Risk factors for development of non-specific musculoskeletal pain in preteens and early adolescents: a prospective 1-year follow-up study

Etiology and Diagnostic Challenges of Ulnar Wrist Pain in Pediatric and Adolescent Patients

PURPOSE

Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology.

METHODS

A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction.

RESULTS

A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n = 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n = 27, 68%) followed by UT split tears (n = 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury.

CONCLUSION

While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic IIb.

Focus Groups to Inform User-Centered Development of an eHealth Sleep Intervention for Adolescents: Perspectives of Youth with Insomnia Symptoms, with and without Pain

INTRODUCTION

Adolescence is a developmental stage that often coincides with increasing sleep problems. Focus groups were conducted to inform development of an adolescent eHealth sleep intervention by exploring opinions about (1) healthy sleep practices, and (2) using an eHealth intervention.

METHODS

Adolescents 14-18 years old experiencing symptoms of insomnia based on the Insomnia Sleep Index, with and without recurrent pain, and associated stakeholders (i.e., parents, school personnel, and health care providers) were recruited. Across six online focus groups, 24 adolescents with insomnia participated (14 pain-free, 10 with recurrent pain; 10 male, 14 female). Across seven online focus groups, 22 stakeholders participated, including 8 parents, 9 school professionals, and 5 health care providers (10 male, 8 female). Using a content analysis, subthemes were induced from transcripts.

RESULTS

Most healthy sleep practices were perceived as reasonable for adolescents to implement, except avoiding technology before bed and using bedrooms only for sleep. Three primary barriers to sleep practices were identified, including a variable schedule due to lifestyle factors, technology at night, and academics interfering with sleep, and only in the pain group, the barrier related to pain was identified. Content addressing adolescent-specific barriers was considered important to include in a sleep intervention. Desirable eHealth components included interactive features, videos, audio, and pictures to present information. A common barrier to using an eHealth sleep intervention was the program feeling too academic, with accessibility of the sleep information and strategies as a common facilitator.

CONCLUSIONS

This research represents the first step in a user-centered approach to developing an adolescent eHealth sleep intervention. These results provide insights from a range of perspectives on guiding adolescents to follow healthy sleep practices. Next, these findings will be integrated in the development of an eHealth intervention for adolescents with and without recurrent pain.

Frequency of Knee Pain and Risk Factors and Its Impact on Functional Impairment: A Cross-Sectional Study from Saudi Arabia

BACKGROUND

Adolescents frequently self-report pain, according to epidemiological research. The knee is one of the sites wherein pain is most commonly reported. Musculoskeletal disorders play a significant role in the prolonged disability experienced by individuals, leading to substantial global personal, societal, and economic burdens. Patellofemoral pain (PFP) is a clinical knee pain commonly affecting adolescents. This study aimed to estimate the frequency of knee pain in Saudi adolescents.

METHODS

This cross-sectional survey was conducted from June to November 2022 and included 676 adolescents aged 10 to 18 years. The participants were questioned regarding their demographics, school habits, and the impact of these factors on back pain, musculoskeletal pain in the past 12 months, as well as quality-of-life scale and knee pain symptoms. The data were analyzed using descriptive statistics, with frequencies and percentages presented for categorical variables. Analysis of variance (ANOVA) was performed to compare means between groups, while the chi-squared test was used to compare categorical variables. Statistical significance was set at p < 0.05.

RESULTS

A total of 676 adolescents participated in the study, with 57.5% females and 42.5% males. Among the participants, 68.8% were aged between 15 and 18 years. The prevalence of knee pain was notably higher among females (26%) compared to males (19.2%). Age and BMI were identified as significant predictors of knee pain. A significant association was also found between BMI classification and knee stiffness (p-value = 0.008). Furthermore, a significant difference was observed between adolescents who engaged in physical activities during leisure time and those who experienced difficulty bending (p-value = 0.03).

CONCLUSIONS

Our study highlights a high prevalence of knee pain among Saudi adolescents, emphasizing the need for increased awareness about its risk factors. Preventive measures, including conservative approaches and lifestyle/activity modifications, can effectively mitigate adolescent knee pain.

Accumulation of health complaints is associated with persistent musculoskeletal pain two years later in adolescents: The Fit Futures study

There is limited knowledge on the association between different health complaints and the development of persistent musculoskeletal pain in adolescents. The aims of this study were to assess whether specific health complaints, and an accumulation of health complaints, in the first year of upper-secondary school, were associated with persistent musculoskeletal pain 2 years later. We used data from a population-based cohort study (the Fit Futures Study in Norway), including 551 adolescents without persistent musculoskeletal pain at baseline. The outcome was persistent musculoskeletal pain (≥3 months) 2 years after inclusion. The following self-reported health complaints were investigated as individual exposures at baseline: asthma, allergic rhinitis, atopic eczema, headache, abdominal pain and psychological distress. We also investigated the association between the accumulated number of self-reported health complaints and persistent musculoskeletal pain 2 years later. Logistic regression analyses estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs). At the 2-year follow-up, 13.8% (95% CI [11.2-16.9]) reported persistent musculoskeletal pain. Baseline abdominal pain was associated with persistent musculoskeletal pain 2 years later (OR 2.33, 95% CI [1.29-4.19], p = 0.01). Our analyses showed no statistically significant associations between asthma, allergic rhinitis, atopic eczema, headache or psychological distress and persistent musculoskeletal pain at the 2-year follow-up. For the accumulated number of health complaints, a higher odds of persistent musculoskeletal pain at the 2-year follow-up was observed for each additional health complaint at baseline (OR 1.33, 95% CI [1.07-1.66], p = 0.01). Health care providers might need to take preventive actions in adolescents with abdominal pain and in adolescents with an accumulation of health complaints to prevent development of persistent musculoskeletal pain. The potential multimorbidity perspective of adolescent musculoskeletal pain is an important topic for future research to understand the underlying patterns of persistent pain conditions in adolescents.

Predictors of Musculoskeletal Pain among Primary School Students Using Smartphones in Nakhon Si Thammarat, Thailand

School-age children increasingly use smartphones to conduct their learning activities; increasing reports of disorders related to smartphone use exist, including visual-related symptoms, stress, and musculoskeletal pain. This study aimed to examine risk factors for musculoskeletal pain among primary school students using smartphones. A cross-sectional study was conducted with 233 school-aged children in Nakhon Si Thammarat, Thailand. Data collection used a questionnaire for musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire with ISO 11,226:2000. Through Chi-square, t-test, and logistic regression analysis, factors independently associated with musculoskeletal pain were determined. An important factor in the development of musculoskeletal pain was the prolonged use of smartphones for longer than 60 min, particularly among children aged 6-9 years old. In regards to musculoskeletal pain, almost 53% of the students used their smartphones while lying down. Posing in a prone position while using a smartphone was 7.37 times more dangerous than sitting. The laying position tilts numerous organs at varying angles, especially the upper arm. The risk of musculoskeletal complaints must be reduced by educating parents, children, and the relevant government organizations about safe smartphone usage. The mentioned factors may be used to anticipate the onset of musculoskeletal pain caused by smartphone use in young children.

