Top

BMC Public Health

Published in:

Open Access 01-12-2015 | Research article

Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study

Authors: Berit Østerås, Hermundur Sigmundsson, Monika Haga

Published in: BMC Public Health | Issue 1/2015

Abstract

Background

Long-term musculoskeletal pain and negative stress are health risks with adverse long-term health effects, and these health risks seem to increase among young people. The mechanisms behind this are unclear. There is a need for a better understanding of perceived stress and musculoskeletal pain among adolescents, in order to improve health promotion and treatment approaches in this group.

Methods

Objectives were to evaluate the current prevalence of perceived stress and musculoskeletal pain in 15 and 16 year olds, to explore stress-pain associations and the probability that perceived stress (PSQ) was related to the reporting of pain and variations in pain, and to investigate possible differences in stress between different types of musculoskeletal pain in the adolescents. A cross-sectional study was conducted. Elementary schools participated. The outcomes were stress (Perceived stress questionnaire; PSQ) and musculoskeletal pain (pain/no pain, pain sites, pain duration and pain intensity (Visual analogue scale; VAS).

Results

Fifty-one point two percent (N = 422) reported pain, of which 70.8 % reported long-term pain. Some more girls (57.9 %) reported pain. 22.0 % of the study population reported moderate to severe stress (PSQ ≥ 0.45), of which 79.6 % were bothered by pain (Pearson Chi-square 38.47, p ≤ .001). All stress and pain variables were significantly associated (p < .01). The strongest association appeared between pain intensity (VAS) and stress (PSQ) (r = 0.40). Perceived stress (PSQ) was associated with the reporting of pain among the adolescents (Odds Ratio [OR] 1.68) and could explain some of the variation in pain intensity (VAS; β = 0.15, p < .001) and number of pain sites (β = 0.14, p < .01), according to the regression analyses. There were no mean differences in stress (PSQ) between different types of musculoskeletal pain.

Conclusions

There was high prevalence of musculoskeletal pain, long-term pain and moderate to severe stress (PSQ ≥ 0.45) in this study sample. Perceived stress (PSQ) was related to the reporting of musculoskeletal pain among the adolescents and could explain some of the variation in pain intensity (VAS) and number of pain sites. There were no differences in stress levels (PSQ) between different types of musculoskeletal pain in the adolescents.

Available only for authorised users

Del Giudice M, Ellis BJ, Shirtcliff EA. The adaptive calibration model of stress responsivity. Neurosci Biobehav Rev. 2011;35(7):1562–92. doi:10.1016/j.neubiorev.2010.11.007. Epub 2010 Dec 8.CrossRefPubMed

Moksnes UK, Espnes GA, Haugan G. Stress, sense of coherence and emotional symptoms in adolescents. Psychol Health. 2013;29(1):32–49. doi:10.1080/08870446.2013.822868. Epub 2013 Aug 1.CrossRefPubMed

Diepenmaat AC, van der Wal MF, de Vet HC, Hirasing RA. Neck/shoulder, low back, and arm pain in relation to computer use, physical activity, stress, and depression among Dutch adolescents. Pediatrics. 2006;117(2):412–6.CrossRefPubMed

Wiklund M, Malmgren-Olsson EB, Ohman 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. doi:10.1186/1471-2458-12-993.CrossRefPubMedPubMedCentral

Prins Y, Crous L, Louw QA. A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents. Physiother Theory Pract. 2008;24(4):221–42. doi:10.1080/09593980701704089.CrossRefPubMed

Hoftun GB, Romundstad PR, Zwart JA, Rygg M. Chronic idiopathic pain in adolescence--high prevalence and disability: the young HUNT Study 2008. Pain. 2011;152(10):2259–66. doi:10.1016/j.pain.2011.05.007. Epub 2011 Jun 16.CrossRefPubMed

Ursin H, Eriksen HR. The cognitive activation theory of stress. Psychoneuroendocrinology. 2004;29(5):567–92.CrossRefPubMed

Eriksen HR, Ursin H. Subjective health complaints, sensitization, and sustained cognitive activation (stress). J Psychosom Res. 2004;56(4):445–8.CrossRefPubMed

Ursin H, Eriksen HR. Cognitive activation theory of stress (CATS). Neurosci Biobehav Rev. 2010;34(6):877–81. doi:10.1016/j.neubiorev.2009.03.001. Epub 2009 Mar 10.CrossRefPubMed

10.

Brodal P. Sentralnervesystemet [the central nervous system]. 5th ed. Oslo: Universitetsforlaget; 2013. p. 230–1.

11.

Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014;94(12):1816–25. doi:10.2522/ptj.20130597. Epub 2014 Jul 17.CrossRefPubMedPubMedCentral

12.

