Background Pain is a risk factor for work disability, however, routes of exit out of paid employment have not been examined in detail. Thus, the aim of this study was to examine the contribution of repeated exposure to pain and subsequent transitions out of paid employment. A further aim was to examine, whether the associations vary by sex, age, occupational class, job demands, job control and body mass index.

Methods We included participants of the Whitehall II study cohort (n=8445, 69% men, aged 35–55 at baseline), who had provided at least 2 measurements of back pain between phases 1 and 3 (1985–1994). People with pain at 1 point in time, and pain at 2–3 time points were compared to people with no pain at any phase. Exit from paid employment was observed between 1995–2013 (phases 4–11). Routes of exit were 1) health-related (long-term sick or retirement on health grounds), 2) unemployment, 3) other early exit, 4) retirement not related to health. Those remaining working served as a reference group. Sex, age, parental and own socioeconomic position, job demands, job control, and body mass index were controlled for. Repeated measures logistic regression models were fitted.

Results Altogether 10% exited the employment due to health-related reasons, 2% due to unemployment and 6.5% due to other reasons. Pain contributed to the transitions out of paid employment due to health reasons. After full adjustments, reporting pain at one time point (26%) was not associated with exit due to health reasons, while reporting repeated pain was associated with such exit (18%, OR 1.52, 95% CI 1.16–2.00), as compared to those who did not report pain during phases 1–3 (56%). Associations were somewhat stronger among middle or lower class employees and non-existent among high class employees, but otherwise differences e.g. by age, working conditions or obesity were small. The risk of exit due to other routes than health-related did not vary between people with or without pain.

Conclusion These results highlight the need for early detection of repeated pain, to prevent the risk of health-related early exit out of paid employment. As the risk varies between different occupational groups and somewhat by working conditions, this emphasises the importance of identification of high risk groups and their modifiable risk factors, such as working conditions.