Impact of sex, sleep, symptoms of central sensitization and psychosocial factors in adolescents with chronic musculoskeletal pain-an exploratory study

OBJECTIVE

This study aimed to explore and compare the association between psychosocial factors, sleep, central sensitization, and chronic neck, back, limbs, and multiregional pain and disability.

METHODS

1730 adolescents responded to an online questionnaire containing: sociodemographic data, Nordic Musculoskeletal Questionnaire, International Physical Activity Questionnaire, Functional Disability Inventory, Depression, Anxiety and Stress Scale, Basic Scale on Insomnia Complaints and Quality of Sleep, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Child Self-Efficacy Scale and Central Sensitization Inventory. Univariable and multivariable regression analysis was used to assess the associations between these variables and pain and disability.

RESULTS

Groups were categorized into neck (n = 54), back (n = 80), upper limb (n = 52), lower limb (n = 109) and multiregional (n = 1140) pain. Multivariable analysis showed that symptoms of central sensitization increased odds of neck, back, and multiregional pain; depression, anxiety and stress, and physical activity increased odds of multiregional pain; and fear of movement increased odds of lower limb pain. Female gender increased the odds of pain in all groups, except in the lower limb group. Depression, anxiety, and stress also remained associated with disability in neck, back, upper limb, and multiregional pain; poorer sleep remained associated with disability in neck, upper limb, and multiregional pain; catastrophizing remained associated with back, and multiregional pain; and fear of movement and symptoms of central sensitization were only associated with disability in multiregional pain.

CONCLUSIONS

There are similar but also different variables associated with the presence of pain and disability in the neck, back, limbs, and multiregional pain.

The Onset of Chronic Musculoskeletal Pain in High School Adolescents: Associated Factors and the Role of Symptoms of Central Sensitization

OBJECTIVE

This study aimed to investigate the association between sociodemographic data, physical activity, depression, anxiety, and stress, sleep, and self-reported symptoms of central sensitization at baseline, in asymptomatic adolescents, and the onset of pain at 6-months follow-up.

METHODS

A total of 252 asymptomatic adolescents were assessed at baseline with an online questionnaire that included sociodemographic data, the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire for Adolescents; the Depression, Anxiety and Stress Scale for Children; the Basic Scale on Insomnia complaints and Quality of Sleep; and the Central Sensitization Inventory. The same questionnaire was repeated at 6-months follow-up.

RESULTS

Of the 231 (91.7%) adolescents who completed the questionnaire at the follow-up, 127 (55.0%) remained asymptomatic and 88 (38.1%) reported a new onset of pain. At the 6-month follow-up, the mean (SD) number of painful body sites was 1.81 (1.04), and the neck region was the most reported (n = 29, 33%). Multivariable analysis showed that being female (OR = 2.34; 95% CI = 1.28-4.27) and reporting more self-reported symptoms of central sensitization (OR = 1.04; 95% CI = 1.01-1.07) were associated with the onset of chronic pain at follow-up.

CONCLUSION

Female sex and self-reported symptoms of central sensitization were considered risk factors for the onset of pain in adolescents but should be further explored in future studies.

IMPACT

Considering the increasing prevalence of chronic musculoskeletal pain in adolescents, understanding the factors that may be associated with its new onset may help to better design preventive strategies and thus minimize the appearance of this type of pain in adolescents.

The associations between sleep disturbance, psychological dysfunction, pain intensity, and pain interference in children with chronic pain

OBJECTIVES

This study aimed to better understand the associations between both sleep disturbance and psychological dysfunction (i.e., anxiety and depressive symptoms, and anger), and pain intensity and pain interference, in a sample of children with chronic pain.

DESIGN

Cross-sectional design.

METHODS

Three hundred and forty-two children with chronic pain (8-18 years) completed measures assessing pain intensity, pain interference, sleep disturbance, anxiety, depressive symptoms, and anger. Regression analyses examined the direct, interaction (with sex), and mediation effects of sleep quality and psychological dysfunction on pain intensity and interference.

RESULTS

Sleep disturbance was significantly associated with both pain intensity and pain interference. However, measures of psychological dysfunction were associated significantly only with pain interference. Sex did not moderate these associations. The measures of psychological dysfunction mediated the associations between sleep disturbance and pain interference, but not those between sleep disturbance and pain intensity.

CONCLUSIONS

The results confirmed significant cross-sectional associations between both sleep disturbance and psychological dysfunction and pain outcomes in children with chronic pain. Future research to test for causal associations is warranted.

From One Pain to Many: The Emergence of Overlapping Pains in Children and Adolescents

OBJECTIVES

The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains.

METHODS

A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study.

RESULTS

Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001).

DISCUSSION

Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.

Risk factors and risk profiles for neck pain in young adults: Prospective analyses from adolescence to young adulthood-The North-Trøndelag Health Study

The objective was to investigate risk factors and risk profiles associated with neck pain in young adults using longitudinal data from the North-Trøndelag Health Study (HUNT). Risk factors were collected from adolescents (13-19 years of age), and neck pain was measured 11 years later. The sample was divided into two: Sample I included all participants (n = 1433), and Sample II (n = 832) included only participants who reported no neck/shoulder pain in adolescence. In multiple regression analyses in Sample I, female sex (OR = 1.9, 95% CI [1.3-2.9]), low physical activity level (OR = 1.6, 95% CI [1.0-2.5]), loneliness (OR = 2.0, 95% CI [1.2-3.5]), headache/migraine (OR = 1.7, 95% CI [1.2-2.6]), back pain (OR = 1.5, 95% CI [1.0-2.4]) and neck/shoulder pain (OR = 2.0, 95% [CI 1.3-3.0]) were associated with neck pain at the 11-year follow-up. Those with a risk profile including all these risk factors had the highest probability of neck pain of 67% in girls and 50% in boys. In Sample II, multiple regression analyses revealed that female sex (OR = 2.2, 95% CI [1.3-3.7]) and perceived low family income (OR = 2.4, 95% CI [1.1-5.1]) were associated with neck pain at the 11-year follow-up. Girls and boys with a perceived low family income had a 29% and 17% higher probability of neck pain than adolescents with a perceived high family income. The risk profiles in both samples showed that co-occurrence of risk factors, such as headache/migraine, neck/shoulder pain, back pain, low physical activity level, loneliness, and perceived low family income cumulatively increased the probability of neck pain in young adulthood. These results underline the importance of taking a broad perspective when studying, treating, and preventing neck pain in adolescents.

