R. Andias1,2, A.G. Silva1,3
1University of Aveiro, School of Health Sciences (ESSUA), Aveiro, Portugal, 2Center for Health Technology and Services Research (CINTESIS), Porto, Portugal, 3Center for Health Technology and Services Research (CINTESIS.UA), Aveiro, Portugal
Background: A significant percentage of adolescents with chronic musculoskeletal pain maintain their complaints at long term follow-up, with a major impact on their daily activities. Depression, anxiety, and sleep impairments have been identified in some longitudinal studies as being associated with the persistence of chronic musculoskeletal pain in adolescents and their impact seems to vary depending on the painful area. However, studies that perform a direct comparison between different painful areas are scarce.
Purpose: This study aims to explore the association between sociodemographic characteristics, physical activity, psychosocial factors, sleep, and central sensitization at baseline, and the persistence of chronic neck, back and limb pain at 6 months follow-up.
Methods: A total of 1605 adolescents completed the same online questionnaire both at baseline and at 6 months follow up, which included:
i) sociodemographic data,
ii) Nordic Musculoskeletal Questionnaire,
iii) International Questionnaire of Physical Activity,
iv) Functional Disability Inventory,
v) Depression, Anxiety and Stress Scale,
vi) Basic Scale on Insomnia Complaints and Quality of Sleep,
vii) Pain Catastrophizing Scale,
viii) Tampa Scale of Kinesiophobia,
ix) Child Self-Efficacy Scale and
x) Central Sensitization Inventory.
At follow up each adolescent was categorized into one of two groups:
i) “persistent” if reporting pain at the same location as reported in the baseline or
ii) “recovered” if no longer reporting pain at the area where pain was felt at the baseline or reporting a decrease in pain intensity by at least 50%.
Univariable and multivariable regression analysis with persistent/recovered as the dependent variable were conducted.
i) sociodemographic data,
ii) Nordic Musculoskeletal Questionnaire,
iii) International Questionnaire of Physical Activity,
iv) Functional Disability Inventory,
v) Depression, Anxiety and Stress Scale,
vi) Basic Scale on Insomnia Complaints and Quality of Sleep,
vii) Pain Catastrophizing Scale,
viii) Tampa Scale of Kinesiophobia,
ix) Child Self-Efficacy Scale and
x) Central Sensitization Inventory.
At follow up each adolescent was categorized into one of two groups:
i) “persistent” if reporting pain at the same location as reported in the baseline or
ii) “recovered” if no longer reporting pain at the area where pain was felt at the baseline or reporting a decrease in pain intensity by at least 50%.
Univariable and multivariable regression analysis with persistent/recovered as the dependent variable were conducted.
Results: Of the 1605 adolescents, 669 (41.7%%) reported chronic neck pain, 305 (19.0%) back pain and 277 (17.3%) limb pain. Of those with neck pain, 178 (23.6%) were categorized as recovered and 334 (44.4%) as persistent. Of those with back and limb pain, 49 (12.8%) and 60 (20.1%) were categorized as recovered and 122 (40.9%) and 98 (32.9%) as persistent, respectively. Being female (OR=1.53; CI95%=1.00-2.33; p<0.05) and having a higher number of painful body sites (OR=1.12; CI95%=1.00-1.25; p<0.05) at baseline were predictors of persistent neck pain at 6 months follow up. Symptoms of central sensitization (OR=1.03; CI95%=1.00-1.06; p<0.05) were a predictor of persistent back pain, and poor sleep (OR=1.15; CI95%=1.03-1.28; p<0.05) and higher number of painful body sites (OR=1.87; CI95%=1.11-3.14; p<0.05) were predictors of persistent limb pain.
Conclusion(s): A higher number of painful body sites at baseline seems to be a relevant factor in predicting the persistence of pain at follow-up, highlighting the need of assessing and treating the adolescent with pain as a whole.
Implications: The fact that predictive factors vary across the 3 groups also suggests that the assessment and the intervention in adolescents with chronic musculoskeletal pain should be tailored and directed at those with multiple body sites, symptoms of central sensitization, and poor sleep as an attempt to minimize pain persistence.
Funding, acknowledgements: This work is part of a PhD scholarship from the Foundation for Science and Technology (SFRH/BD/119528/2016), Portugal.
Keywords: Chronic musculoskeletal pain, Adolescents, Prospective study
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: University of Aveiro
Committee: Council of Ethics and Deontology of the University of Aveiro
Ethics number: 19/2018
All authors, affiliations and abstracts have been published as submitted.
