title: Long-term adolescent multi-site musculoskeletal pain is associated with psychological distress and anxiety.
abstract: Although several studies have shown that adolescent musculoskeletal pain is associated with psychological problems in a cross-sectional setting, the associations of long-term musculoskeletal pain with psychological distress and anxiety are not known.
  
  
  
  The study included 1773 adolescents belonging to the Northern Finland Birth Cohort 1986. They received a postal questionnaire at the age of 16years and a follow-up questionnaire two years later. The first inquiry contained questions about the sites of musculoskeletal pain; the second had the same pain questions, along with measures of distress and anxiety. Risk ratios (RR) were assessed by log-linear regression analysis.
  
  
  
  Multi-site musculoskeletal pain (in ≥2 body locations) at both 16 and 18years was common, reported by 53% of girls and 30% of boys. Multi-site pain at both ages, compared to those with multi-site pain neither at 16 nor 18years, was associated with psychological distress at the age of 18 among both girls (RR 1.8 95% CI 1.2-2.7) and boys (RR 3.5 95% CI 2.1-5.9). For anxiety, the corresponding relative risks were 1.5 (95% CI 1.0-2.2) and 1.8 (95% CI 1.4-2.3), respectively. For short-term multi-site pain (prevalent only at the age of 16 or 18), these relative risks were between 0.8 and 2.3.
  
  
  
  Adolescents with long-term multi-site pain have higher levels of distress and anxiety than those without or with only short-term multi-site pain. Associations were found in both genders, but the relationship between pain and distress was more pronounced among boys. The associations had modest effect strength.
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu, and University Hospital of Oulu, Oulu, Finland; Unit of General Practice, Oulu University Hospital, Finland. Electronic address: juha.auvinen@oulu.fi.
authors.forename: Juha
authors.initials: J
authors.lastname: Auvinen
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland. Electronic address: pasi.eskola@oulu.fi.
authors.forename: Pasi J
authors.initials: PJ
authors.lastname: Eskola
authors.affiliation: Medical Research Center Oulu, University of Oulu, and University Hospital of Oulu, Oulu, Finland.
authors.forename: Hanni-Rosa
authors.initials: HR
authors.lastname: Ohtonen
authors.affiliation: Medical Research Center Oulu, University of Oulu, and University Hospital of Oulu, Oulu, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Paananen
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland; Unit of General Practice, Oulu University Hospital, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Timonen
authors.affiliation: Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland; Finnish Institute of Occupational Health, Helsinki, Finland; Finnish Institute of Occupational Health, Oulu, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland; Finnish Institute of Occupational Health, Oulu, Finland.
authors.forename: Päivi
authors.initials: P
authors.lastname: Leino-Arjas
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, University of Oulu, and University Hospital of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Helsinki, Finland; Finnish Institute of Occupational Health, Oulu, Finland.
authors.forename: Jaro
authors.initials: J
authors.lastname: Karppinen
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000175:diagnosis / Q000523:psychology*; D015995:Prevalence; D012306:Risk; D012737:Sex Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires
keywords: Adolescent; Anxiety; Distress; Multi-site; Musculoskeletal; Pain