Sagittal body alignment in a sitting position in children is not affected by the generalized joint hypermobility

Back pain may be related to an improper sitting position. The aim of the study was to assess the sagittal curvatures of the spine in a sitting position in children with generalized joint hypermobility (GJH). The study included 302 children aged 8-14 years. The sagittal curvatures of the spine (sacral slope, lumbar lordosis, thoracic kyphosis with its lower and upper part) were assessed using the Saunders digital inclinometer. In order to assess GJH a 9-point Beighton scale was used. The study revealed no significant differences (p > 0.05) in sagittal curvatures of the spine in a relaxed sitting position between children with and without GJH. Regardless of the occurrence of GJH, kyphotic alignment of the spine was noted in a relaxed sitting. GJH does not affect the position of the trunk in a sagittal plane in a relaxed sitting position in children aged 8-14 years. A relaxed sitting position in children with and without GJH is characterized by a kyphotic position of the spine caused by an improper position of pelvis and lumbar segment of the spine.

Garment Integrated Spinal Posture Detection Using Wearable Magnetic Sensors

Spine Curvature Disorder (SCD) is a medical condition that affects the shape of the spine. Methods of monitoring SCDs involve visual inspection followed by X-rays and measurements. Once a patient is diagnosed with SCD and treatment or therapy is implemented, progress is tracked by exposing the patient to multiple periodic X-rays to determine the spine responses to treatments or therapies. Multiple exposures to X-rays is not desirable and is also costly. Therefore, we propose a new method for detecting and monitoring SCD and present our initial research results. We are implementing a non-invasive method that can detect and monitor the spinal postures of SCD. Magnets are placed on a shirt a grid form then a sensor system would be placed on the chest of the body. An on-body magnetic sensor records the sensor data values to determine if the upper body posture is straight or is curved which in turn can assist in detecting if the spine is deformed. We present our initial results on magnetic sensor testing and preliminary results using wearable sensors and a garment integrated magnetic shirt.

Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8-16 years

Background

Knowledge about the occurrence and distribution of musculoskeletal problems in early life is needed. The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain.

Method

Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually.

Results

When pain was defined as at least 1 week with pain during a school year, Danish schoolchildren could be divided into three almost equally large groups for all three school years: Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions. Most commonly children experienced pain from the lower extremities (~ 60%), followed by the spine (~ 30%) and the upper extremities (~ 23%). Twice as many girls reported pain in all three sites compared to boys (10% vs. 5%) with no other statistically significant sex or age differences observed. When pain was defined as at least 3 weeks with pain during a schoolyear, 40% reported pain with similar patterns to those for the more lenient pain definition of 1 week.

Conclusion

Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes.

Nonspecific wrist pain in pediatric patients: A systematic review

Determining the cause of wrist pain is a challenge for clinicians due to the complex biomechanical characteristics of the multiple articulations which comprise the wrist, and the intricacies of the soft tissue supporting them. Patients presenting with wrist pain can be diagnosed by obtaining a detailed history, physical examination and radiographic images. For some patients, a diagnosis remains elusive even after a complete appropriate work up, and the pain may persist following conservative management. The aim of this systematic review was to analyze the effect that psychosocial factors have on the development chronic idiopathic wrist pain in children and adolescents.

Test-retest repeatability of questionnaire for pain symptoms for school children aged 10-15 years

Background and aims There is a growing body of evidence, that pain is common at school age. Less is known about the repeatability of pain questionnaires for children. This study aimed to assess the test-retest repeatability of the Finnish version of the electronic pain questionnaire for school-aged children. Methods Primary (n = 79) and lower secondary (n = 127) schoolchildren aged 10-15 years from two schools from the Jyväskylä region of Finland, filled in an electronic questionnaire twice in an interval of 2 weeks. It captured the frequency of pain symptoms with a five-point Likert-scale questionnaire covering nine areas of the body for the last 3 months. The intraclass correlation coefficient (ICC) values 0.40-0.59 reflected fair and 0.60-0.74 good repeatability. Results The highest prevalences of pain were in the head (29%) and neck and shoulder (NS) (23%) areas. ICC values showed good repeatability for questions about pain frequency in the head, NS and lower extremities. In primary school, these values were good in the lower extremities and fair in NS, lower back and the head. In lower secondary school, the ICC values were good in NS and the head, fair in the stomach and lower extremities. Conclusions This electronic questionnaire was an acceptably repeatable indicator to measure the frequency of pain in the most prevalent pain areas: the head and NS. Implications It is important to be aware of the impact of health-related outcomes on children's ability to be successful in their lives. With the help of a simple electronic questionnaire, it is possible to cost-effectively capture, for example, the prevalence and frequency of pain during the school hours. The identification of children's pain symptoms accurately provides more possibilities to prevent and to minimize the chronic pain among schoolchildren.

Neck and shoulder pain among elementary school students: prevalence and its risk factors

Background

Neck and shoulder pain is relatively common among children and teenagers and has a negative impact on their physical and psychological health. This study was carried out to assess the prevalence of neck and shoulder pain among elementary school students, and to investigate the relationship between this pain and its risk factors.

Methods

In this cross-sectional study, 693 elementary school students aged 7 to 12 years from Hamadan city, located in western Iran, were selected through the multistage cluster random sampling method. Data were collected through interviews and questionnaires. For the social and psychological variables, the parent version of the Strengths and Difficulties Questionnaire (SDQ) was used. For assessing each student’s posture, an observational checklist, the Rapid Upper Limbs Assessment (RULA), was used. The data was analyzed using the unadjusted (univariate) and adjusted (multivariate) logistic regression.

Results

The prevalence of the neck pain was slightly higher than that of shoulder pain. The prevalence reported over a month was 35.8 and 30.9% for neck and shoulder pain, respectively. The logistic regression analyses showed that, very high desk height (odds ratio (OR) =1.96, 95% confidence interval CI: 1.02–3.74), backward seat pan inclination (OR = 2.10, 95% CI: 1.37–3.24), forward seat pan inclination (OR = 3.12, 95% CI:1.46–6.68), difficulty in viewing the board (OR = 2.54, 95% CI: 1.10–5.84), too much homework (OR = 2.59, 95% CI: 1.49–4.51), RULA score at level III (OR = 2.88, 95% CI:1.64–5.05), and RULA score at level IV (OR = 3.12, 95% CI: 1.72–5.63) increased the risk of neck pain independently. On the other hand, sitting on desk and seat (OR = 0.59, 95% CI: 0.39–0.91) and laying position for doing homework (OR = 0.53, 95% CI: 0.34–0.81) reduced the related risk. Very short desk height (OR = 2.41, 95% CI: 1.26–4.61) and too much homework (OR = 1.94, 95% CI: 1.10–3.42) increased the risk of shoulder pain.

