INTRODUCTION:The purpose of the study was to examine if dance-specific aerobic fitness test (DAFT) heart rate variables were associated to lower-extremity injuries in contemporary dance students. METHODS:A total of 235 first-year contemporary dance students (18.6 ± 1.2 years) were prospectively followed over the first 4 months of their academic year. Peak heart rate (HRpeak) in the final stage of the DAFT and heart rate recovery (HRR) 1 minute after DAFT completion were measured. Lower-extremity injuries were registered using a self-reported monthly questionnaire including the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H). Three injury definitions were used (all-complaint injury, substantial injury, and time-loss injury). Associations between DAFT HRpeak, HRR and lower-extremity injury prevalence and severity were examined with regression analyses. RESULTS:Lower-extremity injury prevalence was 36.2% (n = 85), 13.6% (n = 32), and 22.6% (n = 53) for all-complaint, substantial and time-loss injuries, respectively. There were no significant associations between HRpeak or HRR and injury prevalence using either of the 3 injury definitions. There were no significant associations between DAFT HRpeak or HRR and injury severity (days off due to injury or OSTRC-H severity score). Multivariate analyses showed significant associations between age and substantial injuries (OR 1.807; 95% CI 1.242-2.630; P < .01) and between age and time-loss injuries (OR 1.441; 95% CI 1.074-1.933; P < .05). CONCLUSION:Aerobic fitness measured with the DAFT was not associated with lower-extremity injury risk or injury severity. Higher age was associated with substantial and time-loss lower-extremity injuries.

Background:Multivariable diagnostic models are often used to identify spinal fractures in patients with spinal pain and/or trauma. However, their performance and clinical utility remain uncertain. We aimed to evaluate the performance of diagnostic models for detecting spinal fractures in individuals with spinal pain and/or trauma. Methods:In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, and Web of Science on April 15, 2024 and May 27, 2024 for relevant work published since database inception. The first search included only studies on spinal pain and the second additionally included spinal trauma studies, following a protocol adjustment during screening. A search update was performed on May 19, 2025. An expert librarian assisted in developing the search strategy, which was limited to work published in English, Italian, and Dutch. We also performed backward and forward citation tracking. We included studies that developed and/or externally validated multivariable diagnostic prediction models for spinal fractures. Two independent reviewers screened studies for eligibility, extracted data using the CHARMS checklist, and assessed the risk of bias using the PROBAST. The certainty of evidence was evaluated using the GRADE approach. The protocol was registered in PROSPERO, CRD42024539898. Findings:We included 27 studies encompassing 34 diagnostic models. All models showed an overall high risk of bias, while the concerns about their applicability varied due to the frequent use of spinal injuries as the outcome instead of explicitly addressing spinal fractures. Meta-analyses of ten studies that externally validated the Canadian C-spine Rule in adults presenting with trauma to emergency departments or trauma centres demonstrated, with very low certainty of the evidence, excellent sensitivity (0.999; 95% CI 0.976-1), an high area under the curve (0.850; 95% CI 0.720-0.970), and a low specificity (0.188; 95% CI 0.063-0.443). We estimated a pooled non-statistically significant positive likelihood ratio of 1.230 (95% CI 0.978-1.548) and a negative likelihood ratio of 0.007 (95% CI 0.001-0.082) for the same model. Other models for traumatic cervical fractures and osteoporotic fractures showed promise but lacked external validation or sufficient reporting on calibration and discrimination measures (with low to very low certainty of the evidence). No models for thoracolumbar fractures were deemed ready to be used clinically. Interpretation:Although the Canadian C-spine Rule shows potential for screening traumatic cervical fractures, the very low to low certainty of the evidence limits confidence in its accuracy and appropriateness for clinical use. We did not identify any externally validated models suitable for clinical use regarding osteoporotic or traumatic fractures of the thoracolumbar spine, and traumatic fractures of the cervical spine in non-emergency settings. Future research with rigorous methodological and statistical approaches should aim to fill these knowledge gaps. Funding:None.

