Children and adolescents who receive consultations for sleep problems or psychological symptoms have an increased risk for a later musculoskeletal condition consultation, according to results published in the European Journal of Pain.

The study included electronic medical records of children and adolescents aged 6 to 19 years from a UK primary care database. The researchers used survival analysis to explore associations between a consultation for sleep problems or psychological symptoms at baseline and a consultation for musculoskeletal conditions within the 2-year follow-up period. The researchers calculated hazard ratios (HRs) and 95% CIs after adjusting for confounders.

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Of the 638 participants included in the sleep problems data set, 107 had sleep problems and 531 were matched control individuals.

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The results indicated that participants who had a consultation for sleep problems had a significantly increased risk for consultation for musculoskeletal conditions (HR, 1.72; 95% CI, 1.14-2.60). However, this association became nonsignificant after adjusting for confounders (HR, 1.49; 95% CI, 0.98-2.27).

Of the 3042 participants included in the psychological symptoms data set, 507 had psychological symptoms and 2535 were matched control individuals.

Participants with a consultation for psychological symptoms had a significantly increased risk for consultation for musculoskeletal conditions (HR, 1.59; 95% CI, 1.31-1.93), and this association remained significant after adjusting for confounders (HR, 1.39; 95% CI, 1.14-1.70).

The study had several limitations, including its use of the Read Codes and inability to adjust for variables related to lifestyle.

“Future studies are needed to elucidate the causal mechanisms between these risk factors and musculoskeletal conditions, which might lay the basis for potential interventions within primary care settings,” the researchers wrote.


Andreucci A, Campbell P, Richardson E, Chen Y, Dunn KM. Sleep problems and psychological problems as predictors of musculoskeletal conditions in children and adolescents [published online October 6, 2019]. Eur J Pain. doi:10.1002/EJP.1491