{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:04:13Z","timestamp":1790687053562,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic pain is a leading cause of disability, yet the longitudinal course of multisite pain\u2014the number of anatomical sites affected\u2014has not been characterised in a nationally representative Asian population. Most prior evidence is cross\u2010sectional or Western.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed five waves (2011\u20132020) of the China Health and Retirement Longitudinal Study, including 23,376 adults aged \u2265\u200945\u2009years with multisite\u2010pain data (painful sites, 0\u201315) in \u2265\u20092 waves. Trajectories were identified by a single\u2010stage zero\u2010inflated Poisson finite\u2010mixture growth model fitted directly to the repeated counts, with pre\u2010specified enumeration criteria. Site\u2010level concordance and baseline factors associated with class membership were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five trajectories were identified (APPA 0.74\u20130.94): persistent minimal (44.9%), low fluctuating (18.6%), low\u2010rising (16.9%), moderate persistent (10.0%) and high increasing (9.6%); two were non\u2010monotonic. Among participants reporting pain at consecutive waves, at least one site recurred in 65%\u201398% of wave pairs, most often the lower back, knees and leg, but the identical site set recurred in fewer than 12%. Higher depressive symptoms (odds ratio per 5 CES\u2010D\u201010 points up to 1.65), greater comorbidity (up to 1.57 per condition), female sex (up to 1.95) and lower education were associated, in a graded manner, with higher\u2010burden trajectories. Refitting the model with sampling weights reproduced the five\u2010class structure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Middle\u2010aged and older Chinese adults follow heterogeneous, often non\u2010monotonic multisite\u2010pain courses, in which a recurring anatomical core is accompanied by movement of pain between sites. Depressive symptoms, multimorbidity, female sex, and lower education mark higher\u2010burden trajectories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Pain\u2010site counts are widely used as a proxy for pain burden, but whether they track a stable anatomical problem or shifting symptoms has not been shown. Coupling trajectory modelling with site\u2010level concordance in a national cohort reveals that a rising count reflects accumulation around a recurring low\u2010back and lower\u2010limb core rather than migration between unrelated sites, giving the count a concrete anatomical meaning for the first time and supporting its use to stratify risk early, before burden accumulates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70389","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:48:04Z","timestamp":1790686084000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nine\u2010Year Trajectories of Multisite Pain in Middle\u2010Aged and Older Chinese Adults: A Group\u2010Based Trajectory Analysis of the\n                    <scp>CHARLS<\/scp>\n                    2011\u20132020"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3025-3573","authenticated-orcid":false,"given":"Yiwen","family":"Wang","sequence":"first","affiliation":[{"name":"Rehabilitation Department Third Affiliated Hospital of Zhengzhou University  Zhengzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengna","family":"Zhu","sequence":"additional","affiliation":[{"name":"Rehabilitation Department Third Affiliated Hospital of Zhengzhou University  Zhengzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1097\/j.pain.0000000000002137","article-title":"Long\u2010Term Trajectories of Chronic Musculoskeletal Pain: A 21\u2010Year Prospective Cohort Latent Class Analysis","volume":"162","author":"Aili K.","year":"2021","journal-title":"Pain"},{"key":"e_1_2_11_3_1","first-page":"703","article-title":"Number of Pain Sites as a Novel Indicator of Widespread Pain","volume":"39","author":"Aoyagi K.","year":"2023","journal-title":"Clinical Journal of Pain"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1016\/S0140-6736(22)01546-X","article-title":"The Path to Healthy Ageing in China: A Peking University\u2013Lancet Commission","volume":"400","author":"Chen X.","year":"2022","journal-title":"Lancet"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1016\/j.pain.2013.05.039","article-title":"Patterns of Multisite Pain and Associations With Risk Factors","volume":"154","author":"Coggon D.","year":"2013","journal-title":"Pain"},{"key":"e_1_2_11_6_1","first-page":"1424","article-title":"Trajectories of Pain Over 6\u2009Years in Older Adults: Results From ELSA","volume":"162","author":"Dainty J. 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