Pain In Schoolchildren Research Articles

Predicting persistent low back pain in schoolchildren: A prospective cohort study

Low back pain (LBP) is common in children but the prognostic indicators are poorly understood. We report the results of a prospective study to determine the risk factors for chronic LBP in children. A total of 330 children with LBP were identified from a cross-sectional survey in schools in Northwest England. Data were collected by self-completion questionnaire on a number of potential risk factors for LBP persistence, including lifestyle factors, the occurrence of other symptoms, behavioral and emotional characteristics, and symptom severity and duration. Participants were then followed over the following 4 years to determine persistent symptoms. Complete followup data were available from 178 children, of whom 46 (26%) reported persistent LBP. Forward stepwise Poisson regression identified 5 independent predictors of pain persistence: peer relationship problems, being of smaller stature, the prior report of widespread body pain, long duration of LBP episodes, and radiating leg pain. Of children with none of these factors at baseline, <5% went on to report persistent LBP. In contrast, of those with 4 or 5 factors, nearly 80% experienced persistent symptoms. Although childhood consultations for LBP are infrequent, we have shown that approximately 25% of children 11-14 years of age with LBP still report symptoms 4 years later. These children can be identified early by a combination of clinical markers and etiologic factors. This provides a basis for considering interventions for secondary prevention; the challenge will be to determine whether we can intervene to alter symptom trajectory at an early stage.

Poster 292: Musculoskeletal Pain in Schoolchildren Aged Between 13 and 15 Years

Poster 292: Musculoskeletal Pain in Schoolchildren Aged Between 13 and 15 Years

Joint hypermobility and its relationship to musculoskeletal pain in schoolchildren: a cross-sectional study

Objectives:To determine if joint hypermobility is associated with musculoskeletal pain in a population of Italian schoolchildren.Design:Cross-sectional, school-based study, using a pretested questionnaire administered to schoolchildren to enquire about musculoskeletal pain...

Helicobacter pylori: prevalence and relationship with abdominal pain in school children in Makkah City, western Saudi Arabia.

Background/Aim:The published data on Helicobacter pylori (H. pylori) prevalence and its relationship with abdominal pain in Saudi Arabia is scarce. This study was carried out to determine the prevalence of H. pylori and its relationship with chronic recurrent abdominal pain (RAP) among school students in Makkah City, Saudi Arabia.Materials and Methods:Three hundred and fourteen school students, 103 at the intermediate level (grades 7-9) aged 12-15 years and 211 at the secondary level (grades 10-12) aged 15-18 years were tested for H. pylori. Urea breath test (UBT) was used for this purpose. Children with chronic RAP were identified as per the Apley criteria.Results:Overall, the UBT was positive in 86/314 (27.4%) students. It was positive in 45/103 (43.7%) intermediate school students and 41/211 (19.4%) secondary students. Out of the 55 students with chronic RAP, 40 (73%) were positive for H. pylori. Further, 62.9% and 82.1% were positive among the intermediate and secondary school students with RAP, respectively. The overall and specific odds ratios of RAP were 12.35 [95% confidence interval (C.I.) 6.30-24.22] and 10.40 (95% C.I. 1.75-11.73) for the intermediate school students and 22.69 (95% C.I. 7.99-64.44) for the secondary school students.Conclusion:The prevalence of H. pylori among the school children in Makkah, Saudi Arabia, is relatively low compared with developing countries. The prevalence was found to be higher among the younger age group. Further, there was a significant relation between H. pylori infection and RAP among the school students.

Does ergonomic mismatch at school impact pain in school children?

