Musculoskeletal Pain in Schoolchildren: Occurrence, prognosis and determinants

Abstract

Tutkimuksen tavoitteena oli selvittää lasten niska-, selkä ja raajakipujen esiintyvyyttä, syytekijöitä ja ennustetta. Tutkimuksessa seurattiin neljän vuoden ajan yli 1700 lahtelaista 10-12 -vuotiasta koululaista ja arvioitiin kyselyiden avulla heidän tuki- ja liikuntaelimistön (TULE) vaivojaan. Lisäksi kysyttiin niiden aiheuttamia haittoja sekä muita vaivoja kuten päänsärkyä, vatsakipua ja unihäiriöitä. Tutkimuksen alussa testattiin myös fyysistä kuntoa ja nivelten yliliikkuvuutta.

Viidenneksellä koululaisista oli tuki- ja liikuntaelimistön kipuja, joka paikantui yleisimmin niskaan tai alaraajaan. Vaivat olivat toistuvia tai pitkäkestoisia, sillä noin puolet alussa niistä kärsineistä raportoi kipua myös vuoden ja neljän vuoden seurannassa. Pitkäaikaista kipua esiintyi eniten lapsilla joiden nivelissä on yliliikkuvuutta. Laaja-alaisia kipuja oli kuitenkin vain 7%:lla ja ne parantuivat paikallisia kipuja useammin. Paljon liikkuvilla oli eniten vammasta johtuvia kipuja, kun taas niillä lapsilla joilla TULE-vaivat eivät johtuneet vammasta esiintyi myös muita enemmän päänsärkyä ja päiväväsymystä.

Tuki- ja liikuntaelimistön kipuoireet ovat yleisiä koululaisilla. Ne liittyvät osin runsaaseen liikuntaan, jossa syntyy sekä vammoja että rasitusta. Toisaalta myös psyykkiset tekijät kuten masentuneisuus, päiväväsymys ja muut psykosomaattiset oireet vaikuttavat kivun esiintymiseen, mahdollisesti siksi että ne ovat yhteydessä vaivan kokemiseen. Laaja-alainen kiputila paranee lapsilla useammin kuin aikuisilla.

The aim of this study was to increase understanding of the problem of musculoskeletal pain (pain in bones and muscles) in Finnish schoolchildren. The study estimated the percentage of children with musculoskeletal pain in Finland and tried to understand its prognosis and causes. To achieve this aim, a large sample of 1756 schoolchildren (10 12 years old) in the city of Lahti were evaluated at three time points: Baseline, 1-year follow-up (11-13 years old), and 4-year follow-up ( 14-16 years old).

At baseline, children were asked about the experience of pain in the following locations: Neck, upper limb, chest, lower limb, upper back, lower back and buttock. Children were also asked about the experience of headache, abdominal pain, physical limitations attributed to pain, frequency of physical activity, day-time tiredness, sleeping problems and depressiveness. This information was collected in the class using a structured pre-tested questionnaire that included a pain manikin. Children, at baseline, were also examined for hypermobility (laxity of joints) using the Beighton method and for physical fitness using the shuttle run test. Children were again asked about theor experience of muscle and bone pains after 1 year (1-year follow-up) and 4 years (4-year follow-up).

Approximatly 21% of Finnish schoolchildren develop muscculoskeletal pain (with a frequency of at least once a week) per year. The neck is the most commonly reported site with non-traumatic pain (pain not initiated by a direct trauma), while the lower limb was the most frequent site for traumatic pain (pain initiated by a direct trauma). About 54% of children who had pain at baseline still reported pain after 1 year and 64% of them reported pain after 4-years. The neck was the site with the most persistent pain , followed by the lower back and the lower limb. Children with traumatic lower limb pain reported significantly more physical limitations compared to children with non-traumatic lower limb pain (P =0.02), but the traumatic group had a significantly better prognosis (their pain subsided in a shorter time).

The percentage of children with widespread bodily pain pain increased from 7% at the age of 10-12 years to 9% at the age of 11-13 to 15% at the age 14-16 years. This condition seemed to have a fluctuating and a relatively favourable course, with only 10% of children with widespread pain consistently reporting these symptoms at both 1-and 4-year follow-ups.

With respect to risk factors of musculoskeletal pain in children, day-time tiredness was significanly associated with pain onset of both traumatic and non-traumatic pain. Non-traumatic lower limb pain.was also predicted by prior report of depressive mood, while traumatic lower limb pain was significanly associated with practicing vigorous exercise (more than 4 times per week of heavy exercise) and having high level of physical fitness. Risk factors for widespread pain included female gender, depressive mood. Hypermobility (having lax joints) was a significant risk factor for the long-term prognosis (the outcome) of pain. However, having lax joints was not associated with the developmememt or the short-term prognosis of musculoskeletal pain.

In conclusion, musculoskeletal pains are common among Finnish schoolchildren. These symptoms do not appear to be constant, but rather have a fluctuating course. Practicing frequent exercise (5-7 times a week) predicts both the onset and prognosis of trauma-induced pain but is not associated with the onset nor the prognosis of non-traumatic type of pain. Traumatic lower limb pain was also significantly associated with day-time tiredness and high level of physical fitness. We have identified three symptoms that might be markers of children at risk for development of non-traumatic pain: Headache, day-time tiredness and depressiveness. In addition, we have identified three factors which might be markers for chronicity of these symptoms: Self-reported headache, pain in multiple musculoskeletal areas and hypermobility. These factors, except for hypermobility, are modifiable and can be assessed with ease, and hence can provide opportunities for preventing these commonly-reported symptoms in Finnish schoolchildren.