Background and aims
Chronic and recurrent pain is prevalent in adolescents and generally girls report more pain symptoms than boys. Also, pain symptoms and sleep problems often co-occur. Pain symptoms have negative effects on school achievement, emotional well-being, sleep, and overall health and well-being. For effective intervention and prevention there is a need for defining factors associated with pain symptoms and daytime sleepiness. The aim of this longitudinal study was to investigate the prevalence and association between neck-shoulder pain, back pain, psychological symptoms and daytime sleepiness in 10-, 12- and 15-year-old children. This study is the first that followed up the same cohort of children from the age of 10 to 15.
A cohort study design with three measurement points was used. Participants (n=568) were recruited from an elementary school cohort in a city of 1,75,000 inhabitants in South-Western Finland. Symptoms and daytime sleepiness were measured with self-administered questionnaires. Regression models were used to analyze the associations.
Frequent neck-shoulder pain and back pain, and psychological symptoms, as well as daytime sleepiness, are already common at the age of 10 and increase strongly between the ages 12 and 15. Overall a greater proportion of girls suffered from pain symptoms and daytime sleepiness compared to boys. Daytime sleepiness in all ages associated positively with the frequency of neck-shoulder pain and back pain. The more that daytime sleepiness existed, the more neck-shoulder pain and back pain occurred. Daytime sleepiness at the age of 10 predicted neck-shoulder pain at the age of 15, and back pain at the age of 10 indicated that there would also be back pain at the age of 15. In addition, positive associations between psychological symptoms and neck-shoulder pain, as well as back pain, were observed. Subjects with psychological problems suffered neck-shoulder pain and back pain more frequently.
This study is the first study that has followed up the same cohort of children from the age of 10 to 15. The studied symptoms were all already frequent at the age of 10. An increase mostly happened between the ages of 12 and 15. Moreover, the self-reported daytime sleepiness at the age of 10 predicted neck-shoulder pain at the age of 15. More attention should be paid to the daytime sleepiness of children at an early stage as it has a predictive value for other symptoms later in life.
School nurses, teachers and parents are in a key position to prevent adolescents’ sleep habits and healthy living habits. Furthermore, the finding that daytime sleepiness predicts neck-shoulder pain later in adolescence suggests that persistent sleep problems in childhood need early identification and treatment. Health care professionals also need take account of other risk factors, such as psychological symptoms and pain symptoms. The early identification and treatment of sleep problems in children might prevent the symptoms’ development later in life. There is a need for an individuals’ interventions to treat adolescents’ sleep problems.
We gratefully thank all the study participants of the Schools on the Move research project.
Research funding: This study was partly funded by The University of Turku and Juho Vainio Foundation.
Conflict of interest: There are no conflicts of interest to declare.
Informed consent: Both the guardians and children gave a written informed consent to participate.
Ethical approval: The study follows the national legislation (Medical Research Act 488/1999) and the general guidelines of research ethics (TENK 2004). The ethical commission of the Hospital District of Southwest Finland has approved the study (8/2004/232).
 King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152:2729–38.2207806410.1016/j.pain.2011.07.016Search in Google Scholar
 Fichtel A, Larsson B. Psychosocial impact of headache and comorbidity with other pains among swedish school adolescents. Headache 2002;42:766–75.10.1046/j.1526-4610.2002.02178.x12390639Search in Google Scholar
 van Gessel H, Gassmann J, Kröner-Herwig B. Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period. J Pediatr 2011;158:977–83.10.1016/j.jpeds.2010.11.051Search in Google Scholar
 Stanford EA, Chambers CT, Biesanz JC, Chen E. The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach. Pain 2008;138:11–21.10.1016/j.pain.2007.10.032Search in Google Scholar
