Background & Aims

The prevalence of chronic musculoskeletal pain in adolescents is as high as 40% (1,2). Adolescents with chronic musculoskeletal pain tend to be female and to report psychosocial and sleep impairments (3–6). More recently, reporting symptoms of central sensitization has also emerged as a relevant factor for the onset and persistence of chronic pain in adolescents (7,8). Central sensitization remains a phenomenon without a currently established measurement. However, quantitative sensory testing, through the semi-objective assessment of pressure pain thresholds (PPT), have been used to explore its possible presence (9,10), particularly when the PPT is decreased in regions distant from the region of pain (10,11). However, few studies have assessed PPT at body sites distant from where pain is reported in adolescents (4,12). Thus, this study aimed to compare adolescents with chronic musculoskeletal pain and asymptomatic adolescents, for PPT, symptoms of central sensitization, and sleep.

Methods

Adolescents were identified as having chronic pain if they reported pain that persisted for the last 3 months on the Nordic Musculoskeletal Questionnaire(NMQ). For adolescents without pain, the algometer assessment was performed at 4 points (laterally to C5/C6; L3/L4; thenar region; tibialis anterior). For adolescents with pain, PPT was performed at the most painful region and at a distant non-painful region, which varied depending on the most painful region: when the neck/thoracic region was the most painful PPT was measured in the tibialis anterior; for low back pain, it was measured in the hand; and for lower limb pain, it was measured in the neck. PPTs measured in the adolescents with pain were compared against the corresponding non-painful region of the adolescents without pain. Adolescents were asked to fill in the online versions of the NMQ, Central Sensitization Inventory, Sleep Quality Scale. Between-group differences were explored using Student’s t-tests and Chi-square tests.

Results

74 adolescents were included in this study. Of these, 41 had chronic pain (mean age±SD=15.7±1.1; 31 F) and 33 were asymptomatic (mean age±SD=15.9±0.9; 13 F). The mean(±SD) number of painful body sites was 3.0(±1.8). Twelve adolescents reported the neck/thoracic region as the most painful region (mean±SD PPT=22.4 ±10.3 N/cm²); 11 reported the low back (mean±SD PPT=32.1±15.2); and 18 reported the lower limb (mean±SD PPT=23.7 ±13.8). In the asymptomatic group, the mean(±SD) PPT was 33.1(±13.7), 39.5(±12.1), 45.1(±13.4) and 50.1(±10.3) N/cm² in the neck, hand, lumbar and tibialis anterior region, respectively. Statistically significant differences were found for all the comparisons between the PPT at the most painful region and the corresponding region in the asymptomatic adolescents (p<0.05). Between group comparisons for the PPT at the non-painful body sites were also statistically significant for the different subgroups (p<0.05). For the remaining variables no differences were found.

Conclusions

The results suggest that adolescents with chronic musculoskeletal pain have lower PPTs both at the most painful body site and at a distant non-painful body site suggesting that central processes are contributing to the reported hyperalgesia. Further studies with larger samples and other quantitative sensory assessment approaches are needed.

References

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Presenting Author

Anabela G. Silva

Poster Authors

Rosa Andias

PhD

CINTESIS.UA@RISE, University of Aveiro

Lead Author

Marta Costa

School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal

Lead Author

Anabela Silva

Universidade de Aveiro

Lead Author

Topics

  • Assessment and Diagnosis