Danielsson M, Heimerson I, Lundberg U, Perski A, Stefansson CG, Akerstedt T. Psychosocial stress and health problems: Health in Sweden: The National Public Health Report 2012. Scand J Public Health. 2012;40(9 Suppl):121–34. doi:10.1177/1403494812459469.CrossRefPubMed

13.

Lager A, Berlin M, Heimerson I, Danielsson M. Young people’s health: health in Sweden: the national public health report 2012. Scand J Public Health. 2012;40(9 Suppl):42–71. doi:10.1177/1403494812459459.CrossRefPubMed

14.

Rathleff MS, Roos EM, Olesen JL, Rasmussen S. High prevalence of daily and multi-site pain—a cross-sectional population-based study among 3000 Danish adolescents. BMC Pediatr. 2013;13:191. doi:10.1186/1471-2431-13-191.CrossRefPubMedPubMedCentral

15.

Eckhoff C, Kvernmo S. Musculoskeletal pain in Arctic indigenous and non-indigenous adolescents, prevalence and associations with psychosocial factors: a population-based study. BMC Public Health. 2014;18(14):617. doi:10.1186/1471-2458-14-617.CrossRef

16.

Skrove M, Romundstad P, Indredavik MS. Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study. Eur Child Adolesc Psychiatry. 2014. doi:10.1007/s00787-014-0601-4.PubMed

17.

Murberg TA, Bru E. School-related stress and psychosomatic symptoms among Norwegian adolescents. Sch Psychol Int. 2004;25(3):317–32. doi:10.1177/0143034304046904.CrossRef

18.

Christensen J, Fisker A, Mortensen EL, Olsen LR, Mortensen OS, Hartvigsen J, et al. Comparison of mental distress in patients with low back pain and a population-based control group measured by symptoms check list - a case-referent study. Scand J Public Health. 2015. doi:10.1177/1403494815581697.

19.

Mikkonen P, Heikkala E, Paananen M, Remes J, Taimela S, Auvinen J, Karppinen J. Accumulation of psychosocial and lifestyle factors and risk of low back pain in adolescence: a cohort study. Eur Spine J. 2015 Jun 13. [Epub ahead of print]

20.

Hoftun GB, Romundstad PR, Rygg M. Factors associated with adolescent chronic non-specific pain, chronic multisite pain, and chronic pain with high disability: the young-HUNT study 2008. J Pain. 2012;13(9):874–83. doi:10.1016/j.jpain.2012.06.001. Epub 2012 Jul 24.CrossRefPubMed

21.

Lovallo WR. Stress & health. Biological and psychological interactions. Thousand Oaks: Sage Publications; 2005. p. 123–94.

22.

Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9(2):122–45. Epub 2007 Dec 21. Review.CrossRefPubMed

23.

Irwin MR, Cole SW. Reciprocal regulation of the neural and innate immune systems. Nat Rev Immunol. 2011;11(9):625–32. doi:10.1038/nri3042.CrossRefPubMedPubMedCentral

24.

Sterrenburg L, Gaszner B, Boerrigter J, Santbergen L, Bramini M, Elliott E, et al. Chronic stress induces sex-specific alterations in methylation and expression of corticotropin-releasing factor gene in the rat. PLoS One. 2011;6(11), e28128. doi:10.1371/journal.pone.0028128. Epub 2011 Nov 23.CrossRefPubMedPubMedCentral

25.

Sterrenburg L, Gaszner B, Boerrigter J, Santbergen L, Bramini M, Roubos EW, et al. Kozicz T Sex-dependent and differential responses to acute restraint stress of corticotropin-releasing factor-producing neurons in the rat paraventricular nucleus, central amygdala, and bed nucleus of the stria terminalis. J Neurosci Res. 2012;90(1):179–92. doi:10.1002/jnr.22737. Epub 2011 Sep 15.CrossRefPubMed

26.

Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, et al. Development of the perceived stress questionnaire: a new tool for psychosomatic research. J Psychosom Res. 1993;37(1):19–32.CrossRefPubMed

27.

Kocalevent RD, Levenstein S, Fliege H, Schmid G, Hinz A, Brähler E, et al. Contribution to the construct validity of the perceived stress questionnaire from a population-based survey. J Psychosom Res. 2007;63(1):71–81.CrossRefPubMed

28.

Hagan MJ, Roubinov DS, Gress-Smith J, Luecken LJ, Sandler IN, Wolchik S. Positive parenting during childhood moderates the impact of recent negative events on cortisol activity in parentally bereaved youth. Psychopharmacology (Berl). 2011;214(1):231–8. doi:10.1007/s00213-010-1889-5. Epub 2010 Jun 3.CrossRef

29.

