Pain in the feet, knees or back (musculoskeletal pain) is common in children. Musculoskeletal pain is a leading cause of disability across the world. Despite this, there is little research about childhood musculoskeletal pain and what happens when a child sees a doctor about pain. Visits to the doctor could be important in shaping how children cope with pain, and how they manage their pain later as adults.
The aim of this study is to find out more about how many children visit the doctor for musculoskeletal pain and for what types of pain, what treatments they are given, and the diagnoses they receive.
We will use data from CPRD Aurum between 2005 and 2021 for children aged between 8 and 18 years to work out:
• how many children visit doctors about musculoskeletal pain and how this has changed over time,
• what diagnoses children get,
• how children are managed including how many are referred to other services such as physiotherapy, how many are sent for an x-ray, and how many are prescribed a painkiller medication and of what sort.
We will compare our findings by age (younger children vs older children), sex, ethnicity, deprivation of the local area and geographical region.
The results of this study will feed into a larger research study, which aims to determine what can help doctors identify who are more likely to get better, and develop an information and support package for children (and their parents and carers) about musculoskeletal pain.
Musculoskeletal pain is common and a leading cause of disability in children and adolescents. Pain in childhood and adolescence increases risk of pain in adulthood. There is currently no NICE guidance on treating musculoskeletal pain in children/adolescents, and broader guidelines, such as for back pain or chronic pain, specifically exclude children. Data on primary care incidence, prevalence, persistence and management of musculoskeletal pain among children and adolescents is scarce. This study is the first part of a funded NIHR programme and aims to produce new knowledge about musculoskeletal pain and its management in children/adolescents. This new knowledge will provide valuable insights, identify gaps and needs in this population and setting, and lay the basis for future studies and guidelines for treating musculoskeletal pain in children and adolescents, including the intervention and self-management resources to be developed as the second part of the NIHR programme.
The aim is to determine the epidemiology of child/adolescent musculoskeletal pain in primary care by deriving consultation prevalence and incidence of musculoskeletal pain in children/adolescents, and their trends over time; and describe management of children/adolescents presenting with musculoskeletal pain in primary care.
The target population comprises children/adolescents (aged 8-18 years) seeking healthcare in primary care for
musculoskeletal pain. We will include site-specific (e.g. knee, foot) pain, diagnoses, and (non-fracture) trauma. We will determine the annual consultation prevalence and incidence of musculoskeletal pain overall and stratified by age and sex. We will repeat for site-specific pain and for specific diagnoses. Patients will be observed prospectively in their records for 6 months from their musculoskeletal consultation to assess management (diagnoses received, analgesics prescriptions, referrals, x-rays).
We will use joinpoint regression to determine trends over time and Poisson or negative binomial regression as appropriate to understand variation in management by age, sex, ethnicity, deprivation and geographical region.
Primary care consultations for musculoskeletal pain;
Diagnoses received for musculoskeletal pain;
Analgesic prescriptions for musculoskeletal pain;
Referrals related to musculoskeletal pain;
X-rays related to musculoskeletal pain;
Kelvin Jordan - Chief Investigator - Keele University
Kelvin Jordan - Corresponding Applicant - Keele University
Anna Jöud - Collaborator - Lund University
Faraz Mughal - Collaborator - Keele University
James Bailey - Collaborator - Keele University
Joanne Protheroe - Collaborator - Keele University
Kate Dunn - Collaborator - Keele University
Kayleigh Mason - Collaborator - Keele University
Kym Snell - Collaborator - Keele University
Martin Thomas - Collaborator - Keele University
Patient Level Index of Multiple Deprivation