Persistent musculoskeletal pain and its association with future mental distress in adolescents: The Fit Futures study

TL;DR

This study found that adolescents with persistent musculoskeletal pain are more likely to experience mental distress two years later.

Contribution

The study shows a strong link between moderate to severe persistent musculoskeletal pain and future mental distress in adolescents.

Findings

Persistent musculoskeletal pain was associated with a 2.57 times higher risk of mental distress after two years.

Moderate to severe persistent musculoskeletal pain was linked to a 4.92 times higher risk of mental distress.

The association remained after adjusting for factors like gender, education, and sleep.

Abstract

The aim of this study was to investigate whether persistent musculoskeletal pain was associated with mental distress two years later in adolescents.

Data for this prospective cohort study on Norwegian adolescents were obtained from the population-based Fit Futures study. A total of 535 students in first year of upper-secondary school, without mental distress at baseline, were included. The primary outcome was mental distress at the two-year follow-up, measured with the Hopkins Symptom Checklist–10. The exposure persistent musculoskeletal pain was defined as pain that persisted or recurred at least weekly for ≥ 3 months, in one or more musculoskeletal sites. Moderate to severe persistent musculoskeletal pain was defined as persistent musculoskeletal pain with an intensity of ≥ 5 on a numeric rating scale from 0 (no pain) to 10 (worst pain imaginable). The associations between the two exposures and mental distress were separately assessed with logistic regression analysis, adjusted for gender, parents´ education, chronic diseases, sleep duration and social acceptance among peers.

Adjusted for potential confounders, adolescents who reported persistent musculoskeletal pain at baseline had an odds ratio (OR) for mental distress at two-year follow up of 2.57 (95% CI 1.40–4.69) compared to those without persistent musculoskeletal pain at baseline. Adolescents who reported moderate to severe persistent musculoskeletal pain at baseline had an OR for mental distress of 4.92 (95% CI 2.37–10.22) compared to those without moderate to severe persistent musculoskeletal pain at baseline.

In adolescents, persistent musculoskeletal pain was associated with mental distress two years later. Adolescents with moderate to severe persistent musculoskeletal pain were particularly vulnerable to developing mental distress. The findings from this study should be replicated in larger studies, and the mechanisms underlying the association further explored to strengthen the foundation for developing preventive strategies for mental distress in adolescents.

The online version contains supplementary material available at 10.1186/s12889-025-25272-w.

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