Musculoskeletal pain in school-aged children is highly prevalent. While there are many potential factors relating to this discomfort, one unexplored factor is the ergonomic mismatch. The objective of this study was to determine whether the degree of mismatch between the body dimensions and the classroom furniture was associated with body discomfort. One hundred and thirty-nine children in a Midwestern U.S. school district participated in the study where demographic information, anthropometric measurements, self-reported regional body discomfort, and furniture measurements were collected. The results indicate an extremely high prevalence of ergonomic mismatch. Contrary to what was hypothesized, the ergonomic mismatch was not associated with body discomfort. The lack of association may have been a result of the extremely high prevalence of ergonomic mismatch as well as potential adaptations by the students. Although almost every student was found to not fit their desk and chairs, ergonomic mismatch had limited impact on the body discomfort. It appears that other factors such as backpack weight and time carrying may contribute more to the discomfort of students. However, caution is stress with regard to dismissing ergonomic mismatch factor as a potential risk factor since the extremely high prevalence may have washed out any effect.

Imaging of activity propagation in the nerve cord of Drosophila larvae

Although heavy backpack carriage has been associated with back pain in schoolchildren, its causal relationship is still unknown. As people with low back pain exhibit an abnormal spinal control and backpack carriage has been shown to affect spinal repositioning ability in static upright stance, the goal of this study is to use dynamical systems theory to investigate the effects of backpack carriage on lumbopelvic control under dynamic situation. Lumbopelvic coordination was quantified in terms of Mean Absolute Relative Phase (MARP) and Deviation Phase (DP) whilst performing a reaching task under four loading conditions, i.e. no load, carrying 5%, 10% and 15% bodyweight (BW). It was shown that inter-segmental coordination was less in-phase (i.e. significant reduction in MARP with p < 0.001) and more variable (i.e. significant increase in DP with p = 0.005) during backpack carriage of 10% and 15% BW in forward reaching movement, suggesting greater alteration in lumbopelvic coordination at heavier weights. As abnormal movement strategies tend to increase the risk of spinal injury, pragmatic approaches should be considered to eradicate the adverse effect of heavy backpack carriage on spinal proprioception.Adverse effects of backpack carriage on lumbopelvic control were demonstrated. Greater alteration in trunk control at heavier weights was shown. Strategies should be devised to eradicate the effects of backpack carriage on proprioception.

Onset, prognosis and risk factors for widespread pain in schoolchildren: A prospective 4-year follow-up study

Little is known about the epidemiology of widespread pain (WSP) in children and adolescents. This study aims to estimate the new-onset and prognosis of WSP in schoolchildren and investigate factors predicting its development. A prospective study was conducted among 1756 schoolchildren (age 10–12 years) in Southern Finland. At baseline, information was collected on WSP, regional musculoskeletal pain symptoms, depressiveness, fatigue, sleep problems, physical activity and joint hypermobility. These children were contacted again 1 year and 4 years later to determine the outcome and the new-onset of WSP. A total of 1282 children (73%) of the baseline study population were found at both follow-ups. Of the children who had WSP at baseline, 31% and 30% reported persistence/recurrence of symptoms at 1- and 4-year follow-up, respectively. However, only 10% of these children reported WSP at both 1 and 4 years. Of the children who were free of WSP at baseline, 18% reported new-onset WSP at 1-year follow-up and 3% reported these symptoms at both follow-up times. The independent baseline risk factors of WSP were older age (OR 1.3 95% CI 1.0–1.8), female gender (OR 1.4, 1.1–1.9), depressiveness (OR 1.5, 1.1–2.2) and regional back pain symptoms (Neck pain: OR 1.7, 1.1–2.4; Upper back pain: OR 2.1, 1.1–4.1; Lower back pain: OR 3.0, 1.6–5.7). Both psychological factors and somatic pain symptoms predict future development of WSP in adolescents.

