Addressing Child and Adolescent Musculoskeletal Pain (CAM-Pain)

Background Musculoskeletal pains (e.g. back or knee pain) are common throughout the lifecourse and are a leading cause of disability worldwide. Musculoskeletal pain in childhood/adolescents appears to increase risk of adult musculoskeletal pain, but research among children/adolescents is scarce. Childhood pain episodes are windows-of-opportunity to empower children to learn new information/skills and adopt positive health and pain management behaviours. Intervening early to support children/adolescents to understand and self-manage pain may reduce impacts of, or prevent, musculoskeletal pain in childhood/adolescence and into adulthood. Aim: To improve understanding, self-management, impact and healthcare of musculoskeletal pain in children/adolescents with early episodes of musculoskeletal pain from individual, family, clinician and policymaker perspectives. Workpackage 1. Objectives: Describe the epidemiology, current management and healthcare costs of musculoskeletal pain in children/adolescents in primary care. Methods: Analysis of a UK database of routinely recorded primary care information from nearly 1500 general practices, with confirmatory analysis in the Skåne Health Care Register, Sweden. Determine trends in annual musculoskeletal pain consultation prevalence/incidence (2005-2020). Describe management and outcomes including repeated consultations/prescriptions/referrals. Describe overall prognosis and identify prognostic factors for musculoskeletal outcomes. Estimate healthcare costs per child/adolescent and overall health service costs. Key outputs: Prevalence, incidence, trends, management, prognosis, prognostic factors and healthcare costs for child/adolescent musculoskeletal pain. Workpackage 2. Objectives: Determine views and experiences regarding child/adolescent musculoskeletal pain, pain management, treatment preferences and priorities, information preferences and needs, and important clinical and patient outcomes. Methods: Diary study with stimulated recall interviews exploring children/adolescents understanding and management of pain. Storyboard interviews with children/adolescents and parents to investigating information and treatment preferences, needs and important outcomes. Primary care clinician focus groups exploring advice and information given, addressing concerns, reassurance and management. Key outputs: Views and experiences of primary care musculoskeletal pain management. Workpackage 3. Objectives: Developing and testing information and self-management resources for musculoskeletal pain in children/adolescents. Methods: Synthesise evidence on best-practice management of musculoskeletal pain in children/adolescents. Consensus group meetings to decide the content and format of the resources. Findings from WP1-3 triangulated to develop an evidence-based logic model outlining the content, mechanisms, outcomes and delivery of the resources. Meetings and interviews with children/adolescents, parents and clinicians to co-develop and refine the information and self-management resources. Evaluate use of the information and self-management resources in general practice. Key outputs: Newly developed and evaluated information and self-management resources. Workpackage 4. Objectives: Explore and plan roll-out of the information and self-management resources. Methods: Regular stakeholder group meetings including children/adolescents, parents, clinicians, researchers, and policy makers to identify facilitators and challenges of adopting new knowledge, and strategies for increasing uptake. Examine healthcare professional's perspectives on uptake of the information and self-management resources in general practice, and plan broader roll-out. Refine and finalise a strategy for roll-out of the resources. Key outputs: Full strategy for roll-out of the information and self-management resources. PPIE including children/adolescents and parents is embedded throughout