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Systematic review with meta-analysis of childhood and adolescent risk and prognostic factors for musculoskeletal pain

Huguet, Anna; Tougas, Michelle E.; Hayden, Jill; McGrath, Patrick J.; Stinson, Jennifer N.; Chambers, Christine T.

doi: 10.1097/j.pain.0000000000000685
Comprehensive Review
Global Year 2016

A variety of factors may be involved in the development and course of musculoskeletal (MSK) pain. We undertook a systematic review with meta-analysis to synthesize and evaluate the quality of evidence about childhood and adolescent factors associated with onset and persistence of MSK pain, and its related disability. Studies were identified from searches of electronic databases (PubMed, EMBASE, PsycINFO, CINAHL, and Web of Science), references of included studies, and the Pediatric Pain mail list. Two independent reviewers assessed study inclusion, completed data extraction, and evaluated the quality of evidence using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Thirty-six studies reporting on 21 cohorts were included. These studies examined 65 potential risk factors for onset of MSK pain and 43 potential prognosis factors for persistence of MSK pain. No study was identified that examined prognostic factors for MSK pain–related disability. High-quality evidence suggests that low socioeconomic status is a risk factor for onset of MSK pain in studies exploring long-term follow-up. Moderate-quality evidence suggests that negative emotional symptoms and regularly smoking in childhood or adolescence may be associated with later MSK pain. However, moderate-quality evidence also suggests that high body mass index, taller height, and having joint hypermobility are not risk factors for onset of MSK pain. We found other risk and prognostic factors explored were associated with low or very low quality of evidence. Additional well-conducted primary studies are needed to increase confidence in the available evidence, and to explore new childhood risk and prognostic factors for MSK pain.

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aCommunity Health and Epidemiology, Dalhousie University, IWK Health Centre, Halifax, NS, Canada

bDepartment of Psychology, Dalhousie University, IWK Health Centre, Halifax, NS, Canada

cCommunity Health and Epidemiology, Dalhousie University, Halifax, NS, Canada

dDepartment of Science, Pediatrics and Psychiatry, Dalhousie University, Research and Innovation, IWK Health Centre and Capital District Health Authority, Halifax, NS, Canada

eChild Health Evaluative Sciences, Chronic Pain Program, The Hospital for Sick Children, Toronto, ON, Canada

fDepartment of Pediatrics and Psychology & Neuroscience, Dalhousie University, IWK Health Centre, Halifax, NS, Canada

Corresponding author. Address: Centre for Research in Family Health, Room K8531, 8th Floor Children's Building, IWK Health Centre, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS B3K 6R8, Canada. Tel.: +1-902-470-752; fax: +1-902-470-6534. E-mail address: (A. Huguet).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received January 28, 2016

Received in revised form July 28, 2016

Accepted August 03, 2016

© 2016 International Association for the Study of Pain
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