Background & Aims

Chronic musculoskeletal pain (CMP) imposes a significant burden to young people (16-24 years), impacting on their physical, social, and emotional health and participation [8,10]. The prevalence of mental health (MH) conditions peaks in this age group [2,4,5], with persisting pain and mental health conditions being strongly comorbid [1]. Evidence suggests this relationship is bidirectional [3,9], however, little is known about the lived and care experiences of pain and MH across this age group. Typically, paediatric populations are binarized (?16 years), with older youth captured in aggregated adult populations, limiting interpretation of findings for this life stage. Our aims were to explore, (i) the lived physical, psychological, and social experiences of young people (16-24 years) experiencing chronic musculoskeletal pain and MH impact; and (ii) the care experiences, preferences, and priorities of young people (16-24 years) experiencing CMP and MH impact.

Methods

Prospectively-registered qualitative evidence synthesis. Inclusion criteria were: primary qualitative studies, participants aged 16–24 years with a lived experience of CMP and disrupted mental health, and the phenomenon explored included lived experience and/or care experiences. Seven electronic databases were searched from inception to 21 February 2023. An expert panel was also consulted for other relevant papers. De-duplicated records were managed in Covidence software for title/abstract and full-text screening. Reference lists of included full text studies were screened for eligibility. Study quality was assessed by 2 reviewers using the Joanna Briggs Checklist for Qualitative Research [7]. First-order text excerpts were extracted from included studies by 2 reviewers and analysed thematically using a staged approached. GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) method was used to assess confidence in each of the meta-synthesis findings [6]

Results

From 8,544 unique citations, 21 studies in 22 reports were included (N=165 participants, age 16-24 years, living with diverse CMP conditions; 68% represented auto-immune inflammatory conditions). 20 studies in 6 high-income countries (USA, UK, Australia, Canada, Sweden, Demark) and 1 from upper-middle-income (South Africa). Aim 1 yielded 4 themes and 12 findings; the two-way relationship between pain and MH (3 findings, moderate confidence); psychosocial implications of CMP (3 findings, low-moderate confidence); uncertainty about the future negatively impacts MH (3 findings, low-moderate); and coping with CMP and MH (3 findings, low-moderate confidence). Aim 2 yielded 3 themes and 8 findings; experiences and preferences of navigating the healthcare system (2 findings, moderate confidence); experiences and preferences for receiving appropriate care for CMP and MH (3 findings, low-moderate confidence); experiences and preference at point of care (3 findings, low-moderate confidence)

Conclusions

Coexisting CMP and mental health disruptions are perceived as highly interconnected, presenting a significant impact on young lives (16-24 years) affecting their identities and social position. Service provision for CMP and mental health is often inadequate and insufficiently integrated for this age group. Further research exploring the lived and care experiences of among this group is needed, especially in those from low-and middle-income settings and living with chronic primary musculoskeletal pain. Deeper explorations of these phenomena are critical to understanding the mechanisms and interplay of pain and mental health in this age group, including more explicit descriptions of how they may be better supported with personalised, holistic and integrated care.

References

[1] Demyttenaere K, Bonnewyn A, Bruffaerts R, Brugha T, De Graaf R, Alonso J. Comorbid painful physical symptoms and depression: Prevalence, work loss, and help seeking. Journal of Affective Disorders 2006;92(2-3):185-193.
[2] Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G, Degenhardt L, Vos T, Whiteford HA, Scott JG. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 2015;45(7):1551-1563.
[3] Hooten WM. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment. Mayo Clin Proc 2016;91(7):955-970.
[4] Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 2007;20(4):359-364.
[5] Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A. Child and adolescent mental health worldwide: evidence for action. Lancet 2011;378(9801):1515-1525.
[6] Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, Bohren MA, Tuncalp O, Colvin CJ, Garside R, Carlsen B, Langlois EV, Noyes J. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci 2018;13(Suppl 1):2.
[7] Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc 2015;13(3):179-187.
[8] Murray CB, Murphy LK, Jordan A, Owens MT, McLeod D, Palermo TM. Healthcare Transition Among Young Adults With Childhood-Onset Chronic Pain: A Mixed Methods Study and Proposed Framework. The journal of pain 2022;23(8):1358-1370.
[9] Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, Machado GC, Prado LR, Maher CG, Ferreira PH. Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta-Analysis. Arthritis Care & Research 2015;67(11):1591-1603.
[10] Slater H, Jordan JE, Chua J, Schütze R, Wark JD, Briggs AM. Young people’s experiences of persistent musculoskeletal pain, needs, gaps and perceptions about the role of digital technologies to support their co-care: A qualitative study. BMJ Open 2016;6(12).

Presenting Author

Helen Slater

Poster Authors

Nardia-Rose Klem

PhD, BSc(Physio)(hons)

Curtin University

Lead Author

E-mail

Andrew M. Briggs

PhD

Lead Author

E-mail

Samantha Rowbotham

PhD

Lead Author

E-mail

Jason Chua

PhD

Lead Author

E-mail

Robert Waller

PhD

Lead Author

E-mail

Jennifer Stinson

PhD

SickKids and University of Toronto

Lead Author

E-mail

Breanna Tory

Lead Author

E-mail

Lorena Romero

Lead Author

E-mail

Susie Lord

FFPMANZCA

Lead Author

E-mail

Robert Schutze

Lead Author

E-mail

Topics

  • Pain in Special Populations: Adolescents