The role of physical activity in children and adolescents with chronic pain: the moderating effects of psychological symptoms and sleep difficulties
Pain. 2026 May 7. doi: 10.1097/j.pain.0000000000003997. Online ahead of print.
ABSTRACT
Chronic pain in children and adolescents affects physical, psychological, social, and academic function. Although physical activity may play a role, its direct effects and its interactions with sleep difficulties and psychological symptoms remain unclear. This cross-sectional study examined whether physical activity is associated with chronic pain, and whether these associations vary by sleep difficulties and psychological symptoms. We analyzed data from 212,105 individuals (49% girls, age: 11-15 years) from the 2018 Health Behavior in School-aged Children study. Chronic pain, psychological symptoms, sleep difficulties, moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed using validated self-report measures. Three multivariate logistic regression models (for chronic back pain, stomachache, and headache) examined main and moderation effects, adjusting for age, gender identity, and socioeconomic status. In adjusted main-effects models, higher MVPA was associated with higher odds of chronic back pain (aOR 1.15, 95% CI 1.06-1.25) and stomachache (aOR 1.02, 95% CI 1.00-1.09) but not headache. Interaction models indicated that MVPA associations differed by sleep difficulties, and the VPA-pain association differed by psychological symptoms. In stratified analyses, several MVPA frequency categories (vs 0 d/wk) were associated with lower odds of back pain and stomachache in both low and high sleep-difficulty groups. Vigorous physical activity was associated with lower odds of back pain and stomachache among adolescents with moderate or high psychological symptoms but not those with low symptom frequency. Overall, physical activity was not uniformly protective; associations were pain-type specific and varied according to adolescents sleep and psychological profiles.
PMID:42093187 | DOI:10.1097/j.pain.0000000000003997