Risk factors for the onset of musculoskeletal pain in children and adolescents
Musculoskeletal pain is a major burden on society. Research in adults has identified risk factors associated with musculoskeletal pain onset, however at present evidence for risk factors in children and adolescents is limited.
Identify potential risk factors for musculoskeletal pain onset in children and adolescents from current literature, and generate specific hypotheses to be tested using existing cohort data.
A systematic review was conducted to summarize existing evidence of risk factors for musculoskeletal pain onset in children and adolescents. Two child and adolescent prospective cohort datasets and a local primary care consultation database were used to test hypotheses using logistic and survival regression analysis.
The systematic review found evidence that sleep problems and psychological symptoms (internalizing and externalizing) were associated with musculoskeletal pain onset with added evidence of potential effect modifiers. For sleep problems, analysis within a prospective cohort showed higher odds (OR 1.35, 95%CI 0.84, 2.16) for musculoskeletal pain onset, but this association was significant only for chronic pain onset (OR 2.22, 95%CI 1.43, 3.44), with evidence of effect modification by gender (association was stronger in boys). Testing within a primary care cohort showed a 49% increased hazard of sleep consultations with musculoskeletal consultations. In a cohort of adolescents musculoskeletal pain was not significantly associated with internalizing symptoms (OR 1.43, 95%CI 0.96, 2.12), however a significant association was found for externalizing symptoms (adjusted OR 1.99, 95% CI 1.28, 3.10), with evidence of effect modification by pubertal status and screen time use. Testing in a primary care cohort revealed a 39% increased hazard for musculoskeletal consultations.
Potential risk factors (sleep and psychological symptoms) and effect modifiers were identified for (chronic) musculoskeletal pain onset within child and adolescent population and primary care samples. Future work is required to explore mechanisms explaining these associations, and develop appropriate interventions.
|Jun 1, 2018