Low back pain (LBP) is common among older adults, and it is a frequent reason for seeking chiropractic care. The STarT Back Screening Tool (SBT) was developed to stratify patients with LBP into low, medium, and high-risk treatment pathways, so that the treatment can be matched to each participant’s risk profile. But its prognostic performance varies across settings and populations. No studies have focused on the SBT’s utility as a stratified-care tool in older adults with LBP in a chiropractic setting. Therefore, our aim was to evaluate the ability of the SBT to predict three-, six-, and 12-month disability and pain outcomes in older adults (≥55 years) with a new episode of LBP consulting chiropractors in the Netherlands, Sweden, and Australia. This was a secondary analysis of the Back Complaints in Older Adults – Chiropractic (BACE-C) cohort. Participants visiting chiropractors with LBP completed baseline questionnaires for demographic and clinical characteristics, including the SBT. Follow-up questionnaires assessed disability (Roland Morris Disability Questionnaire (RMDQ)) and pain intensity (11-point Numerical Rating Scale (NRS)). “No improvement” on disability and pain intensity was defined as less than 30

Objectives: Investigate the association between injury severity and sports-related analgesic use, and explore the types and reasons for analgesic use in Danish youth elite athletes. Design: 4-week prospective cohort study. Methods: 713 youth elite athletes (44 % female) aged 15-20 years provided information on demographics, sports specific questions, and injury severity. We categorized injury severity based on the amount of impact on sports participation: 1) no injury (reference), 2) injury not affecting sports participation, 3) injury causing modifications in sports participation, and 4) injury causing complete absence from sport. Participants were asked weekly over 4 weeks about the number of days with sports-related analgesic use, types, and reasons for use. Mixed-effects regression models were used to assess the association between injury severity and prevalence (yes/no) and frequency (days/week) of analgesic use. Results: Analgesic use at least once during the four weeks was reported by 224 athletes (31 %), with a mean weekly prevalence of 13 %. The odds of analgesic use increased with injury severity compared with the reference group; injury not affecting sports participation: OR 2.6 (95 % CI 1.6-4.2), injury causing modifications in sports participation: OR 3.2 (95 % CI 2.0-5.2), injury causing complete absence from sport: OR 3.6 (95 % CI 1.5-8.7) (test for trend; p = <0.001). The rate (frequency) of analgesic use also increased with injury severity (test for trend; p = 0.003). Athletes most commonly used analgesics to treat pain/injury after sports participation (62 %), and paracetamol was most frequently used (84 %). Conclusions: Injury severity was associated with increased odds and rate of analgesic use.

BACKGROUND:Pain guidelines recommend de-prescribing long-term opioid treatment (LTOT) in non-cancer pain for reasons of risk-benefit balance. However, the prevalence and changes over time with regard to LTOT in patients with chronic non-cancer pain in Dutch primary care are unknown. Hence, we examined the prevalence and characteristics and investigated associated diagnoses, comorbidities, co-medications and changes in prescription numbers between 2013 and 2022. METHODS:This retrospective population-based cohort study was conducted using the Rijnmond Primary Care Database, which includes over 500,000 patient records from at least 240 GPs within the greater region of Rotterdam. All episodes of LTOT (> 3 months) in patients > 18 years from 2013 to 2022 were included. Descriptive statistics were adopted to characterise the study cohort. The prevalence of LTOT from 2013 to 2022 was calculated per 100 patient years. RESULTS:Musculoskeletal complaints were the main registered indication by the first prescription of opioids. Patients were more frequently female (66.9%), with a mean age of 62.6 years. Most common comorbidities included diabetes mellitus and depressive disorder. The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51-0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00-1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022. CONCLUSIONS:This study demonstrated a twofold increase in the prevalence of LTOT for chronic non-cancer pain in Dutch primary care from 2013 to 2022. Musculoskeletal pain complaints were the main indication. From 2013 to 2022 potent opioids assumed a more prominent role in LTOT. SIGNIFICANCE STATEMENT:The about twofold increase in long-term opioid therapy for chronic non-cancer pain between 2013 and 2022, along with the specific rise in potent opioid prescriptions in Dutch primary care, highlights an urgent need for future studies. These studies should focus on developing strategies to accelerate the implementation of revised primary care pain guidelines, especially given the limited effectiveness of long-term opioid treatment in non-cancer pain and the anticipated rise in chronic non-cancer pain due to Europe's ageing population.

