Accessible Unlicensed Requires Authentication Published by De Gruyter April 17, 2018

The prevalence of neck-shoulder pain, back pain and psychological symptoms in association with daytime sleepiness – a prospective follow-up study of school children aged 10 to 15

Marja-Liisa Gustafsson, Camilla Laaksonen, Minna Aromaa, Eliisa Löyttyniemi and Sanna Salanterä


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.

  1. Authors’ statements

  2. Research funding: This study was partly funded by The University of Turku and Juho Vainio Foundation.

  3. Conflict of interest: There are no conflicts of interest to declare.

  4. Informed consent: Both the guardians and children gave a written informed consent to participate.

  5. 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).


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Received: 2017-11-22
Revised: 2018-03-19
Accepted: 2018-03-20
Published Online: 2018-04-17
Published in Print: 2018-07-26

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.