Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

A Tale of Two CitiesThe Effect of Low Intensity Conflict On Prevalence and Characteristics of Musculoskeletal Pain Associated with Chronic Stress

Ablin1,  Jacob, Cohen2,  Hagit, Clauw3,  Daniel, Shalev4,  Ronit, Ablin4,  Eti, Neumann5,  Lily, Buskila6,  Dan

Rheumatology institute, Tel Aviv, Tel Aviv, Israel
Ben-Gurion University, Beer Sheva, Israel;, Beer Sheva, Israel
University of Michigan, Ann Arbor, MI
Haifa University, Haifa, Israel
Ben-Gurion University, Israel
Soroka Medical Center, Beer Sheva, Israel


Although both acute and chronic stress lead to pain, the precise characteristics of this association have not been defined. Sderot is an Israeli town exposed to repeated missile attacks. Ofakim, a town of similar demographic and socioeconomic characteristics, had not been targeted, as of the period of our study. We examined the occurrence and characteristics of pain and related symptoms in Sderot and Ofakim.


The study was conducted as a population survey. 1750 households were contacted by telephone in Sderot and 1939 in Ofakim, with a 59% and 52% participation respectively. A total of 2,030 interviews were conducted.

1024 individuals in Sderot and 1006 in Ofakim were interviewed regarding pain, somatic symptoms, mood, trauma - exposure, and general health status.


Significantly higher levels of trauma-related symptoms and somatic symptoms were noted in Sderot compared with Ofakim (p<0.001). Chronic widespread pain (CWP) was more common in Sderot (11.1%) than Ofakim (8.3 %; OR 1.37, p=0.038). Women were more likely (13.9% vs. 9.3%; OR 1.45, p=0.06) than men (8.9% vs.7.3%, OR 1.24, p=0.37) to experience CWP in Sderot vs. Ofakim. Amongst males, Chronic Regional Pain was more common in Sderot (19.2%) than in Ofakim (14.2%; p=0.036). Pain Severity in Sderot was significantly higher than in Ofakim (p<0.001).


In the current study we have demonstrated the effect of ongoing missile attacks on the civilian population of the Israeli town of Sderot, compared with the town of Ofakim. Significantly increased rates of somatic complaints, including pain, fatigue and IBS-like symptoms, were reported by individuals in Sderot, as well as significantly higher rates of trauma-related symptoms. Widespread pain was reported significantly more frequently by inhabitants of Sderot compared with Ofakim but was not independent of increased self-reported depression. These results strengthen the relationship between low - intensity military conflict and the development of "unexplained" somatic complaints and draw attention to the need for medical resource - allocation to such areas, in order to meet these needs. The results highlight the contribution of external "environmental" factors such as stress to the occurrence of chronic pain as part of a spectrum of related somatic and affective symptoms. It remains to be investigated to what extent these external factors may interplay with a genetic predisposition in the pathogenesis of this symptom array.

To cite this abstract, please use the following information:
Ablin, Jacob, Cohen, Hagit, Clauw, Daniel, Shalev, Ronit, Ablin, Eti, Neumann, Lily, et al; A Tale of Two CitiesThe Effect of Low Intensity Conflict On Prevalence and Characteristics of Musculoskeletal Pain Associated with Chronic Stress [abstract]. Arthritis Rheum 2009;60 Suppl 10 :91
DOI: 10.1002/art.25174

Abstract Supplement

Meeting Menu