HMN 2026: How 86% of Brazilian children with disabling musculoskeletal pain recover

Three out of every 10 Brazilian children and adolescents complain of musculoskeletal pain (affecting bones, ligaments and muscles). This common problem affects their lives and should not be underestimated. The condition, known as disabling musculoskeletal pain, causes children and adolescents to miss school and give up routine and leisure activities, despite having no connection to trauma, repetitive strain or any other specific cause.

A study published in March in the Journal of Orthopaedic & Sports Physical Therapy involving 694 children and adolescents showed that 86% of those with disabling musculoskeletal pain recovered over 18 months. However, about 32% of those who improved experienced disabling pain again at some point, indicating that this is a recurrent condition requiring ongoing attention.

“It’s a type of pain that’s still greatly underestimated and understudied, despite being common. As a result, children and adolescents often receive inadequate treatment, or their complaints are dismissed by their families or the health care system. It isn’t something you can simply wait to go away. In our study, we showed that although the pain usually disappears as suddenly as it appeared, it can persist in 14% of cases,” says Tiê Parma Yamato, an associate researcher at the Universidade Cidade de São Paulo (UNICID) in Brazil and the University of Sydney in Australia. Yamato coordinated the research.

The researchers also identified factors such as quality of life and age as important predictors of recovery. “Younger children with a better quality of life have a higher chance of spontaneous improvement. As they enter adolescence, the statistical chances of improvement decrease, which reinforces the urgency of early intervention,” she says.

A problem for the future

Yamato explains that recurrent or disabling pain during childhood and adolescence is a known risk factor for developing chronic conditions in adulthood. “Understanding the course of that pain in childhood allows us to identify those who need early attention to potentially prevent persistent health problems in adulthood,” she states.

She points out that chronic pain, such as lower back pain, is one of the major health issues worldwide and generates enormous financial costs for public health systems. “Addressing the root of the problem may be a way to reduce that economic and social impact in the future,” she says.

The study is the first to examine the prognosis of musculoskeletal pain in children and adolescents. It aims to identify potential factors related to recovery and possible recurrence episodes and to provide the first data on this condition from low- and middle-income countries.

To that end, the researchers recruited 12,036 children and adolescents from 28 public and private schools in the Brazilian states of Ceará (Fortaleza) and São Paulo (Itu, Salto, São Sebastião and São Paulo). Of these, 2,688 participants, with an average age of 12, agreed to take part in the study.

Participants answered a questionnaire about pain capable of affecting their daily lives. Of those, 694 were monitored for 18 months.

The back was the most frequently cited part of the body, mentioned by 51.3% of respondents, followed by the legs (42.5%) and the neck (20.5%). “But it can occur in any joint, bone or muscle,” Yamato says.

An underestimated condition

The researcher explains that musculoskeletal pain in children and adolescents is poorly studied and often misunderstood. As a result, it is frequently associated with a myth that has never been proved. “Often, that pain is understood and referred to as ‘growing pains.’ The problem is that currently, growing pains are more a matter of common sense than a proved diagnosis. There’s no scientific evidence that the growth process or common growth spurts in childhood and adolescence cause pain,” the researcher states.

“Perhaps because this type of pain lacks a specific cause, different conditions end up being classified as growing pains. The problem with this interpretation is that it often leads to the idea that you just need to wait for the child to grow out of it. However, scientific literature has shown various consequences of not approaching this condition with due caution,” she adds.

Yamato explains that the causes or factors related to the development of musculoskeletal pain in children and adolescents are currently unknown. “For that reason, it’s a condition that often can’t be identified through imaging tests but rather mainly based on the patient’s account,” she says.

She points out that the term “growing pains” leads parents and health care professionals to underestimate real, debilitating pain, leaving children with unclear diagnoses and no appropriate treatment protocols.

“Therefore, the clinical practice guidelines are to reassure families about the good prognosis but to closely monitor those who experience frequent and/or recurrent episodes of pain, with the aim of interrupting the trajectory toward chronic pain in adulthood,” she says.

Importance of the emotional environment

“Since we found that pain may be connected to other issues, such as sleep quality, psychosomatic symptoms and family relationship harmony, the emotional environment also emerges as a possible predictor of recovery.

“Therefore, we suggest that health care professionals pay special attention to the quality of life of children and adolescents, moving beyond a purely physical analysis of pain to understand these children’s and adolescents’ life contexts,” she says.

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