Pain in places such as the feet, knees or back (called 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 which children are more at risk of continuing to have pain.
The aim of this study is to find out more about what happens to the children or adolescents who visit their doctor for musculoskeletal pain, including whether they have further visits to the doctor for the same pain or for different pain over the next few years and what may help doctors identify individuals who are more likely to get better or not.
We will use data for children aged between 8 and 18 years who see their doctor for a new musculoskeletal pain between 2005 and 2021 to work out:
• how many children visit their doctor again for musculoskeletal pain over the next few years,
• whether we can find out what factors (for example, their age, sex, other illnesses they have) increase the likelihood they will see their doctor more often for musculoskeletal pain,
• the cost of health care including visits to the doctor and medicines given to children with musculoskeletal pain.
The results of this study will feed into a larger research study, which aims to develop information and self-management resources for children (and their parents and carers) about musculoskeletal pain.
Musculoskeletal pain is a leading cause of disability in children and adolescents and increases the risk of pain in adulthood. The aim is to determine overall prognosis, factors which may predict persistent or recurrent health care use for musculoskeletal pain, and health service costs of children/adolescents presenting with new musculoskeletal pain.
The study population comprises children/adolescents (aged 8-18 years) seeking primary care for non-specific musculoskeletal pain. We will exclude children with recorded trauma or cancer. Patients will be followed from index musculoskeletal consultation. We will use CPRD Aurum to i) determine the number and patterns of musculoskeletal pain consultations and referrals, ii) identify prognostic factors for persistent and recurrent consultation, and iii) estimate mean cost of healthcare resource utilisation. Potential prognostic factors will include socio-demographic, lifestyle, and musculoskeletal-related (e.g. body site, analgesia) factors as well as comorbidities, non-musculoskeletal pain and other symptoms. Index of Multiple Deprivation data will be utilised as deprivation may be a key prognostic factor given inequalities in musculoskeletal pain by deprivation. This will allow outcomes from this study to be applicable across children/adolescents living in areas of deprivation.
We will summarise median (IQR) number and annual rate of musculoskeletal pain consultations, rate of new musculoskeletal pain consulting episodes, and referrals. Common patterns of annual consultation for musculoskeletal pain over follow-up will be derived through latent class growth analysis. Flexible parametric survival models will be used to determine prognostic factors for a new consulting episode of musculoskeletal pain and Poisson or negative binomial regression (as appropriate) for number of future consultations.
This study is part of a NIHR-funded research programme, and findings will lay the basis for guidelines for treating musculoskeletal pain in children/adolescents, with the programme aiming to develop resources to improve self-management of musculoskeletal pain in children/adolescents and lessen its long-term impact.
i. Number of musculoskeletal pain consultations;
ii. Further new consulting episodes of musculoskeletal pain in the same body-site;
iii. New consulting episodes of musculoskeletal pain in different body-sites;
iv. Onward referral for musculoskeletal pain;
v. Musculoskeletal consultation trajectory over time based on annual patterns of consultation after index consultation;
vi. Mean costs in primary care in the first year after index consultation. Primary care data will include number, type and length of consultations (standard or double appointment) with each health care professional, prescriptions, tests, investigations and referrals.
vii. Overall mean annual cost and the mean cost over a longer period of time (e.g. 5 years; period to be determined once the median follow-up period is established).
Kelvin Jordan - Chief Investigator - Keele University
Kayleigh Mason - 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
Kehinde Adedayo - Collaborator - University of Birmingham
Kym Snell - Collaborator - University of Birmingham
Martin Thomas - Collaborator - Keele University
Sue Jowett - Collaborator - University of Birmingham
Zainab Abdali - Collaborator - University of Birmingham
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record