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Pain and health in adolescents and young adults – pieces of a puzzle
Halmstad University, School of Business, Innovation and Sustainability, The Rydberg Laboratory for Applied Sciences (RLAS). Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).ORCID iD: 0000-0001-9918-461X
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Musculoskeletal pain is a burden for the individual and for society, and it has a negative impact on overall health. The biological, psychological, and social factors that govern pain and health form a complex puzzle to put together. Musculoskeletal pain conditions may be alleviated by physical activity, but a too high level of physical activity may also increase the risk of pain. Youth athletes may be especially vulnerable to developing pain due to factors related to training load and physical maturity. Being physically active and maintaining a healthy diet is associated with better health, but if carried out to excess these health behaviours may become unhealthy. Our understanding of musculoskeletal pain and health in adolescents and young adults needs to be developed, both in individuals involved in sports and exercise and in the general population.

Aim: The overall aim was to study musculoskeletal pain and its relationship to various health-related factors in adolescents and young adults enrolled in sport or general education programmes.

Methods: Study I was a cross-sectional study on university students (aged 19–29) from an exercise science programme (n = 118) and a business programme (n = 89), assessing health status, physical activity, and orthorexia nervosa (an exaggerated fixation on healthy food). Study II was a cross-sectional study (n = 178), and Study III a 2-year longitudinal (n = 131) study on sport school students (aged 14 at baseline), assessing musculoskeletal pain, health status, physical maturity, and sports performance. Study IV was a 3-year longitudinal study on students from a general upper secondary school (n = 256, aged 16 at baseline), assessing chronic musculoskeletal pain, health status, physical activity, sleep, stress, anxiety, and depression.

Results: In Study I, compared to business students, exercise science students reported more pain, but better general health. A high level of physical activity in combination with orthorexia nervosa was most prevalent in men from the exercise science programme. In Studies II and III, pain was common in sport school students. At baseline, boys with constant pain were not as physically mature as boys with infrequent pain. Students with constant pain reported a worse health status than students with infrequent pain. At follow-up, frequent pain, frequent pain in two or more body regions, and a worse health status at baseline were identified as risk factors for having frequent pain at follow-up in girls. For boys, late physical maturation at baseline was a risk factor. Involvement in non-contact sports was also an identified risk factor over time in both sexes. Pain was associated with a worse sports performance in boys at both baseline and follow-up. In Study IV, chronic musculoskeletal pain was common in students from a general upper secondary school. A worse health status, severe sleeping problems, anxiety, and chronic musculoskeletal pain at baseline were associated with reporting chronic musculoskeletal pain at follow-up.

Conclusions: Pain was prevalent, and also persistent, in adolescents and young adults, irrespective of attending sport or general education programmes. Pain is a biopsychosocial phenomenon and must be treated as such. Pain should be frequently monitored, and treatment should be introduced early on to prevent pain from becoming persistent.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2020. , p. 113
Series
Halmstad University Dissertations ; 73
Keywords [en]
musculoskeletal pain, health status, physical activity, orthorexia nervosa, sports, sleep, stress, anxiety, depression, physical maturity, students, school, biopsychosocial
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-43044ISBN: 978-91-88749-54-3 (print)ISBN: 978-91-88749-55-0 (electronic)OAI: oai:DiVA.org:hh-43044DiVA, id: diva2:1464147
Public defence
2020-10-09, Baertlingsalen, Visionen (hus J), Kristian IV:s väg 3, Halmstad, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-09-08 Created: 2020-09-04 Last updated: 2021-03-26Bibliographically approved
List of papers
1. Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students
Open this publication in new window or tab >>Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students
2017 (English)In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 109, p. 137-143Article in journal (Refereed) Published
Abstract [en]

Orthorexia nervosa is described as an exaggerated fixation on healthy food. It is unclear whether students in health-oriented academic programs, highly focused on physical exercise, are more prone to develop orthorexia nervosa than students in other educational areas. The aim was to compare health status, physical activity, and frequency of orthorexia nervosa between university students enrolled in an exercise science program (n = 118) or a business program (n = 89). The students completed the Short Form-36 Health Survey (SF-36), the International Physical Activity Questionnaire (IPAQ), and ORTO-15, which defines orthorexia nervosa as a sensitive and obsessive behavior towards healthy nutrition. The SF-36 showed that exercise science students scored worse than business students regarding bodily pain (72.8 vs. 82.5; p = 0.001), but better regarding general health (83.1 vs. 77.1; p = 0.006). Of 188 students, 144 (76.6%) had an ORTO-15 score indicating orthorexia nervosa, with a higher proportion in exercise science students than in business students (84.5% vs. 65.4%; p = 0.002). Orthorexia nervosa in combination with a high level of physical activity was most often seen in men in exercise science studies and less often in women in business studies (45.1% vs. 8.3%; p < 0.000). A high degree of self-reporting of pain and orthorexia nervosa in exercise science students may cause problems in the future, since they are expected to coach others in healthy living. Our findings may be valuable in the development of health-oriented academic programs and within student healthcare services. © 2016 Elsevier Ltd

