Background & Aims
Visual display terminals (VDTs), including desktop and laptop personal computers (PCs), tablets, and smartphones, are common digital devices that are frequently used for long periods of time in everyday life. Because smartphones are small, lightweight, and have multiple functions useful for both work and play, we can take them anywhere and use them in any position, including lying, standing, sitting, and even walking. Although VDT use is a risk factor for musculoskeletal pain in general, smartphone use may differ from other VDT use. Therefore, we hypothesize that there is a different association of musculoskeletal pain between smartphone use and PC or tablet use. The aim of this study is to determine the associations of long screen time (ST) on smartphone and on PC or tablet with back pain (BP), headache (HA), and limb pain (LP) using data of large-scale web-based self-reported questionnaire surveys, which were conducted as part of the multi-wave longitudinal research project.
Methods
Questionnaires were randomly distributed to a total of 32,000 and 34,000 panelists in September 2022 and February 2023, respectively. We collected data of self-reported ST on smartphone and PC or tablet, averaged over the past week, and severity of BP, HA, and LP in daily life. The study examined the association between long ST of more than two hours on smartphones and severe BP, HA, and LP lasting more than two months in 2022. In addition, the associations of long ST on smartphones with new-onset severe BP, HA, and LP in 2023 were examined in participants aged 30 years and older. Multivariable logistic regression analysis was used for statistical analysis, adjusting for confounding factors such as ST on PC or tablets, age, gender, body mass index, educational background, psychological distress, sleep disorders, and smoking habits. The significance level was set at a two-tailed p-value of less than 0.05.
Results
The study analyzed data from 28,611 participants in 2022 after excluding inappropriate respondents. Among them, 3002 (10.5%), 1456 (5.6%), and 1908 (6.7%) participants reported severe BP, HA, and LP, respectively. Younger people had longer ST on smartphones, with more than 70% of those under 30 years of age browsing for more than 2 hours. The number of people with the long ST on smartphone was greater in women than in men, although that on PC or tablet was greater in men. The multivariable analyses revealed that long ST on smartphone was significantly associated with a high prevalence of severe BP, HA, and LP (odds ratios = 1.34, 1.22, and 1.28, respectively), whereas there was no significant association between long ST on PC or tablet and pain. Longitudinal data analysis revealed a significant association between long ST on smartphone in 2022 and new-onset BP, HA, and LP in 2023 (odds ratio = 1.34, 1.32, and 1.21, respectively).
Conclusions
Long ST on smartphones is a risk factor for severe musculoskeletal pain. Although two hours of ST was a cut-off for the risk factor in people aged 30 years and older in this study, the longer ST may be a risk for the younger people. Perhaps the smartphone has increased the time spent on VDTs and the head is turned to a lower position during smartphone use. However, there is no regulation for smartphone use to prevent severe musculoskeletal pain. The prolonged stretching of neck muscles can cause pain at the site and related headache and back pain. Being close to the display, the eye muscles require greater tension, which may also be a risk for headaches. Holding the smartphone in various positions and doing fine work on the smartphone can put strain on the neck, arm, and hands, resulting in upper limb pain. Although healthy behavior such as adequate exercise is a prevention for musculoskeletal pain, long use of smartphone may take time away from us.
References
Noha Soliman Elserty, Nesma Ahmed Helmy & Khaled Mohmed Mounir (2018): Smartphone addiction and its relation to musculoskeletal pain in Egyptian physical therapy students, European Journal of Physiotherapy, DOI: 10.1080/21679169.2018.1546337.
Hanphitakphong P, Keeratisiroj O, Thawinchai N. Smartphone addiction and its association with upper body musculoskeletal symptoms among university students classified by age and gender. J Phys Ther Sci. 2021 May;33(5):394-400. doi: 10.1589/jpts.33.394.
Zhuang L, Wang L, Xu D, Wang Z, Liang R. Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. J Orthop Sci. 2021 Jan;26(1):110-115. doi: 10.1016/j.jos.2020.02.009. Epub 2020 Mar 20. PMID: 32205018.
Presenting Author
Kenta Wakaizumi
Poster Authors
Kenta Wakaizumi
MD
Keio University
Lead Author
Yoshi Misonoo
MD
Department of Anesthesiology, Keio University School of Medicine
Lead Author
Saki Takaoka
MD
Department of Anesthesiology, Keio University School of Medicine
Lead Author
Morihiko Kawate
MD
Department of Anesthesiology, Keio University School of Medicine
Lead Author
Yuta Shinohara
MA
Interdisciplinary Pain Center, Keio University Hospital
Lead Author
Chisato Tanaka
MD
Interdisciplinary Pain Center, Keio University Hospital
Lead Author
Topics
- Epidemiology