Conclusion

The elementary school students reported a high prevalence of shoulder and neck pain. This study found that improper sitting positions, as well as physical factors such as the school furniture, too much homework, and difficulty in viewing the classroom board, were associated with pain. Proper interventions considering the risk factors assessed in this study, are suggested.

Prevalence of back pain and the knowledge of preventive measures in a cohort of 11619 Polish school-age children and youth-an epidemiological study

The study sought to characterize back pain (BP) (in the period of 12 months) in children and youth aged 10 to 19 from eastern Poland.The study included 11619 children and youth (6254 girls and 5365 boys) aged 10 to 19 from eastern Poland. An original questionnaire was applied as a research tool. Before the study, the reliability of the questionnaire had been assessed. The Kappa coefficient value for all the analyzed variables was equal to or higher than 0.91.Over 74.4% of the respondents admitted that within the last 12 months, they had experienced BP which was usually located in the lumbar spine (55.8%). The percentage of individuals reporting BP increased with age of participants. Girls reported BP more often than boys (82.8% vs 64.3%). The main circumstances in which BP occurred included lifting heavy objects, carrying school backpack and maintaining a sedentary position (70.7% vs 67.4% vs 67.8%). Over 67% of the respondents declared they did not know ergonomic principles.High prevalence of BP was noted. The declared BP was mainly located in the lumbar spine. Girls reported BP more often than boys. The students presented a very low level of knowledge about ergonomics. Therefore, the appropriate education should be included at school.

Prevalence of self-reported musculoskeletal pain symptoms among school-age adolescents: age and sex differences

BACKGROUND AND AIMS

Non-specific musculoskeletal pain symptoms are common in adolescents and may differ between the sexes, and be related to age and daily activities. It is critical to examine the prevalence and frequency of symptoms in adolescent students who tend to have pain which interferes with their routine activities. This study aimed to explore the prevalence and frequency of self-reported musculoskeletal pain symptoms by age and sex, and we also examined the association of symptoms with routine activities of school-age adolescents by area of pain.

METHODS

A cross-sectional survey was conducted among Thai students aged 10-19 years. All 2,750 students were asked to report previous 7-day and/or 12-month pain using the Standardized Nordic Questionnaire (Thai version) in 10 body areas. Multivariable logistic regression adjusted for age and sex was used to analyze the association between daily activity and musculoskeletal pain symptoms.

RESULTS

A total of 76.1% (n=2,093) of students reported experiencing pain in the previous 7 days, 73.0% (n=2,007) reported in the previous 12-month period and 83.8% (n=2,304) reported pain in both 7-day and 12-month periods. The most common pain area was from a headache, with other areas being neck and shoulders, in that order, for both periods of time. The prevalence of musculoskeletal pain was especially higher in older groups and females. Participants reported frequency of pain as "sometimes in different areas" ranging from 78.4% to 88% and severity of pain at 3.82±2.06 out of 10 (95% CI 3.74-3.91). Routine daily activities associated with symptoms of headache, neck, shoulders, and ankles or feet pain were computer use (head, OR=2.22), school bag carrying (neck, OR=2.05), school bag carrying (shoulder, OR=3.09), and playing sports (ankle or foot, OR=2.68).

CONCLUSIONS

The prevalence of musculoskeletal pain symptoms was high in both the previous 7-day and 12-month periods, especially in females and older adolescents, although most of them sometimes experienced pain. Computer use and school bag carrying were associated with headache, neck and shoulder pain, while playing sports was related to symptoms of the foot and ankle.

IMPLICATIONS

The prevalence of pain was high, particularly in the older and female groups. Although they experienced mild symptoms sometimes, the related daily activities leading to these symptoms should be closely noticed.

Musculoskeletal Multisite Pain and Patterns of Association After Adjusting for Sleep, Physical Activity, and Screen Time in Adolescents

STUDY DESIGN

Cross-sectional.

OBJECTIVE

This study aims to describe how pain at multiple body sites is associated after controlling for other predictive factors such as age, sex, sleeping hours, time spent in physical activity, and time spent in screening based activities in adolescents aged 13 to 19 years.

SUMMARY OF BACKGROUND DATA

The prevalence of multisite pain in adolescents is high, but studies investigating the patterns of association between painful body sites are scarce.

METHODS

Pain for the last 3 months was assessed using Nordic Musculoskeletal Questionnaire. In addition, data on time spent in moderate and vigorous physical activity, sleeping, and in screen based activities were also assessed.

RESULTS

In univariable analysis of associations, there is a significant association between most painful body sites (odds ratio [OR\ between 1.52 and 3.73, P < 0.05). After controlling for age, sex, physical activity, sleep and screen time, most of the previous associations remain significant (OR between 1.50 and 3.07, P < 0.05).

CONCLUSION

This study's results seem to suggest that pain at one body site is more important in determining multiple painful body sites than demographic or lifestyle factors. Longitudinal studies exploring the association and chronology of multisite pain are needed.

LEVEL OF EVIDENCE

3.

Does lower extremity pain precede spinal pain? A longitudinal study

The main objective was to investigate whether children aged 9-15 years at baseline were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. Children's musculoskeletal pain was monitored by weekly mobile phone text message responses from parents, indicating whether the child had spinal pain, lower extremity pain, or upper extremity pain the preceding week. Data were analyzed using mixed effect logistic regression models and cox regression models. The association between an incident event of spinal pain and LE pain the preceding weeks increased with increasing observation period and was statistically significant for 12 and 20 weeks (OR = 1.34 (95% CI 1.05 to 1.70) and OR = 1.39 (95% CI 1.11 to 1.75), respectively). We found that the likelihood increased in children with more frequent or longer duration of lower extremity pain. The reversed relationship was investigated as well, and we also found a positive association between spinal pain and a subsequent incidence event of lower extremity pain, but less pronounced.Conclusion: Children were more likely to experience an incident event of spinal pain after experiencing lower extremity pain. The likelihood increased in children with more frequent or longer duration of lower extremity pain. What is Known: • Both spinal pain and lower extremity pain often start early in life and is common already in adolescence. What is New: • Children were more likely to experience an incident event of spinal pain after experiencing LE pain. • The likelihood increased in children with more frequent or longer duration of LE pain.

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

Study Objectives

Musculoskeletal pain is a major burden on the society. Adults with sleep problems are at higher risk of musculoskeletal pain onset, but there is no evidence for this relationship in children and adolescents. This study aimed to systematically review prospective studies on the risk of musculoskeletal pain onset in children and adolescents with sleep problems.

Methods

Five databases (MEDLINE, PsycINFO, AMED, EMBASE, and HMIC) were systematically searched to identify prospective studies that investigated if children and adolescents (aged 6-19 years) with sleep problems are at higher risk of musculoskeletal pain onset. Included studies were assessed for study quality and a best evidence synthesis was carried out on extracted data.