 Hogg-Johnson S, van der Velde G, Caroll LJ, Holm LW, Cassidy JD, Guzman J, Cote P, Haldeman S, Carragee E, Hurwitz E, Nordin M, Peloso P. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:39–51.10.1097/BRS.0b013e31816454c8Search in Google Scholar
 Myrtveit SM, Sivertsen B, Skogen JC, Frostholm L, Stormark KM, Hysing M. Adolescent neck and shoulder pain – the association with depression, physical activity, screen-based activities, and use of health care services. J Adolesc Health 2014;55:366–72.2474667910.1016/j.jadohealth.2014.02.016Search in Google Scholar
 Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003;60:837–44.10.1001/archpsyc.60.8.83712912767Search in Google Scholar
 Sawyer MG, Arney FM, Baghurst PA, Clark JJ, Graetz BW, Kosky RJ, Nurcombe B, Patton GC, Prior MR, Raphael B, Rey J, Whaites LC, Zubrick SR. The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Aust N Z J Psychiatry 2001;35:806–14.10.1046/j.1440-1614.2001.00964.xSearch in Google Scholar
 Bronsard G, Alessandrini M, Fond G, Loundou A, Pascal Auquier, Tordjman S, Boyer L. The prevalence of mental disorders among children and adolescents in the child welfare system: a systematic review and meta-analysis. Medicine 2016;95:e2622.2688660310.1097/MD.0000000000002622Search in Google Scholar
 Forgeron P, King S. Social functioning and peer relationships in children and adolescents with chronic pain: a systematic review. Pain Res Manag 2010;15:27–41.2019555610.1155/2010/820407Search in Google Scholar
 Ramchandani PG, Hotopf M, Sandhu B, Stein A. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: Results of a large, population-based study. Pediatrics 2005;116:46–50.10.1542/peds.2004-185415995029Search in Google Scholar
 Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DPM, Silman AJ, Macfarlane GJ. Low back pain in schoolchildren: the role of mechanical and psychosocial factors. Arch Dis Child 2003;88:12–7.10.1136/adc.88.1.1212495949Search in Google Scholar
 Oddson BE, Clancy CA, McGrath PJ. The role of pain in reduced quality of life and depressive symptomology in children with spina bifida. Clin J Pain 2006;22:784–9.1705756010.1097/01.ajp.0000210929.43192.5dSearch in Google Scholar
 Lahey BB, Rathouz PJ, Van Hulle C, Urbano RC, Krueger RF, Applegate B, Garriock HA, Chapman DA, Waldman ID. Testing structural models of DSM-IV symptoms of common forms of child and adolescent psychopathology. J Abnorm Child Psychol 2008;36:187–206.1791262410.1007/s10802-007-9169-5Search in Google Scholar
 Gregory AM, Caspi A, Eley TC, Moffitt TE, Oconnor TG, Poulton R. Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood. J Abnorm Child Psychol 2005;33:157–63.1583949410.1007/s10802-005-1824-0Search in Google Scholar
 Adamson G, Murphy S, Shevlin M, Buckle P, Stubbs D. Profiling schoolchildren in pain and associated demographic and behavioural factors: a latent class approach. Pain 2007;129:295–303.1715692610.1016/j.pain.2006.10.015Search in Google Scholar
 Vikat A, Rimpelä M, Salminen JJ, Rimpelä A, Savolainen A, Virtanen SM. Neck or shoulder pain and low back pain in Finnish adolescents. Scand J Public Health 2000;28:164–73.10.1177/1403494800028003040111045747Search in Google Scholar
 Roth-Isigkeit A, Thyen U, Raspe HH, Stöven H, Schmucker P. Reports of pain among German children and adolescents: An epidemiological study. Acta Paediatr 2004;93:258–63.1504628510.1111/j.1651-2227.2004.tb00717.xSearch in Google Scholar
 Rees CS, Smith AJ, O’Sullivan PB, Kendall GE, Straker LM. Back and neck pain are related to mental health problems in adolescence. BMC Public Health 2011;25:382.Search in Google Scholar
 Millman R, Working Group on Sleepiness in Adolescents/Young Adults, AAP Committee on Adolescence. Excessive sleepiness in adolescents and young adults: causes, consequences, and treatment strategies. Pediatrics 2005;115:1777–86.Search in Google Scholar
 Campbell IG, Burright CS, Kraus AM, Grimm KJ, Feinberg I. Daytime sleepiness increases with age in early adolescence: a sleep restriction dose–response study. Sleep 2017;40. DOI:10.1093/sleep/zsx046.2841938810.1093/sleep/zsx046Search in Google Scholar
 Calhoun SL, Vgontzas AN, Fernandez-Mendoza J, Mayes SD, Tsaoussoglou T, Basta M, Bixler EO. Prevalence and risk factors of excessive daytime sleepiness in a community sample of young children: the role of obesity, asthma, anxiety/depression, and sleep. Sleep 2011;34:503–7.10.1093/sleep/34.4.503Search in Google Scholar
