than half. This means that more than 2 million Dutch people experience pain on a daily basis, which is a higher prevalence than most common diseases like diabetes and coronary heart disease. A wide variety of risk factors have been described for the development of chronic pain and pain sensitivity. The overall objective of this thesis was to identify and characterize causal and consequential determinants of chronic musculoskeletal pain and pain sensitivity in the general population. Therefore, we used the Rotterdam Study, a large prospective population based study including more than 15,000 participants, which studies determinants of diseases of the elderly. In this thesis, the genetic background of the heat pain threshold and the determinants which influence temperature sensitivity and the heat pain threshold are described. Also, the influence of sex hormones on the development of chronic pain is presented. In addition, using brain MRI, the differences in brain structure in individuals with chronic pain is studied. Finally, gait analysis was used to differentiate between joint pain caused by osteoarthritis and joint pain caused by other conditions.