Results

Thirteen prospective studies were identified. Overall, evidence indicates that sleep problems (quality, quantity, and day time tiredness) are not risk factors for musculoskeletal pain onset. Further analysis on specific body regions shows strong evidence that sleep problems are a risk factor for neck pain onset (only in girls) and that sleep problems are not a risk factor for the onset of widespread pain.

Conclusions

Overall, sleep problems are not a risk factor for musculoskeletal pain onset in children and adolescents. Increased risk was found for some specific body regions and subgroups, but the evidence base was less strong and generally inconsistent. This review found a lack of quality in research methodology compared to research in adults, and further research with improved methodology is required.

Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-A systematic review

The purpose was to perform a systematic review of clinical assessment methods for classifying Generalized Joint Hypermobility (GJH), evaluate their clinimetric properties, and perform the best evidence synthesis of these methods. Four test assessment methods (Beighton Score [BS], Carter and Wilkinson, Hospital del Mar, Rotes-Querol) and two questionnaire assessment methods (Five-part questionnaire [5PQ], Beighton Score-self reported [BS-self]) were identified on children or adults. Using the Consensus-based Standards for selection of health Measurement Instrument (COSMIN) checklist for evaluating the methodological quality of the identified studies, all included studies were rated "fair" or "poor." Most studies were using BS, and for BS the reliability most of the studies showed limited positive to conflicting evidence, with some shortcomings on studies for the validity. The three other test assessment methods lack satisfactory information on both reliability and validity. For the questionnaire assessment methods, 5PQ was the most frequently used, and reliability showed conflicting evidence, while the validity had limited positive to conflicting evidence compared with test assessment methods. For BS-self, the validity showed unknown evidence compared with test assessment methods. In conclusion, following recommended uniformity of testing procedures, the recommendation for clinical use in adults is BS with cut-point of 5 of 9 including historical information, while in children it is BS with cut-point of at least 6 of 9. However, more studies are needed to conclude on the validity properties of these assessment methods, and before evidence-based recommendations can be made for clinical use on the "best" assessment method for classifying GJH. © 2017 Wiley Periodicals, Inc.

Self-Rated Health Status and Cardiorespiratory Fitness in a Sample of Schoolchildren from Bogotá, Colombia. The FUPRECOL Study

To evaluate the relationship between Self-Rated Health (SRH) and cardiorespiratory fitness (CRF) in a sample of children and adolescents enrolled in official schools in Bogotá, Colombia. A cross-sectional study was performed with 7402 children and adolescents between 9 and 17 years of age. Participants were asked to rate their health based on eight validated questions, addressing the participants propensity for headache, stomach-ache, backache, feeling-low, irritability/bad mood, nervousness, sleeping-difficulties, and dizziness. The choices were "rarely or never", "almost every month", "almost every week", and "more than once a week/about every day". Participants performed the international course-navette shuttle run test to estimate CRF, and cut-off points for age and gender were used to categorize the healthy/unhealthy fitness zone according to the FITNESSGRAM® criteria. Overall, 16.4% of those surveyed reported a perception of irritability/bad mood "more than once a week/about every day", followed by feeling-low and nervousness (both with 9.9%). Dizziness had the lowest prevalence with a percentage of 6.9%. Unhealthy CRF in boys increased the likelihood of headaches by 1.20 times, stomach aches by 1.31 times, feeling-low by 1.29 times, nervousness by 1.24 times, and dizziness by 1.29 times. In girls, unhealthy CRF increased the likelihood of headaches by 1.19 times, backache by 1.26 times, feeling-low by 1.28 times, irritability/bad mood by 1.17 times, sleeping-difficulties by 1.20 times, and dizziness by 1.27 times. SRH was associated with CRF in both genders. Early identification of children and adolescents with low CRF levels will permit interventions to promote healthy behaviors and prevent future diseases during adulthood.

Determinants for craniofacial pains in children 6-8 years of age: the PANIC study

OBJECTIVE

Determinants for orofacial pain, headache, morning headache and painful signs of temporomandibular disorders (TMD) were investigated in prepubertal children.

MATERIAL AND METHODS

The participants were a population sample of 439 children aged 6-8 years. Craniofacial pains, eating meals and snacks, sleep bruxism, sleep quality, sleep-disordered breathing (SDB), psychological well-being, parental education and household income were assessed by questionnaires filled out by the parents. Sleep duration was assessed using a combined heart rate and movement sensor and clinical signs of TMD and dental occlusion by a dentist. The determinants of pain conditions were analyzed using logistic regression.

RESULTS

Of all 439 children, 26% had experienced orofacial pain and 31% headache during the past 3 months, 17% had suffered morning headache weekly and 13% had painful signs of TMD in a clinical examination. Restless sleep was associated with increased risk of orofacial pain, the painful signs of TMD and restless sleep with increased risk of headache and restless sleep, sleep bruxism and skipping meals with increased risk of morning headache after adjustment for other independent determinants of these pain conditions. Headache was associated with increased risk for painful signs of TMD.

CONCLUSIONS

Craniofacial pains are common among prepubertal children. Prepubertal children with sleep bruxism, restless sleep and skipping meals have increased likelihood of craniofacial pains.

Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility Type: A Discriminative Analysis

OBJECTIVE

Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia.

METHODS

Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression.

RESULTS

Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). When applying a threshold of 30.8 N/cm² for males and 29.0 N/cm² for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobility, and healthy controls (odds ratio 6.0).

CONCLUSION

Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain.

Chronic pain in high school students is associated with physical activity and sleeping hours but not with screen time

Background Existing studies on the association between physical activity (PA), screen based time and sleeping show conflicting results. Objective This study investigates the association between chronic pain at different body regions and self-reported PA, screen based time and sleeping hours in high school students. Subjects A total of 969 students aged 13-19 years old. Methods Participants completed a questionnaire on chronic pain, time spent in moderate and vigorous PA, screen based time watching televivsion (TV)/digital versatile discs (DVD), playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain and PA, screen based time and sleeping hours were investigated. Results In the univariate model time spent in moderate and vigorous PA, in screen based activities and sleeping were associated with pain in at least one body site. In the multivariate model, screen based activities were not associated with pain; sleeping 7 h or less and increased time in moderate PA were associated with pain at almost all body sites [odds ratio (OR) between 2.69-3.66 and 1.06-1.10, respectively]. Conclusion Time spent in PA and sleeping increased the risk of chronic pain in almost all body regions and might confound the association between screen based time and pain.

Wilson A, M. Palermo T. Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present, limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10-17 years) presenting to the emergency department (n = 47) or orthopedic clinic (n = 41) for evaluation of a new MSK pain complaint (<1 month duration). Youth presented for 2 study visits (T1≤1 month post pain onset; T2= 4-month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a laboratory task assessing conditioned pain modulation. Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life [QOL]). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer conditioned pain modulation and female sex. Higher depressive symptoms at T1 were associated with higher painrelated disability and poorer QOL at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.

