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Help find ‘the invisibles’

By David Butler Physio world, Science and the world, Education for all 04 May 2015

Those who miss out – the 16-18 year olds

Many people miss out on optimal pain treatment. We have detailed some here, such as males and females with pelvic pain and those with neurological disease/trauma such as stroke. Awareness of a group needing help surely is the beginning of providing better care to individuals in that group.

Pain in teenagers is very common (Henchke et al 2014), with prevalence increasing with age. Critically, there is data suggesting that 40% of children who have a pain problem will have problems 4 years later (Et-Metwally 2004). Teenagers often report pain at multiple sites and sixteen year olds with multiple sites of pain are likely to still have multiple sites of pain at 18 years (Paanenen 2011). It is worth adding that in Australia, 1 in 4 young people experience a clinically relevant mental health problem in any one 12 month period (Slade et al 2009). Here is a group that share a unique commonality of context and symptoms, and the evidence suggests that they are missing out on optimal pain treatment. Furthermore, up to 75% of people who experience mental health problems, also experience pain

Who is an adolescent?

Any consumer of the teenage pain literature may have the problem I did – “exactly what is the  group being discussed.” Surely 13 year olds are different to 18 year olds? These groups are also referred to invariably as “children,” the “paediatric population” and “adolescents”.  Yet an 18 year old “adolescent” can vote, or join the military.

In research and clinical practice, the 16-18 years old don’t even have the dignity of a name – surely “young adults” would be better and at least begin to convey the special needs of such a group – coping with the end of school, relationships, reproductive issues, growth spurts, learning methods, coping with an uncertain world, impact of family trauma, isolation, being different, demands of sport etc etc – the kind of things that anyone holding a broad biopsychosocial framework should pick up.

Reflect too, from the clinical side, should they be treated more as adults (a 17 year old in an adult pain group?) or as teenagers or as children. We need to know more about this group and surely there is urgent research required into early identification of pain in this group. The persistent and multiple pain sites in many young adults, coupled with high level of mental distress hints at processes of central sensitisation.

We would love your comments here on this notion of a missing group.


A call for research help

Australian readers may be able to help with a study (this may be undertaken taken internationally later). A group led by Associate Professor Helen Slater from Curtin University is attempting to characterise this group and their special issues.  So if you are a young adult aged 16 -18 years old with persistent pain……

  • we invite you to fill out a survey, and indicate if you are also interested in participating in an individual phone interview/focus group discussion.
  • There are two parts to the study and you can choose to do one or both. This will take about 10-15 minutes for the survey and about 30- 40 minutes for the interview /discussion. A $50 gift voucher is being offered for participants who participate in both study components.
  • If you’re interested (or can forward this post to a young adult you know who may be interested) you can follow this link for more information and to take the survey.

– David Butler

Henschke N et al 2014 BMC Musculoskeletal Disorders 15: 164

Et-Metwally A et al 2004 Pain 110: 550

Paanenen N 2011 University of Oulo Dissertation

Slade et al 2009 Mental health of Australians 2. Aust Dept Health and Aging.


  1. Reblogged this on Edu_OMT and commented:
    David has a point here.
    This population usually is not include in research.
    Any young adult in pain? You could contribute.

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