Pos0738 childhood abdominal/pelvic pain as a predictor of recurrent musculoskeletal pain in adolescent boys and girls: a prospective population-based study

Background Primary musculoskeletal pain conditions interfere greatly with the quality of life and are challenging to manage, from the patient’s and clinician’s perspectives. Susceptibility to chronic musculoskeletal pain syndromes in adulthood can be traced back to childhood when prevention might be most effective. Population-based longitudinal studies in pediatric ages allow for testing different predictors of pain trajectories to assist risk stratification. Recurrent pain experiences in non-musculoskeletal sites are common in young children and may be red flags for future musculoskeletal pain susceptibility [1]. Objectives We aimed to quantify the prospective association of non-musculoskeletal pain experiences at ages 7 and 10 with recurrent musculoskeletal pain at age 13 in a large population-based cohort of boys and girls. Methods We used data from Generation XXI, a population-based birth cohort setup in 2005-06 in the public maternities of Porto, Portugal. Participants were invited to regular follow-up visits at ages 7, 10, and 13 years. In each wave, pain history in the previous 3 months was assessed using the Luebeck Pain Screening Questionnaire, applied to caregivers (ages 7 and 10) and adolescents (age 13). We included only the main pain identified in the questionnaire, and only if it occurred more than once in the previous 3 months. Musculoskeletal pain sites comprised upper/lower limbs, back, neck, shoulders, hips, and generalized musculoskeletal. Non-musculoskeletal sites were head, abdomen/pelvis, or other. We calculated relative risks and 95% confidence intervals for the association between pain sites at ages 7 and 10 and recurrent musculoskeletal pain at age 13. The analysis was stratified by sex at birth. Results We included 3833 participants (47.9% girls). Recurrent pain was reported in 28.4% of children at age 7 (25.7% of boys, and 31.3% of girls), 26.6% at age 10 (23.3% of boys, and 30.2% of girls), and 35.1% at age 13 (28.8% of boys, and 41.9% of girls). For girls, the most reported recurrent pain sites before adolescence were abdomen/pelvis (10.3% at 7, and 9.7% at 10), musculoskeletal (8.1% at 7, and 9.0% at 10), and head (7.7% at 7, and 7.3% at 10). In boys, recurrent pain was more frequent in musculoskeletal sites (9.0% at 7, and 9.6% at 10), followed by abdomen/pelvis (7.7% at 7, and 5.0% at 10), and head (5.1% at 7, and 6.0% at 10). As shown in the Figure 1, in 7-year-old girls, only abdominal/pelvic pain was predictive of future musculoskeletal pain at age 13 RR 1.43; (95%CI 1.07, 1.87). At age 10, musculoskeletal pain became predictive of musculoskeletal pain at age 13 [1.44 (1.07 - 1.84)]. In boys aged 7 years, both musculoskeletal and abdominal/pelvic pain were predictive of future musculoskeletal pain at age 13 [1.49 (1.13, 1.91) and 1.40 (1.02, 1.86), respectively]. At age 10 only musculoskeletal pain remained predictive of musculoskeletal pain at age 13 [1.45 (1.11, 1.84)]. Conclusion In this population-based cohort, musculoskeletal pain in adolescents was preceded by non-musculoskeletal pain experiences - especially abdominal/pelvic pain - during childhood in both boys and girls. Widening the scope to non-musculoskeletal sites may contribute to the early detection and risk stratification of individuals who are more susceptible to developing chronic musculoskeletal pain trajectories. Reference [1]Johnston KJA, Adams MJ, Nicholl BI, Ward J, Strawbridge RJ, et al. (2019) Genome-wide association study of multisite chronic pain in UK Biobank. PLOS Genetics 15(6): e1008164. https://doi.org/10.1371/journal.pgen.1008164 Figure 1. Association between recurrent pain sites at ages 7 and 10, and recurrent musculoskeletal pain at age 13. Acknowledgements This work was supported by FOREUM - Foundation for Research in Rheumatology (Career Research Grant). Generation XXI cohort study is funded by EPIUnit at ISPUP, Universidade do Porto (UID/DTP/04750/2019), Fundação para a Ciência e a Tecnologia, ARS-Norte and Calouste Gulbenkian Foundation. MT was funded by the ERDF, through the North Regional Operational Program in the framework of the project HEALTH-UNORTE (NORTE-01-0145-FEDER-000039). Disclosure of Interests None Declared.