“Jogo da postura”: programa de intervenção de enfermagem em crianças

Objetivo: evidenciar el impacto de un juego para impulsar la educación postural de los niños. El enfermero tiene un rol preponderante en la educación para la salud, por el cual buscamos un camino que les agregara alguna innovación a las Escuelas Posturales ya existentes incorporando una estrategia formativa novedosa: “un juego”. Materiales y método: se trata de un estudio casi experimental con delineamiento de tiempo. La muestra se constituye de 215 niños del pre-escolar y el 1º ciclo de la enseñanza básica, de una ciudad del norte de Portugal. La intervención se realiza por medio de la aplicación de un juego titulado “Juego de la postura”; para evaluar su impacto, se administró un cuestionario sobre hábitos posturales antes y después de la intervención. Resultados: los resultados dan cuenta de una elevada prevalencia de quejas músculo-esqueléticas (48,8 %) y un incremento de respuestas correctas tras la intervención. Hubo cambio en el conocimiento de hábitos posturales antes de la participación de los alumnos en un programa de educación postural y luego de ella. Conclusiones: el juego es una estrategia activa útil y eficaz a utilizarse por los formadores en el contexto de la enfermería y debe replicarse a otras áreas temáticas.

Pain, pain intensity and pain disability in high school students are differently associated with physical activity, screening hours and sleep

Background

Studies exploring the association between physical activity, screen time and sleep and pain usually focus on a limited number of painful body sites. Nevertheless, pain at different body sites is likely to be of different nature. Therefore, this study aims to explore and compare the association between time spent in self-reported physical activity, in screen based activities and sleeping and i) pain presence in the last 7-days for 9 different body sites; ii) pain intensity at 9 different body sites and iii) global disability.

Methods

Nine hundred sixty nine students completed a questionnaire on pain, time spent in moderate and vigorous physical activity, screen based time watching TV/DVD, playing, using mobile phones and computers and sleeping hours. Univariate and multivariate associations between pain presence, pain intensity and disability and physical activity, screen based time and sleeping hours were investigated.

Results

Pain presence: sleeping remained in the multivariable model for the neck, mid back, wrists, knees and ankles/feet (OR 1.17 to 2.11); moderate physical activity remained in the multivariate model for the neck, shoulders, wrists, hips and ankles/feet (OR 1.06 to 1.08); vigorous physical activity remained in the multivariate model for mid back, knees and ankles/feet (OR 1.05 to 1.09) and screen time remained in the multivariate model for the low back (OR = 2.34. Pain intensity: screen time and moderate physical activity remained in the multivariable model for pain intensity at the neck, mid back, low back, shoulder, knees and ankles/feet (Rp² 0.02 to 0.04) and at the wrists (Rp² = 0.04), respectively. Disability showed no association with sleeping, screen time or physical activity.

Conclusions

This study suggests both similarities and differences in the patterns of association between time spent in physical activity, sleeping and in screen based activities and pain presence at 8 different body sites. In addition, they also suggest that the factors associated with the presence of pain, pain intensity and pain associated disability are different.

Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present, limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10-17 years) presenting to the emergency department (n = 47) or orthopedic clinic (n = 41) for evaluation of a new MSK pain complaint (<1 month duration). Youth presented for 2 study visits (T1 ≤1 month post pain onset; T2 = 4-month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a laboratory task assessing conditioned pain modulation. Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life [QOL]). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer conditioned pain modulation and female sex. Higher depressive symptoms at T1 were associated with higher pain-related disability and poorer QOL at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.

Dose-response relationship between sports activity and musculoskeletal pain in adolescents

Supplemental Digital Content is Available in the Text.

A school-based cohort study showed that time spent in sports activity had a linear association with musculoskeletal pain prevalence and risk among Japanese adolescents.

Physical activity has multiple health benefits but may also increase the risk of developing musculoskeletal pain (MSP). However, the relationship between physical activity and MSP has not been well characterized. This study examined the dose–response relationship between sports activity and MSP among adolescents. Two school-based serial surveys were conducted 1 year apart in adolescents aged 12 to 18 years in Unnan, Japan. Self-administered questionnaires were completed by 2403 students. Associations between time spent in organized sports activity and MSP were analyzed cross-sectionally (n = 2403) and longitudinally (n = 374, students free of pain and in seventh or 10th grade at baseline) with repeated-measures Poisson regression and restricted cubic splines, with adjustment for potential confounders. The prevalence of overall pain, defined as having pain recently at least several times a week in at least one part of the body, was 27.4%. In the cross-sectional analysis, sports activity was significantly associated with pain prevalence. Each additional 1 h/wk of sports activity was associated with a 3% higher probability of having pain (prevalence ratio = 1.03, 95% confidence interval = 1.02-1.04). Similar trends were found across causes (traumatic and nontraumatic pain) and anatomic locations (upper limbs, lower back, and lower limbs). In longitudinal analysis, the risk ratio for developing pain at 1-year follow-up per 1 h/wk increase in baseline sports activity was 1.03 (95% confidence interval = 1.02-1.05). Spline models indicated a linear association (P < 0.001) but not a nonlinear association (P ≥ 0.45). The more the adolescents played sports, the more likely they were to have and develop pain.

Idiopathic musculoskeletal pain in Indian children-Prevalence and impact on daily routine

OBJECTIVES

To study the prevalence of idiopathic musculoskeletal pain (IMSP) in school going children and its impact on daily life.

METHODS

One thousand eighteen apparently healthy school children aged 5-16 years were assessed and analysed for IMSP and its associated problems. Standard tests for significance were applied.

RESULTS

One hundred and sixty-five (16.2%) children mostly males (55.2%) reported IMSP. Lower limbs (52.1%) were the most common location of pain. More than 1 year of pain history was present in 15%. Thirty-seven percent children complained of discomfort during walking, 30.9%, had pain during physical exercise, 29.2% had difficulty attending lessons and 4.2% had interference in pursuing hobbies. The children were also further sub grouped into preadolescents and adolescents. There was significant difference in pain duration and duration of each pain episode in the two groups (p=0.01). A significant number of children (21.2%) with IMSP reported school absenteeism (p<0.001). A significant number of adolescents had history positive for contact sports (p=0.001). Sleep disturbances were also reported to be higher in children with IMSP (29% vs. 5.7%, p=0.001). Other associated problems in children with IMSP found were day time tiredness (51.1%), headache (47.3%) and abdominal pain (24.8%).

CONCLUSIONS

Prevalence of IMSP in school children aged 5-16 yrs was found to be 16.2% and a significant percentage of these children experience interference with daily activities including school absenteeism.