Dietz LJ, Stoyak S, Melhem N, Porta G, Matthews KA, Walker Payne M, et al. Cortisol response to social stress in parentally bereaved youth. Biol Psychiatry. 2013;73(4):379–87. doi:10.1016/j.biopsych.2012.08.016.CrossRefPubMed

30.

Bridget M, Kuehn MSJ. AAP: toxic stress threatens Kids’ long-term health. JAMA. 2014;312(6):585–6.CrossRef

31.

Jones GT. Pain in children--a call for more longitudinal research. Pain. 2011;152(10):2202–3. doi:10.1016/j.pain.2011.06.016. Epub 2011 Jul 5.CrossRefPubMed

32.

Dean E, Söderlund A. What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskelet Disord. 2015;16:87. doi:10.1186/s12891-015-0545-y.CrossRefPubMedPubMedCentral

33.

Norwegian Institute of Public Health. Health in children and young people – The Public Health Report 2014. http://www.fhi.no/artikler/?id=111677. Published 07.10.2014, updated 09.04.2015. Accessed 10 Sept 2015.

34.

Norwegian Institute of Public Health. Norwegian priorities in global health. http://www.fhi.no/artikler/?id=103215, published 04.02.2013, updated 07.05.2015. Accessed 10 Sept 2015.

35.

De Vriendt T, Clays E, Maes L, De Bourdeaudhuij I, Vicente-Rodriguez G, Moreno LA, et al. European adolescents’ level of perceived stress and its relationship with body adiposity--the HELENA Study. Eur J Public Health. 2012;22(4):519–24. Epub 2011 Sep 10.CrossRefPubMed

36.

Trondheim commune, ownership unit. «Living conditions 2011. A rapport on living conditions in Trondheim», March 2012. http://www.trondheim.kommune.no. Accessed 20 Jan 2013.

37.

The World Medical Association (WMA). Declaration of Helsinki - ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013. http://www.wma.net/en/30publications/10policies/b3/index.html.

38.

Fliege H, Rose M, Arck P, Walter OB, Kocalevent RD, Weber C, et al. The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med. 2005;67(1):78–88.CrossRefPubMed

39.

Montero-Marin J, Piva Demarzo MM, Pereira JP, Olea M, García-Campayo J. Reassessment of the psychometric characteristics and factor structure of the Perceived Stress Questionnaire (PSQ): analysis in a sample of dental students. PLoS One. 2014;9(1):e87071. doi:10.1371/journal.pone.0087071.CrossRefPubMedPubMedCentral

40.

Stinson JN, McGrath PJ, Hodnett ED, Feldman BM, Duffy CM, Huber AM, et al. An internet-based self-management program with telephone support for adolescents with arthritis: a pilot randomized controlled trial. J Rheumatol. 2010;37(9):1944–52. doi:10.3899/jrheum.091327. Epub 2010 Jul 1.CrossRefPubMed

41.

Kocalevent RD, Hinz A, Brähler E, Klapp BF. Determinants of fatigue and stress. BMC Res Notes. 2011;20(4):238. doi:10.1186/1756-0500-4-238.CrossRef

42.

The International Association for the Study of Pain [IASP] 2014. Classification of Chronic Pain, Second Edition (Revised). August 06, 2014. http://www.iasp-pain.org/PublicationsNews. Accessed 20 Jan 2015.

43.

Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56.CrossRefPubMed

44.

Bailey B, Gravel J, Daoust R. Reliability of the visual analog scale in children with acute pain in the emergency department. Pain. 2012;153(4):839–42. doi:10.1016/j.pain.2012.01.006. Epub 2012 Feb 4.CrossRefPubMed

45.

Sugiura S, Aoki Y, Toyooka T, Shiga T, Otsuki K, Aikawa E, et al. Characteristics of low back pain in adolescent patients with early-stage spondylolysis evaluated using a detailed visual analogue scale. Spine (Phila Pa 1976). 2015;40(1):E29–34. doi:10.1097/BRS.0000000000000657.CrossRef

46.

Sethi J, Sandhu JS, Imbanathan V. Effect of Body Mass Index on work related musculoskeletal discomfort and occupational stress of computer workers in a developed ergonomic setup. Sports Med Arthrosc Rehabil Ther Technol. 2011;3(1):22. doi:10.1186/1758-2555-3-22.CrossRefPubMedPubMedCentral

47.

Silva MR, Badaró AF, Dall’Agnol MM. Low back pain in adolescent and associated factors: a cross sectional study with schoolchildren. Braz J Phys Ther. 2014;18(5):402–9. Epub 2014 Oct 10.CrossRefPubMedPubMedCentral

48.