Asymmetric Loads and Pain Associated With Backpack Carrying by Children

Shoulder and back pain in school children is associated with wearing heavy backpacks. Such pain may be attributed to the magnitude of the backpack load and the manner by which children distribute the load over their shoulders and back. The purpose of this study is to quantify the pressures under backpack straps of children while they carried a typical range of loads during varying conditions. Ten healthy children (aged, 12-14 years) wore a backpack loaded at 10%, 20%, and 30% body weight (BW). Backpacks were carried under 2 conditions, low on back or high on back. Pressure sensors (0.1 mm thick) measured pressures beneath the shoulder straps. When walking with the backpack straps over both shoulders, contact pressures were significantly greater in the low-back condition than in the high-back condition (P = 0.004). In addition, when children carried the backpack in the low-back condition, mean pressures (+/-SE) over the right shoulder were as follows: 98 +/- 31, 153 +/- 48, and 170 +/- 54 mm Hg at 10%, 20%, and 30% BW, respectively, which were significantly higher (P < 0.001) than those over the left shoulder (46 +/- 14, 92 +/- 29, and 90 +/- 29 mm Hg, respectively). Perceived pain with the backpack over 1 shoulder was significantly greater (P = 0.002) than that for donning with both shoulders in the low-back condition. Pressures at 10%, 20%, and 30% BW loads on the right or left shoulder, during low-back or high-back conditions, are higher than the pressure thresholds (approximately 30 mm Hg) to occlude skin blood flow. Furthermore, asymmetric and high pressures exerted for extended periods of time may help explain the shoulder and back pain attributed to backpacks.

Physical activity and low-back pain in schoolchildren

Design of the experiment is to study the cross-sectional sample with retrospective information. The objective is to identify the types of physical activity associated with the decreased occurrence of low-back pain (LBP) in schoolchildren. Physical activity may be hypothesized to possess a potential for LBP prevention. The possible connection between LBP and specific sports activities is however sparsely documented. A total of 546, 15- to 16-year-old schoolchildren filled a questionnaire on current physical activities and LBP occurrence and severity. In multiple logistic regressions, the association of LBP with exposure variables was corrected for body height and weight (data from school health service files) and for anthropometric and school furniture parameters. More than half of the children reported pain or discomfort in the low-back region during the preceding 3 months, and 1/4 experienced a decreased functioning or need of care because of LBP. LBP correlated with physical inactivity, e.g. time spent on homework and hours watching TV or video, and with a series of sports activities, e.g. jogging, handball playing and gymnastics. Among sports activities, only swimming and the number of hours per week participating in soccer were associated with a decreased LBP prevalence. With the exception of swimming and soccer, the types of sport reported by this schoolchild population do not offer themselves for consideration as tools for LBP prevention. Based on the associations found with indicators of physical inactivity, attempts to motivate the children to increase their general physical activity level should be considered for trial.

Non-specific neck pain in schoolchildren: Prognosis and risk factors for occurrence and persistence. A 4-year follow-up study

This study investigated the natural course of neck pain (NP) in 9–12-year-olds during a 4-year follow-up. Risk factors for the occurrence and persistence of weekly NP were explored separately for boys and girls. At baseline, 1756 schoolchildren completed a questionnaire eliciting musculoskeletal pain symptoms, other physical, and psychological symptoms and frequency of physical activity, and were tested for joint hypermobility. Symptoms during the preceding three months were asked using a five-level frequency classification. Re-evaluation was performed after one and four years using identical questionnaires. During follow-up, 24% reported none, 71% fluctuating, and 5% persistent weekly NP. The frequency of NP at baseline was linearly related to weekly NP during follow-up in both genders ( P < 0.001). Furthermore, a significant increasing linear trend towards a more persistent course of NP was seen in children with weekly other musculoskeletal and/or other physical and psychological symptoms at baseline. Among originally neck pain-free pre-/early adolescents, weekly other musculoskeletal pain symptoms (only in girls) and other physical and psychological symptoms (in both genders) predicted the occurrence of weekly NP during follow-up. In conclusion, neck pain in schoolchildren tends to fluctuate, but there also seems to exist a subgroup (5%) with persistent NP already in pre-/early adolescents, or even earlier. Co-occurrence of frequent other musculoskeletal symptoms and/or markers of psychological stress with frequent NP are risk indicators for a more persistent course, at least within next few years. Since adult chronic NP problems might originate in childhood, further studies are needed, including preventive interventions.