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2017
Keywords
Bodily pain, General health, High-intensity exercise, Orthorexia nervosa, Nutrition
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-32455 (URN)10.1016/j.appet.2016.11.028 (DOI)000392772600017 ()27889495 (PubMedID)2-s2.0-85002496983 (Scopus ID)
Note

Funding: Halmstad University; Spenshult Research and Development Center, Halmstad; and Region Halland, Sweden [grant number HALLAND-469111].

Available from: 2016-11-21 Created: 2016-11-21 Last updated: 2020-09-10Bibliographically approved
2. Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students
Open this publication in new window or tab >>Musculoskeletal pain and its association with maturity and sports performance in 14-year-old sport school students
2018 (English)In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 4, no 1, article id e000395Article in journal (Refereed) Published
Abstract [en]

Objectives: In youth sports, musculoskeletal pain is often studied from the standpoint of sports injuries, but little is known about pain conditions in which athletes still participate. The aim was to study the frequency of pain and associations with maturity offset, health status and sports performance in 14-year-old sport school students.

Methods: Cross-sectional design. One hundred and seventy-eight students (108 boys and 70 girls) completed anthropometric measures for maturity offset (height, weight and sitting height), questionnaires (pain mannequin and EQ-5D for health status) and sports performance tests (sprint, agility, counter-movement jump and grip strength). Differences between groups were analysed with Student’s t-test and analysis of covariance.

Results: Thirty-one students (18.6%) reported infrequent pain, 85 (50.9%) frequent pain and 51 (30.5%) constant pain. Students in the constant pain group had worse health status than those in the infrequent pain group. Boys with constant pain (n=27) had a lower mean maturity offset (–0.38 vs 0.07 years; p=0.03) than boys with infrequent pain (n=22), and pain was associated with worse sports performance. There was no difference in maturity or sports performance between girls with constant pain (n=24) and girls with infrequent pain (n=9).

Conclusion: Musculoskeletal pain is common in sport school students and coincides with worse health status and with a younger biological age in boys. The high prevalence of pain should be acknowledged by coaches and student healthcare workers in order to promote a healthy and sustainable development in young athletes. © Author(s) (or their employer(s)) 2018.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2018
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-37488 (URN)10.1136/bmjsem-2018-000395 (DOI)000596798200097 ()2-s2.0-85050373874 (Scopus ID)
Note

Funding: Halmstad University; Spenshult Research and Development Center, Halmstad; Region Halland (grant numbers HALLAND-469111 and HALLAND-639101); and the Mayflower Charity Foundation, Sweden.

Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2023-10-05Bibliographically approved
3. Musculoskeletal pain and its association with health status, maturity, and sports performance in adolescent sport school students: a 2-year follow-up
Open this publication in new window or tab >>Musculoskeletal pain and its association with health status, maturity, and sports performance in adolescent sport school students: a 2-year follow-up
Show others...
2022 (English)In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 14, no 1, article id 43Article in journal (Refereed) Published
Abstract [en]

Background: Musculoskeletal pain and its risk factors are rarely assessed in studies on adolescent athletes. The aim was to identify risk factors at baseline that were associated with the persistence or development of musculoskeletal pain at a two-year follow-up in adolescent sport school students, and to study cross-sectional associations at follow-up between musculoskeletal pain and sports performance.

Methods: Sport school students (79 boys and 52 girls, aged 14 years at baseline) were divided into infrequent (never–monthly) or frequent (weekly–almost daily) pain groups, based on frequency of pain using a pain mannequin. Logistic regression analyses were performed to study longitudinal associations between frequent pain at follow-up and baseline variables: pain group, number of regions with frequent pain, health status by EQ-5D, maturity offset (pre, average, or post peak height velocity), and sports (contact or non-contact). Linear regression analyses were used to study cross-sectional associations between pain groups and 20-m sprint, agility T-test, counter-movement jump, and grip strength at follow-up. Results were stratified by sex.

