Almost 30% of children and adolescents experience pain in muscles, bones or ligaments, study shows

A survey conducted in Brazil provides an overview of musculoskeletal pain in the very young. Back pain and leg pain were the most frequent complaints among 2,688 volunteers aged 12 on average.

By Julia Moióli  |  Agência FAPESP – Some 27% of Brazilian children and adolescents suffer from musculoskeletal pain of unspecified cause, according to a study reported in the Brazilian Journal of Physical Therapy. The problem is frequently underestimated by parents and health professionals, the authors of the article note, and an understanding of its true extent will contribute to better planning of public health policy regarding treatment of chronic pain in adults, the leading cause (https://www.thelancet.com/series/chronic-pain) of disability in the world.

In Brazil, the Ministry of Health estimates that more than 35% of over-fifties suffer from chronic pain. A law passed by Congress last year (Law 14,705/23) establishes guidelines for treatment of these patients by the SUS (Sistema Único de Saúde, Brazil’s network of public health services). Not all the risk factors for chronic pain in bones, ligaments and muscles have been studied in depth, but a prior history of pain is known to be one of them, and the scientific literature contains reports of its emergence during adolescence.

“Few studies have been conducted worldwide on the prevalence of musculoskeletal pain among young people, and their findings are imprecise, ranging from 4% to 40%, for lack of standardized concepts,” said Tiê Parma Yamato, last author of the article. Yamato is a researcher affiliated with Universidade Cidade de São Paulo (UNICID) in Brazil and the University of Sydney in Australia. 

“The proportion appears to range from 20% to 45% in Brazil, according to previous studies. However, most of these investigated specific musculoskeletal conditions didn’t consider the impact of pain on the day-to-day activities of children and adolescents, and were conducted in smaller urban centers.”

The study was led by Yamato and funded by FAPESP via three projects (17/17484-1, 19/10330-4 and 19/12049-0). 

The study involved 2,688 volunteers with an average age of 12. They were students at 28 public and private schools in Fortaleza in Ceará state, and Itu, Salto, São Sebastião and São Paulo in São Paulo state. They completed a questionnaire on bodily pain affecting their daily lives by keeping them away from school, hindering other routine activities, preventing them from participating in sports, etc.

Disabling musculoskeletal pain in the previous 30 days was reported by 27% (728). Back pain was the most frequently mentioned kind (51.8%), followed by leg pain (41.9%) and neck pain (20.7%).

“These numbers should sound the alarm about this pediatric health problem, which currently lacks a specific treatment protocol in the health system. They should also make us aware of what lies ahead: we will need to care for younger members of the population as well if we want to combat chronic pain among adults,” Yamato said.

The findings showed that children with disabling musculoskeletal pain were older (late adolescence) and had worse relationships with their families. They also reported more symptoms of psychosomatic disorders and a lower quality of life (in another questionnaire), and appeared to spend longer time watching television and playing video games. “It’s important to note that we didn’t analyze cause-and-effect relationships in this study,” Yamato said.

The myth of growing pains

The children’s parents completed a separate questionnaire on the health of their offspring and their perceptions of chronic pain in these subjects. “The literature shows that parents tend to underestimate the presence of pain in their children, possibly because they lack a clear understanding of pain in childhood, and this indeed occurred in 17% of our cases,” Yamato said.

A factor that may explain this attitude, and that may camouflage musculoskeletal pain in some ways, is the belief in so-called “growing pains”, especially in the legs. 

“Many families harbor this idea, but nothing in the scientific literature proves that growth actually causes pain,” she said.

If a child complains of pain, she added, parents should be aware that it can have impacts and also that there are ways of dealing with it, particularly through physical activity. “There’s no need for alarm, but it’s important to acknowledge its existence, validate the symptoms, and possibly seek help for those whose lives are affected. We should always bear in mind the fact that it’s a common problem,” she said.

A subsequent study by the same group, with results to be published soon, kept track of these children for 18 months to find out about the duration of their pain and its financial impact on the health system.

The article “Prevalence of disabling musculoskeletal pain in children and adolescents in Brazil: A cross-sectional study” is at: https://www.sciencedirect.com/science/article/abs/pii/S1413355524000042. 

* Image from Freepik