BACKGROUND:Shoulder pain is common amongst adults, but little is known about patients' preferences. OBJECTIVE:The aim of this study was to determine patients' preferences for treatment options offered for shoulder pain in primary care. METHODS:A discrete choice experiment was used to investigate these preferences. Adults with shoulder pain were asked to make 12 choices between two treatment options, or to opt-out. The attributes of the 12 treatment options were presented as varying in: treatment effectiveness (50%, 70%, or 90%), risk of relapse (10%, 20%, or 30%), time to pain reduction (2 or 6 weeks), prevention of relapse (yes/no), requiring injection (yes/no), and including physiotherapy (none, 6, or 12 sessions). A conditional logit model with latent class analysis was used for the analysis and a class assignment model. RESULTS:Three hundred and twelve participants completed the questionnaire with mean age of 52 ± 15.2 years. Latent class analysis revealed three groups. Group 1 preferred to opt-out, unless the attributes were highly favorable (90% effectiveness). Group 2 preferred treatment, but not an injection. Group 3 preferred to opt-out and did not opt for treatment. The likelihood of a participant belonging to one of these groups was 68.8%, 9.3%, and 21.9%, respectively. The class assignment was related to having previously received injection or physiotherapy, as they did not prefer that same treatment again. CONCLUSION:This study showed that most patients with shoulder pain prefer to opt-out, unless treatment attributes are highly favorable. Characteristics of influence on this decision was whether the patient had received an injection or physiotherapy before.

OBJECTIVES:This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of exercise interventions for work-related complaints of the arm, neck or shoulder (CANS) in adults. The outcomes of interest are pain, function, work outcomes, adverse events, quality of life, healthcare use and injury recurrence.

BACKGROUND:Radiating leg pain is common in patients with low back pain (LBP). In this study, we aimed to determine the prevalence and incidence of LBP with radiating leg pain in Dutch general practice, and to describe the prescribed medications and requested imaging diagnostics. METHODS:The Rijnmond Primary Care Database containing over 500,000 primary care patients was used to select patients ≥18 years with LBP with radiating leg pain between 2013 and 2021. Data on patient characteristics, LBP episodes, prescribed medication and requested imaging in the first 3 months of an episode was extracted. Descriptive statistics were used to present patient characteristics and diagnostic/therapeutic interventions. RESULTS:A total of 27,695 patients were included. The total number of LBP with radiating leg pain episodes in these patients was 36,268. In 2021, the incidence and prevalence were 19.1 and 25.7 per 1000 patient years, respectively. In 60% of patients, the episode duration was shorter than 1 month. In 62% of the episodes, patients visited the general practitioner (GP) one to two times. In 59% of the episodes, at least one medication was prescribed, non-steroidal anti-inflammatory drugs (NSAIDs) being the most common one (45%). In approximately 11% of the episodes, additional diagnostic imaging was requested. CONCLUSION:LBP with radiating leg pain is common in Dutch general practice patients. About 2/3rd were prescribed pain medications. Dutch request few to none diagnostic imaging for these patients which is in line with clinical practice guidelines. SIGNIFICANCE:In this new study, we have gained insights into the incidence and prevalence of LBP with radiating leg pain in Dutch general practice. Both remained fairly stable over the study period of 9 years (2013-2021). Overall, the care burden regarding seeking contact with the GPs and the requested diagnostics seem not to be that high. In 62% of the care episodes, there were one or two consultations with the GP, and in 11% of the episodes a diagnostic imaging was requested. Pain medications frequently prescribed (i.e. 2/3rd of the episodes), with NSAIDs being the most common ones.

Introduction:We conducted a systematic review of clinical practice guidelines to identify red flags for serious pathologies in neck pain mentioned in clinical practice guidelines, to evaluate agreement in red flag recommendations across guidelines, and to investigate the level of evidence including what study type the recommendations are based on. Methods:We searched for guidelines focusing on specific and nonspecific neck pain in MEDLINE, EMBASE, and PEDro up to June 9, 2023. Additionally, we searched for guidelines through citation tracking strategies, by consulting experts in the field, and by checking guideline organization databases. Results:We included 29 guidelines, 12 of which provided a total of 114 red flags for fracture (n = 17), cancer (n = 21), spinal infection (n = 14), myelopathy (n = 15), injury to the spinal cord (n = 1), artery dissection (n = 7), intracranial pathology (n = 3), inflammatory arthritis (n = 2), other systemic disease (n = 6), or unrelated to a specific condition (n = 19). Overall, there is very little agreement (median Fleiss' kappa of 0) between guidelines on the red flags to screen for serious pathologies. Conclusion:Red flags were mainly supported by expert opinions. We also observed a general lack of consensus among guidelines regarding which red flags to endorse. Considering the current limitations of the evidence, specific recommendations on which red flags to use cannot be provided, except for using the Canadian C-Spine rule for screening posttraumatic fractures.

