Onset, prognosis and risk factors for widespread pain in schoolchildren: A prospective 4-year follow-up study

Abstract

Little is known about the epidemiology of widespread pain (WSP) in children and adolescents. This study aims to estimate the new-onset and prognosis of WSP in schoolchildren and investigate factors predicting its development. A prospective study was conducted among 1756 schoolchildren (age 10-12 years) in Southern Finland. At baseline, information was collected on WSP, regional musculoskeletal pain symptoms, depressiveness, fatigue, sleep problems, physical activity and joint hypermobility. These children were contacted again 1 year and 4 years later to determine the outcome and the new-onset of WSP. A total of 1282 children (73%) of the baseline study population were found at both follow-ups. Of the children who had WSP at baseline, 31% and 30% reported persistence/recurrence of symptoms at 1- and 4-year follow-up, respectively. However, only 10% of these children reported WSP at both 1 and 4 years. Of the children who were free of WSP at baseline, 18% reported new-onset WSP at 1-year follow-up and 3% reported these symptoms at both follow-up times. The independent baseline risk factors of WSP were older age (OR 1.3 95% CI 1.0-1.8), female gender (OR 1.4, 1.1-1.9), depressiveness (OR 1.5, 1.1-2.2) and regional back pain symptoms (Neck pain: OR 1.7, 1.1-2.4; Upper back pain: OR 2.1, 1.1-4.1; Lower back pain: OR 3.0, 1.6-5.7). Both psychological factors and somatic pain symptoms predict future development of WSP in adolescents.

Low Back Pain With Impact at 17 Years of Age Is Predicted by Early Adolescent Risk Factors From Multiple Domains: Analysis of the Western Australian Pregnancy Cohort (Raine) Study

“…17 Neck/shoulder pain at 14 years of age was identified as increasing the odds for LBP, with and without impact, highlighting that for many people, LBP is comorbid with other pain areas, as previously reported. 24,33 This supports the view that LBP in these cases may be part of a clinical presentation of widespread pain rather than a local tissue disorder.…”

Are Sleep Problems a Risk Factor for the Onset of Musculoskeletal Pain in Children and Adolescents? A Systematic Review

“…When considering only high-quality evidence, similar rates are found (high-quality findings; two studies 34,38 reported significant higher risk, one study 31 mixed, and five findings 31,[35][36][37] no higher risk). Overall, this indicates a trend toward strong evidence of no effect of poor sleep quality as a risk factor for the onset of musculoskeletal pain.…”

“…Of eight findings, two 34,37 (high quality) report a significant effect (both findings in the direction of daytime tiredness predictive of musculoskeletal pain), three 31 (high quality) report mixed effects, and three 36,39,42 (two high quality) report no significant effect indicating inconsistency, with a similar conclusion if only high-quality evidence is considered (please see Table 6 for a full description of effect sizes). Examination by body site revealed one high-quality 31 study reporting mixed evidence and one medium-quality 39 study reporting no effect for back pain onset.…”

“…For widespread pain onset, three high-quality findings are reported. While one study 38 reported significant findings, two studies 35,36 reported no significant effects indicating inconclusive evidence.…”

“…Overall, 10 findings were reported, with 2 findings 34,38 showing that children with poor sleep quality are significantly at higher risk (both findings in the direction of poor sleep quality predictive of musculoskeletal pain), one finding 31 showing mixed evidence, and seven findings 31,[35][36][37]39,40 showing no significant higher risk (please see Table 4 for a full description of effect sizes). When considering only high-quality evidence, similar rates are found (high-quality findings; two studies 34,38 reported significant higher risk, one study 31 mixed, and five findings 31,[35][36][37] no higher risk).…”