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Epidemiology of chronic musculoskeletal pain

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The rate of musculoskeletal pain in adolescent and adult populations is examined, with a focus on three commonly reported pain disorders: shoulder pain, low back pain and fibromyalgia/chronic widespread pain. There is a paucity of data on musculoskeletal pain in adolescent populations. Those studies available suggest that pain is common, although the actual rates are unclear. This is probably due to differences in study methodologies and populations. Pain is commonly reported among adult populations, with almost one fifth reporting widespread pain, one third shoulder pain, and up to one half reporting low back pain in a 1-month period. The prevalence of pain varies within specific population subgroups; group factors (including socioeconomic status, ethnicity and race) and individual factors (smoking, diet, and psychological status) are all associated with the reporting of musculoskeletal pain. However, the precise nature of these relationships, and particularly the mechanisms of association, are unclear and require further investigation.

Section snippets

Prevalence or incidence?

Before describing the epidemiology of chronic musculoskeletal pain, it is useful to briefly consider the different measures that are used to report rates. Musculoskeletal pain is difficult to accurately measure and study. While shoulder, low back and chronic widespread pain are common (see below), these symptoms often have a poorly defined onset. The first ever episode may have occurred early in childhood, the timing of which is difficult to recall – indeed, the best predictor of a new episode

The prevalence of musculoskeletal pain

There is a paucity of data on the rate of musculoskeletal pain in adolescents. Table 1, Table 2 summarize the results of those studies available. It is clear that the reported prevalence of pain differs markedly between studies. For example, reports of low back pain range from 8%3 to 44%4, while the prevalence of chronic widespread pain has been reported to lie between 1%5 and 15%.6 These differences in reports of pain prevalence are, at least in part, a consequence of the different definitions

Age and gender

Studies of pain in children and adolescents have found that the prevalence of musculoskeletal pain increases with age and is particularly prevalent amongst adolescents.33 A 4-year prospective study reported that the occurrence of new-onset low back pain increased with age from 12.5% in subjects aged 12 years to 24.1% in those aged 15 years.8 A study examining the prevalence of chronic pain (regardless of location) in children and adolescents (age birth to 18 years) reported that prevalence

Conclusion

The prevalence of musculoskeletal pain varies greatly across studies. This is probably due to a number of factors, including the different definitions of pain used. There are also a number of measurement issues which make it difficult to draw comparisons. Many of the studies examining pain in adolescents have only examined the occurrence/non-occurrence of pain, and have not examined duration, frequency or intensity. Furthermore, the majority of epidemiological studies of musculoskeletal pain

Acknowledgements

We would like to thank Barbara Nicholl for her help preparing the tables.

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