# Prognosis and bio-psycho-social prognostic factors in children and adolescents with musculoskeletal pain consulting general practice

## TL;DR

This study found that many children and teens with musculoskeletal pain still experience activity-limiting pain six months after visiting their doctor, highlighting the need for better early management.

## Contribution

The study identifies specific bio-psycho-social factors associated with persistent pain in children and adolescents in general practice settings.

## Key findings

- 36% of children and adolescents still had activity-limiting pain after 6 months.
- Factors like feeling nervous, tired, or difficulty sleeping increased the risk of persistent pain.
- Persistent pain was linked to functional difficulties like carrying a schoolbag or bending down due to pain.

## Abstract

To investigate the 12-months prognosis and prognostic factors of 8-19-year-olds with musculoskeletal pain in general practice. A prospective cohort was conducted in a setting of Danish general practice clinics. Participants were children and adolescents aged 8–19 years old consulting the general practitioner with self-reported musculoskeletal pain completed a questionnaire at baseline, 3-, 6-, and 12-month follow-up. No interventions were applied. The primary outcome was activity-limiting pain at 6 months, regardless of pain location. We included one hundred children and adolescents (median age 13 years interquartile range 12–16.5, 55% female) with a follow-up rate of 70% at 6 months and 67% at 12 months. The most common pain site was the knee. After 6 months, 36% reported activity-limiting pain and 42% reported multi-site pain. After 12 months, 26% reported activity-limiting pain. Children and adolescents who felt nervous (odds ratio (OR) 4.2 95% confidence interval (CI) 1.4–12.5) or tired during the day (OR 2.9 95% CI 1.1–7.7), with 1–7 days of pain episodes (OR 7.1 95% CI 1.8–28.9), who used pain medication (OR 5.4 95% CI 1.6–18.4), had difficulties falling asleep (OR 4.8 95% CI 1.7–13.9), carrying a schoolbag (OR 3.8 95% CI 1.1–13.1), or bending down to put on socks due to pain (OR 4.1 95% CI 1.3–13.2) had a higher risk of pain after 6 months.

Conclusion: One-third of adolescents consulting their GP for MSK pain continue to experience activity-limiting pain at 6 months. This highlights the need for early identification of risk factors and a biopsychosocial approach to pain management in general practice. This study was performed at the Center for General Practice at Aalborg University, Fyrkildevej 7 1st floor, 9220 Aalborg Ø, Denmark. This work was supported by the Multidisciplinary Committee (MPU) providing a grant used for compensation for the general practice clinic’s time spent on recruitment [grant number ID: MPU 20–2017/date 100117]. ClinicalTrials.gov (Identifier NCT03678922) and link: https://clinicaltrials.gov/study/NCT03678922?term=NCT03678922&rank=1.

What is Known:• Musculoskeletal pain, among other pain sites; headache and abdominal pain account for most of the recurrent painful states among children and adolescents; they may have a poorer prognosis and the MSK pain a larger impact than realized.• Many adolescents consult their GP with MSK pain, but there is a lack of data in this setting of early stage management resulting in a limitation in the current body of evidence on the prognosis of adolescent MSK pain complaints is studies based on secondary care population or school-based population.What is New:• A substantial proportion of children and adolescents (36%) continue to experience activity-limiting MSK pain six months after consulting their GP, with 26% still affected after 12 months.• Children and adolescents with persistent MSK pain at six months was characterized by functional difficulties in daily activities, all linked to their pain, - one of the most notable challenges was carrying a schoolbag.

The online version contains supplementary material available at 10.1007/s00431-025-06217-2.