Predictors of abdominal pain in schoolchildren: a 4-year population-based prospective study

Background:Chronic abdominal pain (CAP) is common among schoolchildren, but risk factors for its onset are still largely unknown.Aims:To determine the frequency of onset of CAP in schoolchildren and investigate risk...

Recurrent abdominal pain in school children: effect of obesity and diet

To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children. We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong-Baker FACES scale for pain intensity and calculated the gender/age-specific body mass index (BMI) Z-score using NCHS standards. Obesity was defined as a BMI>or=95th percentile for age and gender. A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p=0.28) and reached its peak among children aged 7-9 (29%) years. Children with BMI>or=95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR=1.8, p=0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p<0.002). Logistic regression analysis confirmed BMI>or=95th percentile and low consumption of fruits are significant risk factors for RAP. There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co-morbidity between RAP and obesity could have important implications on RAP management and treatment.

Perceived Health and Pain in School Children in Relation to Physical Activity and Overweight

Perceived Health and Pain in School Children in Relation to Physical Activity and Overweight

Recurrent abdominal pain in school children revisited: fitting adverse food reactions into the puzzle

Recurrent abdominal pain in school children revisited: fitting adverse food reactions into the puzzle

Classroom posture and self-reported back and neck pain in schoolchildren

The study reported here aims to identify the extent of back pain experienced by 11–14 year old schoolchildren, and establish the intensity, duration and frequency of exposure to physical risk factors present in schools. This paper considers the sitting postures of schoolchildren in the classroom. The sitting postures of 66 children were recorded in normal lessons using the Portable Ergonomic Observation Method (PEO). The study found significant associations between flexed postures and low back pain. Static postures and neck and upper back pain were also associated. This study has implications for schools, designers and people in the field of work related musculoskeletal disorders. Further research is required to examine the association between sitting posture and pain reported at different spinal locations.

Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents.

This cross-sectional study was carried out to investigate any correlation between backpack carrying, spinal curvatures, and athletic activities on schoolchildren's dorsal (DP) and low back pain (LBP). Three thousand four hundred forty-one students aged from 9 to 15 years who carried backpacks to school were included in this study and asked for DP and LBP experiences in the school period while carrying the backpack. Nonradiating methods (surface back contour analysis) were used to indirectly measure frontal spinal curve (scoliosis) with the scoliometer and lateral curves (thoracic kyphosis and lumbar lordosis) with the kyphometer. All data analyses were undertaken regarding school year level, age, gender, sports participation, backpack weight, and way of carrying (one versus both shoulder) in relation to magnitude of scoliosis, thoracic kyphosis, lumbar lordosis, and DP and LBP while carrying the backpack. DP increased with increasing backpack weight (P < 0.05). The way (one versus both shoulder) of backpack carrying did not correlate either with DP or with LBP. Girls experienced much more LBP and DP than boys (P < 0.001). There was no difference in the prevalence of LBP and DP between adolescents and children. Students' age, height, and body weight as well as magnitude of kyphosis, lordosis, and scoliosis did not correlate with either LBP or DP. At the age of 11 years, girls and boys showed the highest prevalence for DP (72% and 38.5%, respectively), while at the age of 14 years, girls reported significantly (P < 0.05) more DP than boys. Girls showed the highest prevalence of LBP (71%) at the age of 11 years, while for the boys, it was at the age of 15 years (21%). Girls showed at the age of 11 years significantly more LBP (P < 0.05) than boys. Sports exposure seemed to increase LBP in girls (P < 0.001). The results of this study suggest a differential DP and LBP prevalence in schoolchildren and adolescents carrying backpacks with regard to gender and age. The peak in pain prevalence was immediately before puberty as well as immediately after its onset. Girls who participated in sports activities seem to experience more often DP and LBP than boys. Short children who carry backpacks as heavy as do tall children at the same age are more prone to LBP.

