Musculoskeletal Pain in Children and Adolescents: Insights into Risk and Prognosis

Abstract

Musculoskeletal (MSK) pain is common in children and adolescents, with many experiencing persistent symptoms into adulthood. Despite advances in MSK research in adults, understanding of risk and prognosis in younger populations remains limited, impeding effective intervention development. Spinal pain, a subset of MSK pain, is thought to arise from interactions between biomechanical, psychological, and social factors. This thesis investigated sedentary behaviour as a potential predictor of spinal pain through three studies: a systematic review with meta-analysis, a cross-sectional analysis of adolescents with spinal pain, and a longitudinal causal analysis of adolescents who developed chronic spinal pain. These studies found only weak associations and no causal relationship between sedentary behaviour and spinal pain, with low certainty of evidence. The findings challenge the assumption that sedentary behaviour is a major contributor to spinal pain in adolescents and suggest that interventions targeting sedentary time alone are unlikely to be effective. Effective interventions require a thorough understanding of MSK pain prognosis to identify and target children and adolescents at higher risk of developing chronic, high-impact pain. This thesis also conducted a Cochrane review on MSK pain prognosis and a feasibility study tracking the clinical course of spinal pain in adolescents. The prognosis of MSK pain in youth is poorly understood, with substantial variability in recovery and persistence. Limited high-quality evidence highlights the need for robust longitudinal research. Weekly tracking of spinal pain progression in adolescents via SMS is highly feasible, with strong response and retention rates. However, recruitment challenges suggest future studies should expand clinician participation and explore alternative recruitment strategies. Future research should prioritise longitudinal studies addressing the complex biopsychosocial contributors to MSK pain in youth