ABSTRACTObjectivePatients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1‐year clinical course and to identify prognostic factors associated with non‐recovery in older BP patients with radiating leg pain.DesignPatients in the BACE cohort aged >55 years with a new episode of BP and radiating leg pain were included (n = 377). Data on clinical outcomes were collected until 1‐year follow‐up. Uni‐ and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non‐recovery outcomes at the 1‐year follow‐up.ResultsMore than half of the patients (65%) did not recover after 12 months. In multivariable analyses, poor self‐rated health (odds ratio [OR] 2.34, 95% CI: 1.20–4.56) and BP duration at baseline (OR 1.48, 1.12–1.96) were significantly associated with non‐recovery for BP as outcome; age (OR 1.04, 1.03–1.05), smoking (OR 1.14, 1.00–1.30), depressive symptomatology (OR 1.03, 1.02–1.04), kinesiophobia (OR 1.03, 1.02–1.04), poor self‐rated health (OR 2.09, 1.83–2.39), baseline disability (OR 1.16, 1.14–1.17), BP duration (OR 1.49, 1.41–1.57), leg pain (OR 1.52, 1.37–1.68), pain during rotation (OR 1.71, 1.53–1.90) and other musculoskeletal complaints (OR 1.34, 1.17–1.52) were associated with disability. No factors were associated with leg pain.ConclusionsSeveral prognostic factors were associated with non‐recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients.

Objective:To determine the association between patient-reported spinal morning stiffness and lumbar disc degeneration (LDD) and systemic inflammation, as measured by C-reactive protein (CRP), in older patients with non-specific back pain. The ultimate objective is to help shape a future definition of spinal osteoarthritis (OA). Design:Baseline data from the Dutch "Back Complaints in the Older Adults" (BACE) study was used. The relationship between the severity and duration of patient-reported spinal morning stiffness, LDD (i.e., multilevel disc space narrowing and multilevel osteophytes), and CRP was assessed. Regression models adjusted for confounding variables were performed. Results:Six hundred and seventy-five patients were included. The mean age was 66.52 years (SD 7.69), with a mean CRP of 3.20 ​mg/L (SD 7.61). The severity of spinal morning stiffness was associated with multilevel disc space narrowing: OR 2.89 (95 ​% CI: 1.24 to 6.74) for 'mild', OR 2.97 (95 ​% CI: 1.18 to 7.44) for 'moderate', OR 3.23 (95 ​% CI: 1.17 to 8.90) for 'severe', and OR 5.62 (95 ​% CI: 1.70 to 18.60) for 'extreme' morning stiffness severity. However, spinal morning stiffness severity was not associated with multilevel osteophytes, and both multilevel features of LDD showed no associations with the duration of spinal morning stiffness. No associations were found between spinal morning stiffness severity or duration, and CRP levels. Conclusions:Our results suggest that the severity of patient-reported spinal morning stiffness might be considered in future definitions of symptomatic spinal OA and that spinal morning stiffness is probably a symptom of a degenerative process in the spine rather than a symptom of systemic inflammation in patients with back pain.

The potential to classify low back pain as being characterised by dominant nociceptive, neuropathic, or nociplastic mechanisms is a clinically relevant issue. Preliminary evidence suggests that these low back pain phenotypes might respond differently to treatments; however, more research must be done before making specific recommendations. Accordingly, the low back pain phenotyping (BACPAP) consortium was established as a group of 36 clinicians and researchers from 13 countries (five continents) and 29 institutions, to apply a modified Nominal Group Technique methodology to develop international and multidisciplinary consensus recommendations to provide guidance for identifying the dominant pain phenotype in patients with low back pain, and potentially adapt pain management strategies. The BACPAP consortium's recommendations are also intended to provide direction for future clinical research by building on the established clinical criteria for neuropathic and nociplastic pain. The BACPAP consortium's consensus recommendations are a necessary early step in the process to determine if personalised pain medicine based on pain phenotypes is feasible for low back pain management. Therefore, these recommendations are not ready to be implemented in clinical practice until additional evidence is generated that is specific to these low back pain phenotypes.