Clinical Phenotyping of Youth With New-Onset Musculoskeletal Pain: A Controlled Cohort Study

OBJECTIVES

The course of pediatric musculoskeletal pain from acute to chronic has not been well described and there is limited understanding of how to identify individuals with new-onset pain who may be predisposed to developing persisting symptoms. Thus, the purpose of this study was to describe the clinical phonotype of treatment-seeking youth with new-onset musculoskeletal pain compared with youth with and without chronic pain. Further, we tested predictors of pain-related disability and pain sensitivity in the new-onset pain sample.

METHODS

Participants were 191 youth, ages 10 to 17 years, representing 3 cohorts (new-onset musculoskeletal pain, chronic musculoskeletal pain, and a comparison group without chronic pain). Participants completed questionnaire measures of pain characteristics, psychological functioning, sleep, and pain-related disability. They also attended a laboratory visit to complete an experimental pain assessment using heat and cold stimuli to assess pain sensitivity and conditioned pain modulation.

RESULTS

Findings revealed youth with new-onset musculoskeletal pain had a distinct clinical phenotype where symptoms of pain and disability were in the mid-range between those of youth with diagnosed chronic musculoskeletal pain and youth in the community without chronic pain. Linear regressions within the new-onset pain sample demonstrated poorer sleep quality and higher pain fear predicted greater pain-related disability, and pain catastrophizing predicted cold pressor sensitivity.

DISCUSSION

Clinical phenotyping of youth with new-onset musculoskeletal pain highlights factors relevant to the pain experience. Future research can examine the roles of these variables in predicting longitudinal risk for chronic pain and disability.

Screening for musculoskeletal problems in Japanese schoolchildren: a cross-sectional study nested in a cohort

OBJECTIVES

To clarify the frequency of musculoskeletal problems in public elementary and junior high school children and to determine the advantages and problems of musculoskeletal examinations.

STUDY DESIGN

School-based cross-sectional study nested in a cohort.

METHODS

We examined 41,376 public elementary and junior high school children (aged 6-15 years) in Miyazaki, Japan, from 2008 to 2014. Participation was voluntary. Participants received an in-school primary musculoskeletal examination (clinical examination with check items and a questionnaire) and a secondary examination at an orthopaedic outpatient clinic as indicated. Estimated prevalence rates for musculoskeletal problems were calculated from the results of both examinations.

RESULTS

The total estimated prevalence of musculoskeletal problems was 8.6%. Prevalence by school grade ranged from 3.2% to 13.7%. Estimated prevalence rates increased as grade increased and were higher in junior high school students than in elementary school students. The secondary examination identified musculoskeletal problems on the back (65.4%), knee (8.1%), ankle or feet (7.3%) and elbow (5.4%). Of those referred for a secondary examination, 44.4% had not reported musculoskeletal complaints on the initial questionnaire. Overall, 69.8% of problems diagnosed in the secondary examination were previously undiagnosed.

CONCLUSIONS

School-based musculoskeletal examination enables early detection of abnormal growth and disorders of the locomotive organs and is expected to support children's musculoskeletal growth and development. We recommend musculoskeletal examinations as part of school check-ups in Japan. Our findings suggest musculoskeletal examinations should be conducted for students in higher elementary school grades and for all junior high school students. Evaluation should include both direct clinical examination and questionnaires.

Neck pain in children: a retrospective case series

INTRODUCTION

Spinal pain in the paediatric population is a significant health issue, with an increasing prevalence as they age. Paediatric patients attend for chiropractor care for spinal pain, yet, there is a paucity of quality evidence to guide the practitioner with respect to appropriate care planning.

METHODS

A retrospective chart review was used to describe chiropractic management of paediatric neck pain. Two researchers abstracted data from 50 clinical files that met inclusion criteria from a general practice chiropractic office in the Greater Toronto Area, Canada. Data were entered into SPSS 15 and descriptively analyzed.

RESULTS

Fifty paediatric neck pain patient files were analysed. Patients' age ranged between 6 and 18 years (mean 13 years). Most (98%) were diagnosed with Grade I-II mechanical neck pain. Treatment frequency averaged 5 visits over 19 days; with spinal manipulative therapy used in 96% of patients. Significant improvement was recorded in 96% of the files. No adverse events were documented.

CONCLUSION

Paediatric mechanical neck pain appears to be successfully managed by chiropractic care. Spinal manipulative therapy appears to benefit paediatric mechanical neck pain resulting from day-today activities with no reported serious adverse events. Results can be used to inform clinical trials assessing effectiveness of manual therapy in managing paediatric mechanical neck pain.

Pain is prevalent among adolescents and equally related to stress across genders

Background

Young people seem increasingly disabled due to pain and stress. Pain and stress are health risks with adverse long-term health effects. Traditionally, these health risks have been most prevalent and strongest associated in females, also regarding children and adolescents. Main objectives in this study were to investigate current gender differences in musculoskeletal pain and perceived stress in adolescents aged 15 and 16 years with respect to prevalence and group differences for various aspects of stress and pain, and to explore the relationship between stress and pain, specified for gender.

Methods

A cross-sectional study was conducted with 17 participating public schools. The survey was administrated by the schools in accordance with given procedures, emphasizing the volunteer and anonymous participation of the pupils. Primary study measurements were pain and stress. The pain measurements addressed different aspects of musculoskeletal pain including pain sites, pain duration and pain intensity (measured by a Visual analogue scale; VAS). The stress instrument used was the Perceived stress questionnaire (PSQ) comprising different factors of stress, i.e. worries, tension, joy and demands. The secondary study measurement was body mass index (BMI).

Results

The study sample comprised 422 adolescents aged 15 and 16 years; 218 females and 204 males. The pain reporting was high in both genders, 57.3 per cent of the females and 44.6 per cent of the males. In general, the female adolescents reported more pain and stress, although several pain measures corresponded between genders. The pain prevalence was similar across genders with respect to lower extremity pain, back pain and arm pain. Lower extremity pain was the most frequent reported pain in both genders. More females reported head pain (Pearson Chi-Square 7.11, p = .008), severe pain (VAS ≥ 7, Pearson Chi-Square 13.12, p = .004) and moderate to severe stress (PSQ ≥ 0.45, Pearson Chi-Square 29.11, p < .001). Comparison analyses of the continuous pain and stress variables revealed significant mean (95% confidence interval [CI]) differences between genders for all stress variables with the highest mean scores in females. In both genders there were significant (p < .01) correlations between all the continuous pain and stress variables. In 9 out of 15 correlations, the stress-pain associations were strongest in males (Pearson product-moment correlation (r) between 0.34 and 0.38). Only in females, the body mass index (BMI) appeared associated (weakly) to pain and stress, in terms of pain intensity (VAS, r = 0.19) and lack of joy (as a factor of stress, r = 0.16).

