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: Chronic musculoskeletal pain is a common complaint among adolescents and its prevalence has been increasing over the last few years. Several different factors have been associated with chronic musculoskeletal pain and associated disability in adolescents, including psychosocial factors, sleep, and physical activity. Both psychosocial factors and sleep impairments also have been associated with central sensitization. However, few studies have explored the association between psychosocial factors, sleep, central sensitization, and pain and disability or have compared different painful conditions.

Purpose: The study aims to explore and compare the association between chronic neck, back and limb pain and associated disability and psychosocial factors, sleep, and central sensitization.

Methods: 1730 adolescents who attended the 10th, 11th, and 12th grades from four high schools in Portugal, were asked to complete an online questionnaire including sociodemographic data and the
i) Nordic Musculoskeletal Questionnaire,
ii) International Questionnaire of Physical Activity,
iii) Functional Disability Inventory,
iv) Depression, Anxiety and Stress Scale,
v) Basic Scale on Insomnia Complaints and Quality of Sleep,
vi) Pain Catastrophizing Scale,
vii) Tampa Scale of Kinesiophobia,
viii) Child Self-Efficacy Scale and
ix) Central Sensitization Inventory.
Based on pain location, adolescents with chronic pain were grouped into one of three groups:
i) neck pain,
ii) back (thoracic and low back) pain, and
iii) lower limb pain.
Independent univariable and multivariable regression analysis with pain and disability as the dependent variables were conducted.

Results: A total of 1435 adolescents were subdivided into the group with neck pain (n=753), the group with back pain (n=384) and into the group with limb pain (n=298). The multivariable regression analysis suggested that female gender (OR=1.72-3.88; CI95%=1.20-5.38; p<0.05) significantly increased the odds of reporting pain in any of the three groups. Sleep impairments (OR=1.58; CI95%=1.10-2.27 and OR=2.07; CI95%=1.42-3.02; p<0.05) and symptoms of central sensitization (OR=5.25; CI95%=2.56-10.76 and OR=3.49; CI95%=1.64-7.45; p<0.05) were associated with increased odds of reporting neck and back pain and fear of movement (OR=1.99; CI95%=1.37-2.88; p<0.05) was associated with increased odds of reporting back and limb pain. Regarding disability, catastrophizing, number of painful body sites and sleep were associated with increased pain-associated disability for all groups. Anxiety, depression, and stress were associated with increased disability in the group with neck and back pain, central sensitization and self-efficacy were associated with increased disability in the group with neck pain and BMI and fear of movement were associated with increased disability in the group with limb pain. The adjusted R² was 0.42 for the group with neck pain, 0.34 for the group with back pain and 0.24 for the group with limb pain.

Conclusion(s): The findings suggest that there are common but also different determinates associated with the presence of chronic neck, back and limb pain and disability. 

Implications: Pain assessment and interventions in adolescents with chronic musculoskeletal pain may have a common structure, however, they also need a specific component that target those determinates that are specific of each group. School-based interventions are a means of reaching a high number of adolescents with chronic pain.

Funding, acknowledgements: 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, Predictors, Adolescents

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.

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