Opioïden worden vaak voorgeschreven voor acute lagerug- en nekpijn, maar gegevens over de effectiviteit waren tot voor kort niet beschikbaar. Recent onderzoek in Australië vergeleek opioïden met een placebo en ontdekte geen significant verschil in pijnreductie na 6 weken. Na 52 weken was er zelfs een lichte verbetering in de placebogroep. Vanwege het gebrek aan effect in vergelijking met een placebo, het verhoogde verslavingsrisico en mogelijke bijwerkingen moeten opioïden niet worden aanbevolen voor acute lagerug- en nekpijn.

Background Vertebral and carotid artery dissections may present as neck pain and/or headache in their early phases. Consequently, clinicians must screen for arterial dissections when assessing neck pain and/or headache patients. Considering that no secondary studies have been published on the red flags to screen for arterial dissections in patients with neck pain/headache, our scoping review will aim to gain a comprehensive understanding of the existing literature on patients with a carotid or vertebral artery dissection presenting with a primary complaint of neck pain and/or headache regarding the prevalence of associated signs and symptoms (e.g., neurological impairments and visual problems), the pain characteristics (e.g., intensity and localization), the demographic characteristics (e.g., gender and age), the prevalence of risk factors (e.g., cardiovascular), the mechanism of onset, and other relevant clinical predictors (e.g., comorbidities). Methods We will search MEDLINE (via PubMed), Embase, CINHAL, and Scopus. In addition, we will use Web of Science to implement backward and forward citation tracking strategies. We will include any primary study design (e.g., case–control studies, case reports and case series, and cohort studies) written in English, Dutch, or Italian without any time restriction. To be included, studied had to focus on adult patients (> 18 years of age) of any gender with a diagnosis of vertebral or artery dissection and with a primary complaint of neck pain and/or headache, with a reporting on other signs/symptoms, pain characteristics, demographic information, risk factors, or onset mechanisms. Two authors will independently perform the study selection and data extraction phases. Results from the scoping review will be summarized descriptively through tables and diagrams. As a scoping review, we will highlight any gaps in the existing literature regarding our research questions. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study will be available upon reasonable request to the authors.

This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.

This systematic review summarizes the evidence on associations between physical and psychosocial work-related exposures and the development of carpal tunnel syndrome (CTS). Relevant databases were searched up to January 2020 for cohort studies reporting associations between work-related physical or psychosocial risk factors and the incidence of CTS. Two independent reviewers selected eligible studies, extracted relevant data, and assessed risk of bias (RoB). We identified fourteen articles for inclusion which reported data from nine cohort studies. Eight reported associations between physical exposure and the incidence of CTS and five reported associations between psychosocial exposures and the incidence of CTS. Quality items were generally rated as unclear or low RoB. Work-related physical exposure factors including high levels of repetition, velocity, and a combination of multiple physical exposures were associated with an increased risk of developing CTS. No other consistent associations were observed for physical or psychosocial exposures at work and CTS incidence.

Objective: It is difficult for health care providers to diagnose structural spinal osteoarthritis (OA), because current guidelines recommend against imaging in patients with back pain. Therefore, the aim of this study was to develop and internally validate multivariable diagnostic prediction models based on a set of clinical and demographic features to be used for the diagnosis of structural spinal OA on lumbar radiographs in older patients with back pain. Design: Three diagnostic prediction models, for structural spinal OA on lumbar radiographs (i.e. multilevel osteophytes, multilevel disc space narrowing (DSN), and both combined), were developed and internally validated in the 'Back Complaints in Older Adults' (BACE) cohort (N = 669). Model performance (i.e. overall performance, discrimination and calibration) and clinical utility (i.e. decision curve analysis) were assessed. Internal validation was performed by bootstrapping. Results: Mean age of the cohort was 66.9 years (+7.6 years) and 59% were female. All three models included age, gender, back pain duration and duration of spinal morning stiffness as predictors. The combined model additionally included restricted lateral flexion and spinal morning stiffness severity, and exhibited the best model performance (optimism adjusted c-statistic 0.661; good calibration with intercept -0.030 and slope of 0.886) and acceptable clinical utility. The other models showed suboptimal discrimination, good calibration and acceptable decision curves. Conclusion: All three models for structural spinal OA displayed lesuboptimal discrimination and need improvement. However, these internally validated models have potential to inform primary care clinicians about a patient with risk of having structural spinal OA on lumbar radiographs. External validation before implementation in clinical care is recommended.

Abstract Background The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations. Methods Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain − 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person’s country of residence influenced this relationship. Results The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. Conclusion Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.