Objectives Musculoskeletal pain is common among children and adolescents. Despite the lack of evidence regarding harms and benefits, musculoskeletal pain is often managed with pain medication. The aim of this systematic review is to assess the prevalence of pain medication use for musculoskeletal pain among children and adolescents and the factors and side effects associated with use. Content Three databases (EMBASE, CINAHL and PsychINFO) were systematically searched to identify studies designed to examine the prevalence, frequency or factors associated with the use of pain medication for musculoskeletal pain in children and adolescents (aged 6–19 years). The included studies were assessed for study quality and data were extracted. Summary The search initially provided 20,135 studies. After screening titles, abstracts and full-texts, 20 studies were included. In school settings, 8–42% of children used pain medication for musculoskeletal pain, and 67–75% of children in sports clubs and from pain clinics used pain medication. The most consistent factors associated with the use of pain medications were pain characteristics and psychological factors (e.g. being bullied, low-self-esteem), while mixed evidence was found for increasing age and female gender. Only two studies reported on the duration of use and only one study on adverse effects related to the use of pain medication. Outlook We found that 8–42% of adolescents from school-based samples use pain medication for MSK pain, while the prevalence among adolescents from sports clubs and pain clinics is higher (67–75%). Pain characteristics (pain duration, severity, intensity, disability levels and the presence of ≥2 pain conditions or multisite pain) and psychological factors were associated with a higher use of pain medication, while for higher age and female gender the evidence of association was mixed. Future studies should systematically collect information on the type, duration of use of pain medication and side effects to confirm the findings of this review.

Objectives: The aim of this study was to investigate how a specifically designed teaching program for adolescents on the subject of pain medication affects their knowledge and attitudes regarding pain medication. Methods This prospective interventional study used both quantitative and qualitative methods. The teaching intervention was codeveloped with end users. Adolescents completed a questionnaire at 3 time points: 1) at baseline before the teaching intervention, 2) immediately after the intervention and 3) at follow-up after approximately 1 or 2 months, depending on the schools' availability. A qualitative component with interviews on a subsample of participants was carried out between baseline and the 1 or 2 months follow-up. Results Nine classes, corresponding to 181 adolescents with a median age of 14 were exposed to the teaching intervention. 22% used pain medication at least once a week at baseline. Their baseline knowledge regarding the mechanism of action, side effects, dosage, and alternative methods to treat pain was low. Their levels of knowledge improved after the teaching intervention and we observed higher levels of knowledge and less uncertainty. However, despite the immediate positive effect, the retainment of knowledge was slightly reduced at the 1 or 2 month follow-up. Discussion Our intervention increased the overall knowledge on pain medication and reduced the adolescents' uncertainty. However, the retainment of knowledge was reduced after 1 or 2 month follow-up. Future interventions carried out on a longer time-span and with the inclusion of parents and delivery of online material might be designed to improve retainment of knowledge.