Background/Purpose: Chronic musculoskeletal pain can affect up to 20% of persons under the age of 25 and is a risk factor for persistent chronic musculoskeletal pain in adulthood. Among those who consult a physician, prescribed treatment approaches vary and can be pharmacologic and nonpharmacologic. The goal of this study was to investigate chronic musculoskeletal pain in young people. Specifically we sought to 1) present a portrait of persons with chronic musculoskeletal pain in terms of sex, race/ethnicity, smoking status, and the various diagnoses related to chronic musculoskeletal pain in a representative sample of young Americans; 2) describe the initial clinical management of chronic musculoskeletal pain in this group; and 3) explore factors associated with prescribed treatments.

Methods: We analyzed data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey-Out Patient Department (NAMCS) between 2007 and 2015. Visits among persons under the age of 25, with a new chronic musculoskeletal pain condition were identified using pre-determined diagnostic criteria. We documented the following treatment prescriptions: opioids, non-opioid pain medication, physical therapy, counseling and other non-pharmacological treatments. We describe the sample according to sex, age group (< 15 and 15-24), race/ethnicity, payment type for services (serving as a proxy for socioeconomic status), and type of physician (pediatrician, family doctor, specialist). Logistic regression models to determine factors associated with treatment prescription will be calculated.

Results: There were 1,316 initial visits over the 9-year period with a diagnosis of chronic musculoskeletal pain in the NAMCS database for persons under the age of 25, translating into 32,423,549 weighted initial visits, for a frequency of 3.4% of Americans < 25 years of age. Opioid prescription was low for those under the age of 15 years at 1.2% but increased to 13.9% in the 15-24 year old group. Non-opioid pain medications were prescribed in 33.2% of the cases for the younger group and 40.6% in the older group. The proportions prescribed physical therapy, counseling and other nonpharmacological treatments were respectively, 6.3%, 8.3% and 15.4% in those under 15 years and 13.6%, 10.4% and 9.4% in those 15-24 years.

Conclusion: Nearly 3.5% of young Americans consult a physician for a chronic musculoskeletal pain condition. Pharmacologic treatment is used much more than nonpharmacologic treatment, and opioid prescription in the adolescent and young adult group nears estimates of opioid prescription in adults with these problems. Reasons for the low use of nonpharmacologic treatments need to be elucidated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/chronic-musculoskeletal-pain-and-its-initial-management-in-children-adolescents-and-young-adults-in-the-united-states/