“ Idiopathic musculoskeletal pain, musculoskeletal

pain syndromes, and use of electronic devices in

adolescents with asthma “

Alzena Yasmine Arinta Br Ginting

NIM : 223307010204
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Abstract
Objective: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with
asthma and healthy controls.
Methods: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered
questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were
evaluated, and Asthma Control Test (ACT) was assessed.
Results: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly
lower in asthmatic adolescents than in con- trols. The frequency of pain in the hands and wrists was reduced in asthmatic than in con- trols
(12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001),
simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial
syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with
musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use,
and
weekends and weekdays of cell phone use, as independent variables, showed that female patients with asthma symptoms and well-controlled
disease reported a lower prevalence of mus- culoskeletal pain.
 Methods
A cross-sectional study was performed at a tertiary univer- sity hospital in the city of
Sa~o Paulo, Brazil. The inclusion cri- teria were asthma according to GINA criteria 2
and adolescents with current age between 10 and 19 years. All
of them were recruited between January 2017 and March 2018. The pre-established
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exclusion criteria were: absence of musculoskeletal inflammatory pain or

musculoskeletal pain syndromes secondary to infectious, rheumatic, onco- logical,
genetic, diabetes mellitus, or thyroid diseases, nor

did these patients experience any recent trauma. The healthy control group included 300
adolescents (10 19 years of age) without chronic diseases, recruited from a public school in the
same area covered by the study’s hospital. The Ethics Committee of the present hospital
approved this study (identification number: 1.907.909/ 2013). Informed consent was obtained from
all adolescents
and their legal guardians.
Of the 155 recruited asthma patients, three parents did not give consent and two were excluded due
to recusal in the clinical examination. Thus, 150 asthmatic adolescents were assessed in this study.
All adolescents completed an anonymous and self-adminis- tered questionnaire before physician’s
appointment
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Statistical analysis

The sample size provided a power of 80% to detect dif- ferences in the frequency of
musculoskeletal pain among the asthmatic adolescents and healthy controls
(GraphPad StatMate 1.01, GraphPad Software, Inc., CA, USA). The results for
continuous variables are pre-
sented as median (minimum and maximum value) or mean § standard deviation,
and for categorical

[ 2
variables, as frequency (percentage). The scores that had a normal distribution were
compared using Stu- dent’s t-test, and those with abnormal distribution were evaluated

1
by the Mann Whitney U test. In the case of categorical variables, the differences were
cal- culated using the Fisher’s exact test or chi-square test, as appropriate. A logistic
regression analysis (backward stepwise) was performed in asthmatic adolescents with
musculoskeletal pain by including independent varia-
bles that presented a level of statistical significance of
≤ 20% in the univariate analyses. Statistical signifi- cance was set at p ≤ 0.05.

0
3
Discussion
The authors demonstrated that female sex was associated with musculoskeletal pain in
asthmatic adolescents, whereas patients with asthma symptoms and well-controlled disease
reported a lower incidence of musculoskeletal pain.
The main strength of this study was the anonymous, self- reported, and standardized
survey, including figures of dif- ferent body parts, to show the multiple localizations of
mus- culoskeletal pain.12 The exclusion of inflammatory or mechanical etiologies of
musculoskeletal pain, particularly
infectious, rheumatic, oncological, and recent trauma were relevant, since these conditions
may induce recurrent and chronic pain, even in patients with mild alterations in the
physical examination. Another strength of this study was the assessment of seven diffuse or
localized frequent musculo- skeletal pain syndromes in adolescents. ACT evaluation is also
important since this score can help physicians to deter- mine if asthma symptoms are well-
controlled.1,2,9,20
Approximately 40% of asthmatic adolescents presented with musculoskeletal pain, mainly
back and cervical pain. Another study using the same questionnaire found recurrent
Funding

This study was supported by grants from Conselho Nacional de Desenvolvimento

Científico e Tecnolo´gico (CNPq 304984/ 2020-5 to CAS), Fundac¸ a~o de
Amparo a` Pesquisa do Estado de Sa~o Paulo (FAPESP 2015/03756-4 to CAS)
and
de by Nu´cleo
Apoio a` Pesquisa “Sau´de da Crianc¸ a e do Adolescente” da USP (NAP-
CriAd) to CAS.

Acknowledgments
The authors would like to express our fullest gratitude to Ulysses Doria-Filho for
the statistical analysis support. The authors also thank all asthmatic and healthy
adolescents that participated in the present study.
Thank you