Conclusion

Pain and stress were prevalent in the adolescent sample, with generally higher reporting among females. Several pain measures corresponded between genders, but stress differed significantly between genders for all variables. Scrutinizing the relationship between pain and stress revealed significant stress-pain associations regarding all variables across genders, i.e. the pain complaints among the adolescents seemed equally related to stress in males and females in the sample.

EPIDEMIOLOGY OF MUSCULOSKELETAL DISORDERS IN PRIMARY SCHOOL CHILDREN IN BOSNIA AND HERZEGOVINA

Introduction:

Musculoskeletal disorders represent a significant problem of modern society which are more pronounced in young people and school children. Etiology of these disorders is found in inadequate ergonomic conditions, too heavy school bag, school furniture inadequate to age, poor posture, sedentary lifestyle, reduction of physical activity and lack of exercise.

Material and methods:

This cross-sectional study included 1315 pupils aged 8- 12 years. As a method was used “cluster sample” in the selection of subjects. The survey was conducted by questionnaire containing information on the demographic and individual characteristics of participants (age, gender, class), the manner and style of life and the performance of school tasks, followed by standardized Nordic questionnaire. The following parameters were measured: body height and weight for each student, and the weight of full and empty school bag that students that day brought to class.

Results:

The incidence of musculoskeletal pain regardless of localization was 48%. There is a statistically significant correlation between acute pain in the right shoulder and total weight of school bags, duration of caring the bag in school and time of wearing bag from school to home but not with the manner in which school bag was carried. Acute pain in the right shoulder and acute neck pain were significantly associated with the duration of sitting in school or in front of a computer at home. Acute pain in the shoulder negatively correlated with BMI percentile value of the respondents. Acute pain in the neck is also significantly associated with the weight of a full school bags, as well as time spent sitting at home doing homework. Acute back pain is statistically significantly correlated with the weight of school bags and duration of sitting periods in school.

Conclusion:

The prevalence of musculoskeletal pain, particularly chronic pain in school children aged 8-12 years is high. Weight of school bags, manner in which the bag is carried to and from school, duration of carrying bags, time spent sitting in the school and in front of the computer, duration of sitting and posture during homework, body mass index are ergonomic reasons for the development of musculoskeletal pain.

Musculoskeletal symptoms in an adolescent athlete population: a comparative study

Background

Musculoskeletal pain, symptoms or injuries are prevalent in the adolescent athlete population as well as in the general adolescent population, and often have significant consequences on their future musculoskeletal health. However, differences between these two populations in regards to their musculoskeletal health are not known and have not yet been explored. Therefore, the main objectives of this study are to 1) compare the 6-month prevalence of musculoskeletal symptoms and their impact on school attendance and reduction in sport or leisure activity between a group of adolescent athletes and a group of control adolescents, and 2) determine if gender has different effects on the prevalence of musculoskeletal symptoms in these two populations.

Methods

Among adolescents who participated in the 2012 Québec summer games, 1,865 agreed to participate and constituted the adolescent athletes group (mean age:14.12 ± 1.22). An additional cohort of 707 adolescents from two schools was also recruited to form the comparison control group (mean age: 14.69 ± 1.38). Anthropometric data were collected, and the musculoskeletal 6-month prevalence of symptoms and their related impacts were assessed using the Teen Nordic Musculoskeletal Screening Questionnaire (TNMQ-S). Participants’ characteristics as well as symptoms prevalence for the nine anatomical regions as well as their impact on school/work absence and reduction in physical/leisure activities were compared between athletes and control adolescents.

Results

When compared to athlete adolescents, significantly more controls had a positive 6-month prevalence of symptoms affecting the neck (48.8 % vs 26.3 %), upper back (41.3 % vs 18.1 %) and low back (45.4 % vs 35.8 %) when compared to athlete. Symptoms affecting the spine led to significantly more school absence and reduction in physical activity in the control group. Controls also showed higher prevalence of shoulder (37.1 % vs 28.3 %) and wrist/hand (23.8 % vs 17.4 %) symptoms, while athletes had a higher prevalence of elbow symptoms (8.7 % vs 11.4 %).

Conclusion

Despite their higher risk of injuries related to high levels of competition or sport participation, adolescent athletes have fewer symptoms affecting the spine than “typical adolescents”, and similar prevalence of symptoms affecting the body’s extremities. Further investigations are necessary to understand the differences between athletes and non-athletes in regard to disability and long-term complications associated to musculoskeletal pain or symptoms.

Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge

Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).

[Idiopathic musculoskeletal pain in Indian Children-prevalence and impact on daily routine]

OBJECTIVES

To study the prevalence of idiopathic musculoskeletal pain (IMSP) in school going children and its impact on daily life.

METHODS

One thousand eighteen apparently healthy school children aged 5-16 years were assessed and analysed for IMSP and its associated problems. Standard tests for significance were applied.

RESULTS

One hundred and sixty five (16.2%) children mostly males (55.2%) reported IMSP. Lower limbs (52.1%) were the most common location of pain. More than 1 year of pain history was present in 15%. Thirty seven percent children complained of discomfort during walking, 30.9%, had pain during physical exercise, 29.2% had difficulty attending lessons and 4.2% had interference in pursuing hobbies. The children were also further sub grouped into preadolescents and adolescents. There was significant difference in pain duration and duration of each pain episode in the two groups (p=0.01). A significant number of children (21.2%) with IMSP reported school absenteeism (p<0.001). A significant number of adolescents had history positive for contact sports (p=0.001). Sleep disturbances were also reported to be higher in children with IMSP (29% vs. 5.7%, p=0.001). Other associated problems in children with IMSP found were day time tiredness (51.1%), headache (47.3%) and abdominal pain (24.8%).

CONCLUSIONS

Prevalence of IMSP in school children aged 5-16 yrs was found to be 16.2% and a significant percentage of these children experience interference with daily activities including school absenteeism.

Chronic recurrent multifocal osteomyelitis: typical patterns of bone involvement in whole-body bone scintigraphy

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of unknown etiology. It affects children and adolescents predominantly and occurs mostly in the female population. It is characterized by the insidious onset of pain and swelling, with a fluctuating clinical course of relapses and remissions. Typically, several bones are affected, either synchronously or metachronously, and bilateral involvement is common. CRMO most commonly affects the metaphysis of long bones, especially the tibia, femur, and clavicle. The spine, pelvis, ribs, sternum, and mandible may also be affected. Although lesions are mostly multiple, patients may present with a single symptomatic focus. Radiographic findings may be negative early in the course of the disease. Bone scintigraphy is useful in determining the presence of abnormality and the extent of disease. The imaging and clinical features of CRMO overlap with those of infectious osteomyelitis, bone malignancy, and inflammatory arthritis. Nonetheless, CRMO can be confidently diagnosed with the recognition of typical imaging patterns in the appropriate clinical setting. This article reviews imaging findings with special emphasis on bone scintigraphy and specific disease sites.