Results: A higher percentage of girls than boys reported frequent pain at follow-up (62% vs. 37%; p = 0.005). In boys, frequent pain at follow-up was associated with being pre peak height velocity at baseline (OR 3.884, CI 1.146–13.171; p = 0.029) and participating in non-contact sports (OR 3.429, CI 1.001–11.748; p = 0.050). In girls, frequent pain at follow-up was associated with having frequent pain in two or more body regions at baseline (OR 3.600, CI 1.033–12.542; p = 0.044), having a worse health status at baseline (OR 3.571, CI 1.026–12.434; p = 0.045), and participating in non-contact sports (OR 8.282, CI 2.011–34.116; p = 0.003). In boys, frequent pain was associated with worse performances in 20-m sprint and counter-movement jump, but not in agility T-test and grip strength.

Conclusions: Baseline risk factors for having frequent pain at follow-up were late maturation in boys, frequent pain and worse health status in girls, and participation in non-contact sports in both sexes. Boys with pain performed worse in sports tests. Coaches and school health-care services should pay attention to the risk factors and work towards preventing pain from becoming persistent. © 2022, The Author(s).

Place, publisher, year, edition, pages
London: BioMed Central (BMC), 2022
Keywords
Epidemiology, Exercise physiology, Health status, Maturity, Sports performance
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences
Identifiers
urn:nbn:se:hh:diva-43031 (URN)10.1186/s13102-022-00437-x (DOI)000771455100001 ()35313966 (PubMedID)2-s2.0-85126734264 (Scopus ID)
Funder
Region Halland, HALLAND-639101Region Halland, HALLAND-469111Halmstad University
Note

Funding: Open access funding provided by Halmstad University. The study was supported financially by Halmstad University; Spenshult Research and Development Center, Halmstad; Region Halland (Grant Numbers HALLAND-469111, HALLAND-639101, and HALLAND-749041); and the Mayflower Charity Foundation, Sweden. The sources of funding had no involvement in the study design, data collection, analysis of data, interpretation of data, writing of the manuscript, or submission for publication.

Available from: 2020-09-02 Created: 2020-09-02 Last updated: 2023-01-02Bibliographically approved
4. Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up
Open this publication in new window or tab >>Worse health status, sleeping problems, and anxiety in 16-year-old students are associated with chronic musculoskeletal pain at three-year follow-up
Show others...
2019 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 1565Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chronic musculoskeletal pain is common in adolescents, and it has been shown that adolescents with pain may become young adults with pain. Pain often coincides with psychosomatic symptoms in adults, but little is known about longitudinal associations and predictors of pain in adolescents. The aim was to investigate chronic musculoskeletal pain and its associations with health status, sleeping problems, stress, anxiety, depression, and physical activity in 16-year-old students at baseline, and to identify risk factors using a three-year follow-up.

METHODS: This was a longitudinal study of 256 students attending a Swedish upper secondary school. Questionnaires regarding chronic musculoskeletal pain and distribution of pain (mannequin), health status (EQ-5D-3 L), sleeping problems (Uppsala Sleep Inventory), stress symptoms (single-item question), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (International Physical Activity Questionnaire) were issued at baseline and follow-up. Student's t-test and chi2 test were used for descriptive statistics and logistic regression analyses were used to study associations between chronic pain and independent variables.

RESULTS: Fifty-two out of 221 students at baseline (23.5%) and 39 out of 154 students at follow-up (25.3%) were categorized as having chronic musculoskeletal pain. Chronic musculoskeletal pain at follow-up was separately associated with reporting of an EQ-5D value below median (OR 4.06, 95% CI 1.83-9.01), severe sleeping problems (OR 3.63, 95% CI 1.69-7.82), and possible anxiety (OR 4.19, 95% CI 1.74-10.11) or probable anxiety (OR 3.82, 95% CI 1.17-12.48) at baseline. Similar results were found for associations between chronic musculoskeletal pain and independent variables at baseline. In multiple logistic regression analysis, chronic musculoskeletal pain at baseline was a predictor of chronic musculoskeletal pain at follow-up (OR 2.99, 95% CI 1.09-8.24, R2 = 0.240).

CONCLUSION: Chronic musculoskeletal pain at baseline was the most important predictor for reporting chronic musculoskeletal pain at the three-year follow-up, but a worse health status, severe sleeping problems, and anxiety also predicted persistence or development of chronic musculoskeletal pain over time. Interventions should be introduced early on by the school health services to promote student health.

Place, publisher, year, edition, pages
London: BioMed Central, 2019
Keywords
Adolescent, Anxiety, Chronic musculoskeletal pain, Epidemiology, Health status, Sleep, Student
National Category
Health Sciences
Identifiers
urn:nbn:se:hh:diva-41079 (URN)10.1186/s12889-019-7955-y (DOI)000505960700004 ()31771551 (PubMedID)2-s2.0-85075688564 (Scopus ID)
Note

The study was supported financially by Halmstad University; The Swedish Rheumatism Association; and Region Halland (grant number HALLAND-469111), Sweden.

Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2023-08-28Bibliographically approved

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