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BackgroundLong-term musculoskeletal pain and negative stress are health risks with adverse long-term health effects, and these health risks seem to increase among young people. The mechanisms behind this are unclear. There is a need for a better understanding of perceived stress and musculoskeletal pain among adolescents, in order to improve health promotion and treatment approaches in this group.MethodsObjectives were to evaluate the current prevalence of perceived stress and musculoskeletal pain in 15 and 16 year olds, to explore stress-pain associations and the probability that perceived stress (PSQ) was related to the reporting of pain and variations in pain, and to investigate possible differences in stress between different types of musculoskeletal pain in the adolescents. A cross-sectional study was conducted. Elementary schools participated. The outcomes were stress (Perceived stress questionnaire; PSQ) and musculoskeletal pain (pain/no pain, pain sites, pain duration and pain intensity (Visual analogue scale; VAS).ResultsFifty-one point two percent (N = 422) reported pain, of which 70.8 % reported long-term pain. Some more girls (57.9 %) reported pain. 22.0 % of the study population reported moderate to severe stress (PSQ ≥ 0.45), of which 79.6 % were bothered by pain (Pearson Chi-square 38.47, p ≤ .001). All stress and pain variables were significantly associated (p < .01). The strongest association appeared between pain intensity (VAS) and stress (PSQ) (r = 0.40). Perceived stress (PSQ) was associated with the reporting of pain among the adolescents (Odds Ratio [OR] 1.68) and could explain some of the variation in pain intensity (VAS; β = 0.15, p < .001) and number of pain sites (β = 0.14, p < .01), according to the regression analyses. There were no mean differences in stress (PSQ) between different types of musculoskeletal pain.ConclusionsThere was high prevalence of musculoskeletal pain, long-term pain and moderate to severe stress (PSQ ≥ 0.45) in this study sample. Perceived stress (PSQ) was related to the reporting of musculoskeletal pain among the adolescents and could explain some of the variation in pain intensity (VAS) and number of pain sites. There were no differences in stress levels (PSQ) between different types of musculoskeletal pain in the adolescents.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2414-x) contains supplementary material, which is available to authorized users.

In subjects with long-term subacromial pain syndrome, HD medical exercise therapy is superior to a conventional LD exercise programme. For clinicians to obtain similar positive results with HD medical exercise therapy, factors such as good communication skills, constant close personal supervision during exercise treatment and having from three to five subjects in a group setting are important.

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A better understanding about prerequisites of health and well-being in adolescents is important to prevent chronicity and comorbidities of stress and to improve health promotion in this group. For this purpose, useful instruments are required. The Perceived Stress Questionnaire (PSQ) is developed for research, with an emphasis on predictive validity. The PSQ comprises different components of stress, and the instrument might be useful in studying prerequisites and predictors of health and well-being in adolescents. However, the instrument has not been evaluated in Norwegian psychosomatic populations and in adolescents. Moreover, the factor structure of the PSQ seems to vary between populations, and invariance across gender and concurrent validity regarding mindfulness are not previously tested. The objective of this study were to evaluate the psychometric properties of the Norwegian version of the PSQ in adolescents, including evaluate the fit of previously proposed PSQ-models in females and males and test measurement invariance across gender. Concurrent validity with respect to mindfulness (Mindful Attention Awareness Scale- Adolescent [MAAS-A]) was preliminary evaluated. Confirmatory factor analysis for each previously proposed model was conducted, separately for females and males. Multi-group factor analyses were performed to test measurement invariance of the different PSQ-models across gender. The associations between the PSQ and the MAAS-A and inter-scale correlations were preliminary evaluated. Preceding the data collection and main analyses, the instruments were translated to Norwegian following standardized procedures. The participants in study were Norwegian adolescents aged 15–16 years (N = 524). The overall PSQ performance seemed to correspond to previous findings, and internal consistency was supported across gender. A four-factor model of the PSQ showed best fit to the data in both females and males and configural and metric invariance seemed supported. Full scalar invariance was not supported for the four-factor model, implying that cross-group comparisons (between females and males) on latent means may be uncertain and must be interpreted with caution. Concurrent validity with respect to mindfulness (MAAS-A) was preliminary supported. Further studies might be needed to confirm the findings from this study.

AbstractBackgroundYoung people seem increasingly disabled due to pain and stress. Pain and stress are health risks with adverse long-term health effects. Traditionally, these health risks have been most prevalent and strongest associated in females, also regarding children and adolescents. Main objectives in this study were to investigate current gender differences in musculoskeletal pain and perceived stress in adolescents aged 15 and 16 years with respect to prevalence and group differences for various aspects of stress and pain, and to explore the relationship between stress and pain, specified for gender.MethodsA cross-sectional study was conducted with 17 participating public schools. The survey was administrated by the schools in accordance with given procedures, emphasizing the volunteer and anonymous participation of the pupils. Primary study measurements were pain and stress. The pain measurements addressed different aspects of musculoskeletal pain including pain sites, pain duration and pain intensity (measured by a Visual analogue scale; VAS). The stress instrument used was the Perceived stress questionnaire (PSQ) comprising different factors of stress, i.e. worries, tension, joy and demands. The secondary study measurement was body mass index (BMI).ResultsThe study sample comprised 422 adolescents aged 15 and 16 years; 218 females and 204 males. The pain reporting was high in both genders, 57.3 per cent of the females and 44.6 per cent of the males. In general, the female adolescents reported more pain and stress, although several pain measures corresponded between genders. The pain prevalence was similar across genders with respect to lower extremity pain, back pain and arm pain. Lower extremity pain was the most frequent reported pain in both genders. More females reported head pain (Pearson Chi-Square 7.11, p = .008), severe pain (VAS ≥ 7, Pearson Chi-Square 13.12, p = .004) and moderate to severe stress (PSQ ≥ 0.45, Pearson Chi-Square 29.11, p < .001). Comparison analyses of the continuous pain and stress variables revealed significant mean (95% confidence interval [CI]) differences between genders for all stress variables with the highest mean scores in females. In both genders there were significant (p < .01) correlations between all the continuous pain and stress variables. In 9 out of 15 correlations, the stress-pain associations were strongest in males (Pearson product-moment correlation (r) between 0.34 and 0.38). Only in females, the body mass index (BMI) appeared associated (weakly) to pain and stress, in terms of pain intensity (VAS, r = 0.19) and lack of joy (as a factor of stress, r = 0.16).ConclusionPain and stress were prevalent in the adolescent sample, with generally higher reporting among females. Several pain measures corresponded between genders, but stress differed significantly between genders for all variables. Scrutinizing the relationship between pain and stress revealed significant stress-pain associations regarding all variables across genders, i.e. the pain complaints among the adolescents seemed equally related to stress in males and females in the sample.

In patients with longstanding subacromial pain, HD medical exercise therapy might be an efficient treatment approach.

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