 Calhoun SL, Fernandez-Mendoza J, Vgontzas AN, Mayes SD, Tsaoussoglou M, Rodriguez-Muñoz A, Bixler EO. Learning, attention/hyperactivity, and conduct problems as sequelae of excessive daytime sleepiness in a general population study of young children. Sleep 2012;35:627–32.Search in Google Scholar
 Gustafsson M-L, Laaksonen C, Aromaa M, Asanti R, Heinonen O, Koski P, Koivusilta L, Löyttyniemi E, Suominen S, Salanterä S. Association between amount of sleep, daytime sleepiness and health-related quality of life in schoolchildren. J Adv Nurs 2016;72:1263–72.2689948710.1111/jan.12911Search in Google Scholar
 Luntamo T, Sourander A, Rihko M, Aromaa M, Helenius H, Koskelainen M, McGrath PJ. Psychosocial determinants of headache, abdominal pain, and sleep problems in a community sample of Finnish adolescents. Eur Child Adolesc Psychiatry 2012;21:301–13.10.1007/s00787-012-0261-1Search in Google Scholar
 Brun Sundblad G, Saartok T, Engström L-MT. Prevalence and co-occurrence of self-rated pain and perceived health in school-children: age and gender differences. Eur J Pain 2007;11:171–80.1654286010.1016/j.ejpain.2006.02.006Search in Google Scholar
 Valrie CR, Bromberg MH, Palermo T, Schanberg LE. A systematic review of sleep in pediatric pain populations. J Dev Behav Pediatr 2013;34:120–8.2336995810.1097/DBP.0b013e31827d5848Search in Google Scholar
 Pallesen S, Hetland J, Sivertsen B, Samdal O, Torsheim T, Nordhus IH. Time trends in sleep-onset difficulties among Norwegian adolescents: 1983–2005. Scand J Public Health 2008;36:889–95.10.1177/1403494808095953Search in Google Scholar
 Landgraf MN, von Kries R, Heinen F, Langhagen T, Straube A, Albers L. Self-reported neck and shoulder pain in adolescents is associated with episodic and chronic migraine. Cephalalgia 2016;36:807–11.10.1177/033310241561087526460336Search in Google Scholar
 Wiklund M, Malmgren-Olsson EB, Öhman A, Bergström E, Fjellman-Wiklund A. Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender – a cross-sectional school study in Northern Sweden. BMC Public Health 2012;12:993.10.1186/1471-2458-12-993Search in Google Scholar
 Hakala P, Rimpelä A, Salminen JJ, Virtanen SM, Rimpelä M. Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Br Med J 2002;325:743.10.1136/bmj.325.7367.743Search in Google Scholar
 Kronholm E, Puusniekka R, Jokela J, Villberg J, Urrila AS, Paunio T, Välimaa R, Tynjälä J. Trends in self-reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011. J Sleep Res 2015;24:3–10.10.1111/jsr.1225825367818Search in Google Scholar
 Weaver RG, Webster CA, Egan C, Campos CMC, Michael RD, Vazou S. Partnerships for active children in elementary schools: Outcomes of a 2-year pilot study to increase physical activity during the school day. Am J Health Promot 2018;32:621–30.10.1177/089011711770728928482678Search in Google Scholar
 Galland BC, Gray AR, Penno J, Smith C, Lobb C, Taylor RW. Gender differences in sleep hygiene practices and sleep quality in New Zealand adolescents aged 15 to 17 years. Sleep Health 2017;3:77–83.10.1016/j.sleh.2017.02.00128346161Search in Google Scholar
 Fairclough S, Hackett A, Davies I, Gobbi R, Mackintosh K, Warburton G, Stratton G, Sluijs E, Boddy L. Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study. BMC Public Health 2013;13:626.10.1186/1471-2458-13-62623819701Search in Google Scholar
 Chung S, McBride A. Social and emotional learning in middle school curricula: a service learning model based on positive youth development. Child Youth Serv Rev 2015;53:192–200.10.1016/j.childyouth.2015.04.008Search in Google Scholar
 Durlak J, Weissberg R, Dymnicki A, Taylor R, Schellinger K. The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Dev 2011;82:405–32.10.1111/j.1467-8624.2010.01564.x21291449Search in Google Scholar
 Veltro F, Ialenti V, Morales García MA, Iannone C, Bonanni E, Gigantesco A. Evaluation of the impact of the new version of a handbook to promote psychological wellbeing and emotional intelligence in the schools (students aged 12–15). Riv Psichiatr 2015;50:71–9.25994617Search in Google Scholar
 Voss, C, Sandercock, GRH. Associations between perceived parental physical activity and aerobic fitness in schoolchildren. J Phys Act Health 2013;10:397–9.10.1123/jpah.10.3.39722820022Search in Google Scholar
 Liu Y, Wang M, Tynjälä J, Yan Lv, Villberg J, Zhang Z, Kannas L. Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China. BMC Med Res Methodol 2010;10:73.10.1186/1471-2288-10-7320696078Search in Google Scholar
©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.