School bag carriage and pain in school children

Purpose: In South Africa (SA), anecdotal evidence for the incidence of shoulder, back and neck pain in school children is alarming but no scientific studies have confirmed this impression. The purpose of the present study was to determine the relationship between pain and school bag carriage in scholars in Durban, SA.Method: A study was carried out at four different schools in the Verulam and Chatsworth Regions in Kwa-Zulu Natal, SA. Schools were selected by convenience. One hundred and seventy six scholars between the ages of 11 and 14 years correctly filled out a questionnaire with open-ended and closed-ended questions. Each child also had his/her body and bag weight measured.Results: In this study, most of the scholars experienced shoulder and a combination of shoulder and other bodily pain. The majority of the children carried backpacks over two shoulders. The type of bag carried was significantly related to pain experienced (0.00). A significantly larger number of female scholars experienced pain.Conclusion: The shoulder and other bodily pain experienced by the sample of scholars are strongly related to the type of bag and the gender of the children. More in-depth studies into identifying risk factors for bodily pains in school children are indicated.

Risk factors for non-specific low back pain in schoolchildren and their parents: a population based study

A survey of adolescent schoolchildren and their parents through a self-administered questionnaire was conducted to determine the prevalence of low back pain (LBP) in schoolchildren and their parents and to assess its association with exposure to known and presumed risk factors. A previously validated, self-administered questionnaire was used for collecting information on back pain history, anthropometric measures, physical and sports activity, academic problems, hours of leisure sitting, smoking, and alcohol intake. Schoolchildren between the ages of 13 and 15 in schools of the island of Mallorca and their parents ( n=16,394) took part in the study. The lifetime prevalence of LBP was 50.9% for boys and 69.3% for girls; point prevalence (7 days) was 17.1% for boys and 33% for girls. There was a significant association with LBP and pain in bed (OR=13.82, 95% CI: 10.47–18.25, P<0.001), reporting scoliosis (OR=2.87, 95% CI: 2.45–3.37, P<0.001), reporting difference in leg length (OR=1.26, 95% CI: 1.02–1.56, P=0.033), practice of any sport more than twice a week (OR=1.23, 95% CI: 1.09–1.39, P=0.001) and being female (OR=1.11, 95% CI: 1.04–1.19, P=0.001). There was no association found between LBP and body mass index, the manner in which books were transported, hours of leisure sitting, alcohol intake or cigarette smoking. Among parents, the lifetime prevalence of LBP was 78.2% for mothers and 62.6% for fathers; point prevalence (7 days) was 41% for mothers and 24.3% for fathers, and there were significant associations with LBP and pain in bed ( OR=18.07, 95% CI: 14.72–22.19, P<0.001), report of scoliosis ( OR=8.77, 95% CI: 6.44–11.95, P<0.001), report of difference in leg length ( OR=2.21, 95% CI: 1.60–3.04, P<0.001), being a university graduate ( OR=1.89, 95% CI: 1.21–2.98, P=0.006), being female ( OR=1.49, 95% CI: 1.33–1.67, P<0.001), and swimming ( OR=1.10, 95% CI: 1.4–1.18, P=0.002). There was no association found between LBP and alcohol intake, cigarette smoking or the practice of other sports. Although there was a positive association in terms of scoliosis between biological parents and their children ( P<0.001), there was no association found in familial (biological or not) occurrence of LBP. The prevalence of LBP among adolescents in southern Europe is similar to northern Europe, it is comparable to that in adults, and is associated with several factors. There is a strong association between pain in bed or upon rising in both adolescents and adults. Scoliosis, but not LBP, appears to be related to heredity. Further longitudinal studies are necessary to establish risk factors that are predictive for LBP in adolescents.

Back Pain in Schoolchildren: Some Reassuring Findings

Back Pain in Schoolchildren: Some Reassuring Findings

Low back pain in schoolchildren: the role of mechanical and psychosocial factors

Background: Low back pain (LBP) in schoolchildren with no apparent clinical cause is known to be a common problem, but considerably less is understood regarding the aetiology of such pain....