Hartung J, Knapp G, Sinha BK. Statistical meta-analysis with application. New York: Wiley; 2008.CrossRef

49.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Earlbaum Associates; 1988.

50.

Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, Bohnen AM, van Suijlekom-Smit LW, Passchier J, et al. Pain in children and adolescents: a common experience. Pain. 2000;87(1):51–8.CrossRefPubMed

51.

El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M. Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren. BMC Musculoskelet Disord. 2006;18(7).

52.

Boćkowski L, Sobaniec W, Kułak W, Smigielska-Kuzia J, Sendrowski K, Roszkowska M. Low back pain in school-age children: risk factors, clinical features and diagnostic managment. Adv Med Sci. 2007;52 Suppl 1:221–3.PubMed

53.

Galli F, Caputi M, Gallucci M, Termine C, Chiappedi M, Balottin U. Headache and psychological disorders in children and adolescents: a cross-generational study. Minerva Pediatr. 2015 Jun 4. [Epub ahead of print]

54.

Bergdahl J, Bergdahl M. Perceived stress in adults: prevalence and association of depression, anxiety and medication in a Swedish population. Stress Health. 2002;18:235–41. doi:10.1002/smi.946. www.interscience.wiley.com.CrossRef

55.

Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. Phys Ther. 2011;91(5):700–11. doi:10.2522/ptj.20100330. Epub 2011 Mar 30.CrossRefPubMed

56.

Meeus M, Nijs J, Hermans L, Goubert D, Calders P. The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets? Expert Opin Ther Targets. 2013;17(9):1081–9. doi:10.1517/14728222.2013.818657. Epub 2013 Jul 9.CrossRefPubMed

57.

Moeller-Bertram T, Strigo IA, Simmons AN, Schilling JM, Patel P, Baker DG. Evidence for acute central sensitization to prolonged experimental pain in posttraumatic stress disorder. Pain Med. 2014;15(5):762–71. doi:10.1111/pme.12424. Epub 2014 Apr 16.CrossRefPubMed

58.

Kaasbøll J, Lydersen S, Indredavik MS. Psychological symptoms in children of parents with chronic pain-the HUNT study. Pain. 2012;153(5):1054–62. doi:10.1016/j.pain.2012.02.013. Epub 2012 Mar 21.CrossRefPubMed

59.

Hoftun GB, Romundstad PR, Rygg M. Association of parental chronic pain with chronic pain in the adolescent and young adult: family linkage data from the HUNT Study. JAMA Pediatr. 2013;167(1):61–9. doi:10.1001/jamapediatrics.2013.422.CrossRefPubMed

60.

Norwegian Social Research (NOVA). “Ungdata”. National results 2014. NOVA Report 7/15. ISBN: 978-82-7894-556-8 (print), 978-82-7894-557-5 (electronical). http://www.hioa.no/Om-HiOA/Senter-for-velferds-og-arbeidslivsforskning/NOVA. Accessed 20 Sept 2015.

61.

Monticone M, Cedraschi C, Ambrosini E, Rocca B, Fiorentini R, Restelli M, et al. Cognitive-behavioural treatment for subacute and chronic neck pain. Cochrane Database Syst Rev. 2015;5, CD010664. doi:10.1002/14651858.CD010664.pub2.

62.

Pincus T, Anwar S, McCracken LM, McGregor A, Graham L, Collinson M, et al. Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk; results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs Physiotherapy. BMC Musculoskelet Disord. 2015;16(1):147. doi:10.1186/s12891-015-0594-2.CrossRefPubMedPubMedCentral

63.

Bruffaerts R, Demyttenaere K, Kessler RC, Tachimori H, Bunting B, Hu C, et al. The associations between preexisting mental disorders and subsequent onset of chronic headaches: a worldwide epidemiologic perspective. J Pain. 2015;16(1):42–52. doi:10.1016/j.jpain.2014.10.002. Epub 2014 Oct 22.CrossRefPubMed

64.

Title: Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study
Authors: Berit Østerås
Hermundur Sigmundsson
Monika Haga
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-015-2414-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: an epidemiological cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2015

Assessment of training and technical assistance needs of Colorectal Cancer Control Program Grantees in the U.S.

Strengthening HIV surveillance in the antiretroviral therapy era: rationale and design of a longitudinal study to monitor HIV prevalence and incidence in the uMgungundlovu District, KwaZulu-Natal, South Africa

Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults

Low back pain and physical activity – A 6.5 year follow-up among young adults in their transition from school to working life

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS)

Balancing expectations amidst limitations: the dynamics of food decision-making in rural Kerala